New Directions for Oral Submucous Fibrosis Research: Whole Evaluation for Holistic Rehabilitation!

Oral submucous fibrosis (OSF) is an oral potentially malignant disorder (OPMD) associated with prolonged betel-quid (BQ) use. It affects both physiological and psychological dimensions, leading to a significant morbidity. Some challenges in OSF research include: Assessment and correction of: (i) Quality of life, (ii) burning sensation, and (iii) nutritional deficiency. There are numerous medical treatments for OSF, but most of them fail to offer complete rehabilitation. This is because some underpinnings of this condition like "mental factors" that contribute to habit continuation at root level, "poor quality of life," and "nutritional deficiencies" are still uncorrected. We believe that OSF must be managed at the "mind and body" level to accomplish holistic rehabilitation. Herein, we briefly describe the general condition of OSF patients, and highlight the possibility of a novel telomere-based assessment of psychosocial stress, and support use of meditation to counter excessive "telomere shortening" which is linked to oral cancer. We also expand the current view on "burning sensation" in OSF from an entire physical concept to a possibility of mental factors, and finally recommend rich, micronutrient supplementation (through diet) to counter free radical production within the hypoxic oral epithelium.

Prosthetic rehabilitation of oral submucous fibrosis patients: A systematic review of published case reports and case series.

BACKGROUND: Oral submucous fibrosis (OSF) is an insidious chronic condition characterized by restricted mouth opening. Prosthetic rehabilitation is challenging for OSF patients as obtaining a good impression requires adequate mouth opening. The aim of the present review is to systematically present the data from case reports published in the English-language literature. METHOD: A comprehensive search of the literature databases (PubMed, Medline, SCOPUS, Web of Science and Google Scholar) along with the references of published articles on prosthetic rehabilitation in OSF patients published to date was conducted. Keywords included a combination of 'Oral submucous fibrosis', 'prosthesis', 'dentures' and/or 'restricted mouth opening'. Citations from selected references and bibliographic linkages taken from similar cases were included in this review. The inclusion criteria selected for case reports on prosthetic rehabilitation in OSF patients, and cases of restricted mouth opening due to causes other than OSF were excluded from the study. RESULTS: A total of 21 cases were identified and analysed from 17 papers published in the English-language literature. Of these, 9 cases employed the sectional denture technique, 4 cases emphasized the need-based treatment approach in which conventional methods were modified, and 4 cases used mouth exercising devices. Finally, 1 case each involved, flexible denture, oral screen prosthesis, oral stents, surgery in conjunction with dentures. CONCLUSION: Prosthetic rehabilitation in OSF patients is a multifaceted approach and should be patient specific, although sectional dentures have achieved the best results.

Importance of patient's cooperation in surgical treatment for oral submucous fibrosis.

PURPOSE: The aim of this study was to investigate the results of surgical treatment for oral submucous fibrosis (OSF) in patients who did or did not cooperate with the rehabilitation regimen. PATIENTS AND METHODS: There were 54 patients who had surgical treatment of trismus caused by OSF. Split-thickness skin grafts were used to repair surgical defects after surgery on the fibrous bands. According to postoperative collaboration in the rehabilitation regimen, patients were defined as non-cooperative patients (group I) and cooperative patients (group II). Group I (n = 28) and group II (n = 26) were analyzed separately for changes in preoperative, intraoperative, and postoperative interincisal distances (ID) for at least 6 months after surgery. RESULTS: The mean preoperative ID was 18.9 mm (range, 8 to 25 mm) in group I and 18 mm (range, 7 to 25 mm) in group II. The intraoperative ID increased to an average of 39 mm in group I and 38.5 mm in group II. The mean final follow-up ID was 22 mm in group I and 36.1 mm in group II. When evaluating the changes of ID, only a statistically significant difference was found at final visit between groups. CONCLUSIONS: In our study, we found the patient's cooperation is the primary requirement for success in the treatment of OSF.

[Oral submucous fibrosis in a 31-year-old Indian women: first case report from Germany]. / Orale submuköse Fibrose bei einer 31-jährigen Inderin: Erster Fallbericht aus Deutschland.

BACKGROUND: Oral submucous fibrosis (OSF) is a chronic disease characterized by subepithelial collagen deposition with formation of bands involving the oral cavity and adjacent structures. Oral submucous fibrosis is a precancerous condition. It is caused by chewing of betel quid (Areca catechu L., Piper betle, lime and tobacco) and ready-made products like pan masala and gutka which also contain areca nut. These products are available all over South Asia. The hallmark of OSF is extremely restricted mouth opening. CASE REPORT: A 31-year-old Indian woman who has lived in Germany since 1997 presented herself because of limitation of mouth opening. She reported that she has chewed pan masala and gutka since she was 17 years of age. History, clinical and histological findings clearly pointed to the diagnosis of OSF. DISCUSSION: Conservative as well as surgical interventions for OSF have not resulted in adequate long-term results. Since OSF may occur in children and young adults, the primary aim should be to avoid progression of the disease, initially by physiotherapy. Surgical interventions should not be applied at an early stage of the disease because recurrences and further surgical interventions are often necessary. Due to the increasing numbers of migrants from South Asia more cases of OSF will probably also be observed in Germany, where areca nut-containing products are also available.

A method using vestibulo-sulcoplasty combining a split-thickness skin graft and a palatal keratinized mucosa graft for peri-implant tissue secondary to oral cancer surgery.

Twelve patients presented with oral submucosal fibrosis and loss of keratinized gingiva in a compromised vestibule of a severely deficient mandibular edentulous ridge secondary to oral cancer surgery. They received implant rehabilitation with a total of 49 fixtures without major bone graft augmentation. To overcome vestibular compromise, soft tissue management consisting of simultaneous vestibulo-sulcoplasty, split-thickness skin graft (STSG), and palatal keratinized mucosa graft (KMG) was performed as a second stage when healing abutment was transferred to replace the cover screw of the dental implant. Postoperative follow-up of all patients consisted of clinical and radiographic examinations for an average of 4 years, revealing good stability of implant fixtures with a 91.8% success rate and generally healthy peri-implant tissue, the latter with an average sulcus depth of 2.9 +/- 0.6 mm. Satisfactory results were also demonstrated regarding improved morphology of the vestibule, cosmetics, and prosthetic functionality. Vestibulo-sulcoplasty combining STSG and palatal KMG offers a stable and convenient method for rebuilding peri-implant tissue without need for bone grafting in selected patients who have compromised atrophic ridges secondary to cancer surgery.