ABCs of Oral Sub-mucous fibrosis

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Oral sub-mucous fibrosis (OSMF) disease was discovered in the year 1952 by Schwartz when he treated five Indian women in Kenya.

It has been estimated that about 2.5 million people are affected because of oral sub-mucous fibrosis. Most of these persons are in Indian sub-continent – in particular in southern India. OSMF affects not only all age groups but also all socioeconomic strata in India. Introduction of Gutka in the market has increased the incidence of OSMF. Oral sub-mucous fibrosis in the United States exists only in the South Asian population who has the habit of chewing betel nuts.

This article details the symptoms, causes and treatments for oral sub-mucous fibrosis.

Oral submucous Fibrosis image 01 Oral submucous Fibrosis image 02


The term oral sub-mucosal fibrosis has been derived from the following:

Oral sub-mucous fibrosis is a chronic disease of the oral cavity that could weaken a person to a great extent; the main characteristics of this disease are – inflammation and progressive fibrosis of the sub-mucosal tissues. The patient affected by this disease feels burning sensations in his mouth that too while taking hot and spicy foods. Further there will be multiple ulcerations or inflammatory reactions in the oral mucosa. This can cause excessive or decreased salivations and defective gustatory sensations.

This disease causes rigidity of oral mucosa that makes it extremely difficult to open the mouth. The mucosa that is related to the cheeks or the mouth cavity is the site affected mostly; however it is possible that other oral cavity sites including pharynx also could be affected.

The condition is likely to cause malignancy and is mainly associated with betel quid chewing. People in Southeast Asia and India have been practicing this for thousands of years and this is similar to tobacco chewing in western nations. The betel quid mixture contains – areca nut, betel leaf, tobacco, slaked lime and catechu.

Oral submucous Fibrosis image 03 Oral submucous Fibrosis image 04

What are the signs and symptoms of Oral sub-mucous fibrosis ?

During the initial period if you touch the mucosa you will feel that it is wet and leathery; in the advanced stages the resilience of the oral mucosa is lost and it becomes very stiff. Normally this disease starts from the posterior part of the oral cavity and it slowly spreads to the anterior locations.


These signs are followed by leukoplakia which is a pre cancer state and found in 25% of cases of oral sub-mucus fibrosis, severe trismus (interincisal distance less than 15mm) and finally frank cancer due to malignant change throughout the mucosa.

Laboratory findings

What are the causes for Oral sub-mucous fibrosis?

The reasons for Oral sub-mucous fibrosis are as follows:

What is the treatment for Oral sub-mucous fibrosis?

The type of treatment to be rendered is dependent mainly on the stage of the disease. If you stop taking Pan Masala at the right time it is possible to reverse the disease. However the existence of this disease is discovered when it reaches the moderate to severe stage in most of the cases.

Two types of treatments are given for Oral sub-mucous fibrosis – medical and surgical. Before treating for this disease it is necessary to get biopsy screening done.

As a part of the treatment the patient should adhere to the following:

What are the medications for Oral sub-mucous fibrosis?

The following medical treatments are given:

What are the surgical treatments for Oral sub-mucous fibrosis?

The following surgical treatments are given:

Surgical treatment includes reconstructive surgery by orofacio-maxillary or plastic surgeon. Simple excision of fibrous band is to be avoided to prevent contracture of tissue and exacerbation.

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