Mr. Ayaz Baig, a 25-year-old male, presented with a chief complaint of restricted mouth opening and burning sensation in the mouth when consuming spicy foods for the past 1-2 months. On examination, fibrous bands were seen bilaterally on the buccal mucosa, mouth opening was limited to 15mm, and pit and fissure caries were detected. A provisional diagnosis of stage III oral submucous fibrosis bilaterally was made. The treatment plan included stopping tobacco use, nutritional supplements and intralesional injections to reduce inflammation, followed by restorative treatment and regular follow ups.

1. LONG CASE
(Oral Sub Mucous
Fibrosis)
Presented By : Fatema Mithaiwalla
( Intern )

2. General Information
PATIENT’S NAME: Mr. Ayaz Baig
AGE/SEX :25 yrs/ Male
ADDRESS : Bhawani peth, Pune
OCCUPATION : Service
OPD NO : 25504H

3.  CHIEF COMPLAINT: Patient complains of restricted mouth opening and
burning sensation in the mouth on consumption of hot and spicy foodstuff since
1-2 months
 HISTORY OF PRESENT ILLNESS:
Patient complains of restricted mouth opening and burning sensation in the
mouth on consumption of hot and spicy foodstuff since 1-2 months. Patient was
asymptomatic 2 months back,after which he began experiencing burning
sensation in the mouth on consumption of hot and spicy foodstuffs. Initially the
burning sensation was very mild and localised to the buccal mucosa region only
but now it has increased in intensity and become more severe and generalised.
Patient also noticed stiffness on opening the mouth which was mild initially but
gradually increased in severity to the present state due to which the patient has
difficulty in eating and speaking.

4.  MEDICAL HISTORY: No relevant medical history.
No history of any drug allergy.
 FAMILY HISTORY : No relevant family history.
 PAST DENTAL HISTORY :
No relevant past dental history.
 PERSONAL HISTORY:
HABIT : Chewing Tobacco 5 - 6 times daily since 7-8 years.
Patient also gives history of chewing “Ghutka” 6-7
times a day which he stopped 6 months back.
Oral hygiene : Patient cleans his teeth once a day in
morning with tooth brush and
toothpaste.

5. EXTRAORAL EXAMINATION:
 On extra oral examination the patient was of moderate built, had a normal
gait.
 Face was apparently symmetrical
 Had a convex profile.
 Lips are competent.
 Lymph nodes non palpable and non tender.
 No abnormality detected in left and right TMJ.
 Mouth opening is 27 mm

6. EXTRAORAL PHOTOGRAPHS
FRONT VIEW

7. INTRA ORAL EXAMINATION:
1) TEETH:
 Teeth Present : 87654321 12345678
87654321 12345678
 Teeth missing : No teeth Absent.
 Caries :
Occlusal caries involving enamel,dentin and pulp with
6
Proximal caries involving dentin with 6
Pit and fissure caries with 78 6
 Restoration : Absent
 Tenderness on Percussion : Absent
 Mobility/Discolored : Absent
 Attrition/Abrasion/Erosion : Absent
 Calculus/Stains : Gen. Calculus &
Stains ( grade III)
 Occlusion : Angle’s Class I
occlusion on both sides.
 Overjet & Overbite : Normal

8. SOFT TISSUE EXAMINATION
 Tongue/Lips : No abnormality detected.
 Hard and soft palate : No abnormality detected.
 Floor of mouth : No abnormality detected.
 Buccal mucosa : Fibrous Bands that are blanched seen on the
right & left buccal mucosa extending from the commissure of the
mouth to the Pterygomandibular raphae.
 Gingival condition : Generalized marginal and papillary
gingival inflammation seen.

9. DETAILED EXAMINATION Of THE Area of Chief Complaint:
Examination of the Right & Left Buccal Mucosa
 On Inspection :
Inflamed buccal mucosa on both left and right sides. There are
no lesions on the labial vestibule and soft palate. Fibrous
Bands seen on the right & left buccal mucosa. The mucosa
appears blanched extending from the commissure of mouth
to Pterygomandibular raphae .
 On Palpation :
All findings of inspection are confirmed on palpation.
mouth opening is reduced and tongue protrusion.
Fibrous bands are felt on the right and left buccal mucosa.
There is stiffening of the buccal mucosa in that area. The
cheek flexibility is reduced The mucosa appears blanched.
The surface is rough and leathery in texture .

10. INTRAORAL PHOTOGRAPHS
Right Buccal view Left Buccal view

11. Mouth opening- 15 mm

12. Provisional Diagnosis
 Oral Sub Mucous Fibrosis Bilaterally (Stage III)
Other Diagnosis
 Pit and fissure caries with 7
67
 Chronic Generalized marginal & Papillary
Gingivitis

13. Differential Diagnosis
 Scleroderma
 Trismus
 Iron Deficiency Anemia

14. INVESTIGATION’S
 History
 Clinical examination
 Biopsy required

15. FINAL DIAGNOSIS
 Oral Sub mucous Fibrosis bilaterally (Stage III)
 Pit and fissure caries with 7
67
 Chronic Gen. Marginal and papillary Gingivitis

16. TREATMENT PLAN
EMERGENCY TREATMENT: Not Required
PLANNED TREATMENT
I ] PREPARATORY PHASE :
 Stoppage of Tobacco chewing Habit immediately.
 Oral prophylaxis and polishing.
 Patient education and motivation.
 Going on bland food, free from chillies and peppers.
Nutritional support:
 Iron supplements like Cap.Fefol Z
 Cap. Becosules 30..
Intralesional Injections :
 Inj Hydrocortisone HCl 3 times a week (by multiple puncture method)
 Inj Placentrix
 Inj Betnesol
II ] SURGICAL PHASE :
 Not required.
III] RESTORATIVE PHASE :
 Excavation of caries followed by Silver Amalgam restoration for
IV ] MAINTAINANCE PHASE:
 Cleaning teeth twice a day using tooth brush and fluoridated tooth paste.
 Use of dental floss for interdental cleaning.
 Use of tongue cleaner for cleaning tongue.
 Gum massaging with finger.
 Use of 0.2% chlorhexidine mouth wash three times a day for 15 days.
 Recall after one week.

17. Thank You!!!