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Review
. 2015 Apr 13:8:193-204.
doi: 10.2147/CCID.S80576. eCollection 2015.

Oral submucous fibrosis: an update

Uwe Wollina  1 , Shyam B Verma  2 , Fareedi Mukram Ali  3 , Kishor Patil  4
Affiliations
Review

Oral submucous fibrosis: an update

Uwe Wollina et al. Clin Cosmet Investig Dermatol. .

Abstract

Oral submucous fibrosis (OSF) is a premalignant condition caused by betel chewing. It is very common in Southeast Asia but has started to spread to Europe and North America. OSF can lead to squamous cell carcinoma, a risk that is further increased by concomitant tobacco consumption. OSF is a diagnosis based on clinical symptoms and confirmation by histopathology. Hypovascularity leading to blanching of the oral mucosa, staining of teeth and gingiva, and trismus are major symptoms. Major constituents of betel quid are arecoline from betel nuts and copper, which are responsible for fibroblast dysfunction and fibrosis. A variety of extracellular and intracellular signaling pathways might be involved. Treatment of OSF is difficult, as not many large, randomized controlled trials have been conducted. The principal actions of drug therapy include antifibrotic, anti-inflammatory, and antioxygen radical mechanisms. Potential new drugs are on the horizon. Surgery may be necessary in advanced cases of trismus. Prevention is most important, as no healing can be achieved with available treatments.

Keywords: betel nut; betel quid; fibrosis; oral disease; squamous cell carcinoma; tobacco.

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Figures

Figure 1
Figure 1
Handmade and commercial forms of betel. Notes: (A) Typical ingredients of hand-made betel quid: green piper betel leaves (left), areca nut (lower right), slaked lime (upper left), and a mixture of spices (upper right). (B) Some commercial brands ready to use.
Figure 2
Figure 2
Dental staining and irregular cobble-stone pattern of oral mucosa.
Figure 3
Figure 3
Blanching of buccal mucosa in oral submucous fibrosis.
Figure 4
Figure 4
Redness and irregular cobble-stone appearance in oral submucous fibrosis. Note: In such cases a biopsy is recommended to exclude initial oral squamous cell carcinoma.
Figure 5
Figure 5
Blanching present on soft palate of patient with oral submucous fibrosis.
Figure 6
Figure 6
Decreased mouth opening in patient with advanced-stage oral submucous fibrosis.
Figure 7
Figure 7
Advanced-stage oral submucous fibrosis. Notes: (A) Severe decreased mouth opening and blanching seen on buccal mucosa. (B) Leukoplakia of the tongue; a biopsy is indispensable to exclude cancer of the tongue.
Figure 8
Figure 8
Oral squamous cell carcinoma in a patient with oral submucous fibrosis.
Figure 9
Figure 9
Histopathological picture showing initial stage of oral submucous fibrosis. Note: Hematoxylin and eosin staining, ×10.
Figure 10
Figure 10
Histopathological picture showing advanced stage of oral submucous fibrosis. Notes: (A) Hematoxylin and eosin staining, ×100. (B) Closer view (hematoxylin and eosin staining, ×400).
See this image and copyright information in PMC

References

    1. Haider SM, Merchant AT, Fikree FF, Rahbar MH. Clinical and functional staging of oral submucous fibrosis. Br J Oral Maxillofac Surg. 2000;38(1):12–15. - PubMed
    1. Ali FM, Patil A, Patil K, Prasant MC. Oral submucous fibrosis and its dermatological relation. Indian Dermatol Online J. 2014;5(3):260–265. - PMC - PubMed
    1. Pandya S, Chaudhary AK, Singh M, Singh M, Mehrotra R. Correlation of histopathological diagnosis with habits and clinical findings in oral submucous fibrosis. Head Neck Oncol. 2009;1:10. - PMC - PubMed
    1. Ceena DE, Bastian TS, Ashok L, Annigeri RG. Comparative study of clinicofunctional staging of oral submucous fibrosis with qualitative analysis of collagen fibers under polarizing microscopy. Indian J Dent Res. 2009;20(3):271–276. - PubMed
    1. Patil S, Maheshwari S. Proposed new grading of oral submucous fibrosis based on cheek flexibility. J Clin Exp Dent. 2014;6(3):e255–e258. - PMC - PubMed