Prevalence of Oral Submucous Fibrosis With Other Oral Potentially Malignant Disorders: A Clinical Retrospective Study

Abstract

Background Oral submucous fibrosis (OSMF) is a chronic, progressive, and potentially malignant oral disorder that causes scarring of the oral cavity, pharynx, and upper oesophagus. It is most common in Southeast Asia, but it is also found in other parts of the world. Oral potentially malignant disorders (OPMDs) are a group of oral lesions that have an increased risk of developing into oral cancer. The study aimed to evaluate the prevalence of OSMF associated with other OPMDs. The presence of multiple OPMDs existing in one patient is a significant finding, as it is associated with an elevated risk of developing malignancy. The risk of malignant transformation increases with the number of OPMDs present in a patient; patients with two OPMDs have a three to four times higher risk of developing malignancy than those with a single OPMD. Patients with three or more OPMDs have a 7-10 times higher risk and the risk of malignant transformation depends on the type of OPMD. Materials and methods The study was conducted in the Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Chennai, India, to investigate the prevalence of OSMF with other OPMDs. The study team retrieved 630 case records of patients with OSMF from the electronic database between January 2018 and March 2023. All of the patients in the study had OSMF, as well as other OPMDs such as leukoplakia, candidiasis, actinic cheilitis, dyskeratosis congenita, erythroplakia, lichen planus, sideropenic dysphagia (Plummer-Vinson syndrome), and discoid lupus erythematosus. Both clinical and histopathological examinations confirmed these diagnoses. Oral mucosal lesions without coexisting OSMF were excluded. The study was done on the basis of age group, habits, type of habits, associated coexisting lesions, and systemic condition. Results The patients were clinically examined and diagnosed. Of the 630 cases, 10% had OSMF with OPMDs. The most common OPMDs associated with OSMF were leukoplakia (86%), followed by candidiasis (12%) and both leukoplakia and candidiasis (2%). Based on gender, the incidence of OSMF was higher in males compared to females with 67% and 33%, respectively. Conclusion OSMF is more likely to develop into malignancy; the widespread use of areca nut products in India has contributed to the rising incidence of OSMF. Accumulating epidemiological data can help to identify high-risk populations for prevention and control measures. Earlier oral cancer diagnosis and treatment can increase the likelihood of a favourable outcome.

Keywords: areca nut; candidiasis; leukoplakia; oral potentially malignant disorders; oral submucous fibrosis.

Figure 1. Oral leukoplakia has the highest association with oral submucous fibrosis with a value of 86%.

Figure 2. Patients with OSMF with OPMDs had a habit of chewing areca nut (62%); chewing areca nut and smoking (14%); chewing areca nut and consuming alcohol (4%); chewing areca nut, consuming alcohol, and smoking (20%).

OSMF: Oral submucous fibrosis; OPMDs: Oral potentially malignant disorders

Figure 3. Prevalence of oral submucous fibrosis among male and female populations in which 67% were males and 33% were females.

Figure 4. Out of 630 cases, 46 were males and four were females who had oral submucous fibrosis associated with other oral potentially malignant disorders.

Figure 5. The age distribution of oral submucous fibrosis, which showed prevalence was higher in 20-40 years of age.

Figure 6. The age distribution of patients with oral submucous fibrosis with other oral potentially malignant lesions; it revealed that the prevalence was higher in patients >40 years.

Figure 7. Clinical staging of OSMF; grade 1 (13%), grade 2 (60%), grade 3 (20%), grade 4A (10%), grade 4B (1%), and grade 5 (2%).

The clinical staging was done based on Kerr et al. [13]. OSMF: Oral submucous fibrosis

Figure 8. Diabetes had the most association with oral submucous fibrosis with a value of 52%.

Figure 9. Histopathological section of oral submucous fibrosis.

Figure 10. Histopathological section of oral submucous fibrosis associated with leukoplakia.

Figure 11. Histopathological section of oral submucous fibrosis, leukoplakia, and oral squamous cell carcinoma.