Current protocols in the management of oral submucous fibrosis: An update

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Oral submucous fibrosis (OSMF) is a challenging clinical condition associated with various devastating effects. As the condition progresses, patient can experiences both severe physical and mental illness.1 Furthermore, progressive restricted mouth opening leads to poor oral hygiene which can hinder social life.1 A number of treatment modalities have been advocated to manage both the symptoms and treat the abnormal fibrotic tissue that occurs as the disease progresses.3 However, as the pathogenesis of this disease is still not fully understood, no single treatment regime has proved to be entirely satisfactory.3
Characteristically, OSMF patients complain of two main problems—an inability to open the mouth, which impedes function and a burning sensation on oral mucosa with intolerance to spicy foods (intolerance to normal diet in severe cases).1 Management is usually based on disease severity and focuses on reversing or alleviating these signs and symptoms, stopping the disease progressing, and minimizing the risk of malignant transformation.1 Usually simply stopping the areca/betel nut chewing habit will often resolve symptoms particularly if the condition is diagnosed before the occurrence tissue fibrosis.3 However, once trismus has become established, treatments are dictated by both clinical presentation and functional severity of the condition.1
Two recent systematic reviews3 fail to show reliable evidence for the effectiveness of any specific interventions for the management of OSMF; thus, an evidence‐based management strategy is not possible.
The current OSMF protocol for managing the condition can be divided into two broad groups: conservative treatment and surgical therapy. Conservative management is recommended for mild to moderate stages of OSMF with interincisal mouth opening of greater than 25 mm, while surgery is considered in later stages, especially when patients have severe trismus.6 Conservative therapy is divided into physical therapy and medical treatment (Table 1).

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