Post on 22-Oct-2014
ORAL SUBMUCOUS FIBROSIS(atrophica idiopathic mucosae oris)
O
CONTENTSDefinitionEtiologyPathogenesisClinical findingsDiagnosismanagement
Definition:An insidious chronic disease affecting any
part of the oral cavity and sometimes pharynx although ocassionally preceded by or associated with vesicle formation,it is always associated with juxtaepithelial inflammatory reaction followed by fibroelastic changes in the lamina propria,with epithelial atrophy leading to stiffness of oral mucosa and causing trismus and inability to eat.
Etiology
1)habitual chewing of areca nut.2)genetic predisposition.3)vit b12 deficiency or nutritional deficiency4)collagen disorder.5)chilly consumption.6)tabacco chewing
Clinical findings:Age & sex distribution:Between 20 to 40 yrs of age
affect both sexes.
Site distribution:buccal mucosa,lip,palate,palatal fauces,uvula,tongue,labial mucosa,floor of the mouth.
Prodromal Symptoms:first sign is erythematous lesion sometimes in conjugation with petechiae,pigmentation & vesicles.
Burning sensation of the oral mucosa & it is aggravated by spicy food.
Hypersalivation or dryness of mouth may be seen.Late symptoms:trismus,difficulty in tongue
protrusion,difficulty in swallowing,interference with speech.tongue mobility,decrease ability to open mouth.
Reffered pain.Blanching of mucosa due to impairment of local vascularity.
CLINICAL GRADING OF OSMF ACCO.TO SEVERITYFEATURES
GRADE I INCIPIENT(very early stage)
GRADE II (mild)
GRADE III (moderate)
GRADE IV (advanced stage)
GRADE V (advanced premalignant&malignant changes)
Symtoms Burning sensation,dryness of mouth,vesicle or ulceration
Burning sensation,dryness of mouth
Burning sensation,dryness of mouth
Burning sensation,dryness of mouth
All classical sing of OSMF&associated with leukoplakia and lichen planus
Spicy food
Irritation with spicy food
Irritation with spicy food
Irretation with spicy food
Irretation with spicy food
FEATURES
GRADE I INCIPIENT(very early stage)
GRADE II (mild)
GRADE III (moderate)
GRADE IV (advanced stage)
GRADE V (advanced premalignant&malignant changes)
Mucosal color
No change in mucosal color
Mucosa is blanched&Loses its sensation
Blanched opaque leather like mucosa
Blanched opaque leather like mucosa
Fribrosis No fibrosis,bands palpable
No clear-cut fibrotic bands
Vertical fibrotic bands on buccal mucosa making it stiff
Thick fibrosed bands occuring on both the buccal mucosa in retromolar area&Pterygomandibular raphe
Mouth opening
normal44mm
Slight restriction26-35mm
Considerable restriction15-25mm
Very little mouth opening2-15mm
FEATURES
GRADE 1INCIPIENT(very early stage)
GRADE(mild)
GRADE(moderate)
GRADE(advanced stage)
GRADE(advanced premalignant&malignant changes)
Tongue Tongue protrusion normal
Tongue protrusion normal
Not much affected
Restricted tongue protrusion
Eating&speaking
_ _ Difficulty in eating &speaking
Eating &speaking very much impaired
Oral hygine
_ _ Poor oral hygiene
Very poor oral hygiene
DIAGNOSIS:
Based on clinical characteristicBased on patient report of a habit of betel quid
chewing.Blood chemistry & hematological variation.An international consensus has been reached
where atleast one of the following characteristics should be present:
-palpable fibrous band-mucosal texture feel tough and leathery-blanching of mucosa together with
histopathological features consistent with osmf.
MANAGEMENT.Restriction of habit and behavioural therapy.Nutritional support.Immuno modulatory drugs: systemic application
of steroids.Physiotherapy.Local drug delivery:local injection of
corticosteroids & placental extract in addition to hyaluronidase,collagenase & substance that decreases collagen formation.
Combined therapy.Surgical managementBy laser,cryotherap,diathermy.
REACTION TO MECHANICAL TRAUMAMorsicatioFrictional hyperkeratosis
MORSICATIOMorsicatio is instigated by habitual chewingThis parafuntional behavior is done
unconsciously & is therefore difficult to bring to an end.
Most frequently seen in the buccal & lip mucosa.
The prevalence has been reported to be in the range of 1.2 to0.5%.
ETIOLOGY:neurological,psychological,dental.
CLINICAL FEATURESAge&sex:occurs at any age,lesion is three
more common among women.site:on buccal mucosa at the level of
occlusion,lip, lateral border of tongue.appearence:there is lacerated&reddened
area.Signs-rough on palpation
DIAGNOSISTypical clinical appearance with typical location.D/D-hairy leukoplakia,candidiasis.
MANAGEMENTPsycotherapy.Acrylic guard.
FRICTIONAL HYPERKERATOSISIt is a white lesion observed in area of oral
mucosa subjected to increased friction caused by for eg. Food intake.
ETIOLOGY
It is observed in area subjected to increased abrasion
Due to minor traumaSmoking&alcohol consumption
CLINICAL FINDINGSMostly seen in edentulous areas of alveolar
ridge that are exposed to increased friction.Lesion is nonsymptomatic.
DIAGNOSISIt is based on clinical featuresIf doubtful biopsy is mandatory
MANAGEMENTOn the bases of etiologyNo surgical intervention is indicated