This document provides information on oral submucous fibrosis (OSMF), including its definition, history, pathogenesis, clinical features, and staging classifications. OSMF is a chronic disease affecting the oral cavity and sometimes pharynx, characterized by juxtaepithelial inflammatory reaction and fibrosis of the lamina propria. Chewing betel quid and areca nut releases alkaloids and tannins that cause irritation and inflammation, activating fibroblasts and increasing production and cross-linking of collagen over time, resulting in stiffness and inability to open the mouth. OSMF is considered a precancerous condition due to its association with oral cancer. Staging systems describe progression from initial symptoms to trismus and possible malignancy
Introduction
Epidemiology
Etiology
Manifestations
TNM staging
Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges.
( Pindborg et al, 1997).
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
Introduction
Epidemiology
Etiology
Manifestations
TNM staging
Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges.
( Pindborg et al, 1997).
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
The presentation explain white lesions in oral cavity and the classification the demonstrate the etiology, histopathology, diagnosis and treatment for each one.
One of the most painful but easy-to-treat dental emergencies is a dry socket.
• Dry socket symptoms are experienced after a tooth extraction.
• This condition requires follow-up care by the doctor who performed the surgery, an oral surgeon or a dentist who is familiar with how to treat it.
For more information, contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
#drysocket #management #thirdmolarextraction #extractioncomplications
The presentation explain white lesions in oral cavity and the classification the demonstrate the etiology, histopathology, diagnosis and treatment for each one.
One of the most painful but easy-to-treat dental emergencies is a dry socket.
• Dry socket symptoms are experienced after a tooth extraction.
• This condition requires follow-up care by the doctor who performed the surgery, an oral surgeon or a dentist who is familiar with how to treat it.
For more information, contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
#drysocket #management #thirdmolarextraction #extractioncomplications
Oral submucous fibrosis is defined as “An insidious chronic disease affecting any part of the oral cavity and sometimes the pharynx. A wide range of treatment including drug therapy, surgical therapy, and physiotherapy have been attempted till date, with varying degrees of benefit, but none have been able to cure this disease.
The treatment depends on the level of clinical involvement. At a very early stage, cessation of the habit is adequate. Medical/surgical treatment is necessary for moderate to severe cases. Surgical treatment is the method of choice in patients with marked limitation of mouth opening or in patients not responding to the conservative management.
this seminar emphasizes abour osmf,historical background,nearly all classification were covered,its pathogenesis starting from physical changes to cellular changes in oral mucosa and treatment modalities
OSMF is a precancerous condition. The frequency of malignant transformation in OSF has been reported to be in the range of 7–13%. Clinically, patients present with a lustreless, marble-like blanching of the oral mucosa. The treatment of patients with oral submucous fibrosis depends on the degree of clinical involvement. If the disease is detected at a very early stage, cessation of the habit is sufficient.
As per AJCC 7th Ed, a pictorial review with prediction for change in future edition.
Presented at "Oral Oncology-An update" CME conducted by Shri Mata Vaishno Devi Narayana Superspecialty Hospital, Katra at Fortune Inn Riviera Hotel, Jammu on 21st Jan, 2017.
An overview of various pathological processes affecting the Jaw Bones- Maxilla and Mandible including odontogenic cysts and tumours including their radiological findings!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
3. DEFINITION
It is an insidious chronic disease affecting any part of
the oral cavity and sometimes the pharynx. Although
occasionally preceded by and /or associated with
vesicle formation ,it is always associated with juxtaepithelial inflammatory reaction followed by a fibroelastic changes of the lamina propria with epithelial
atrophy leading to stiffness of the oral mucosa and
causing trismus and inability to eat.
(J.J Pindborg and Sirsat 1966)
4. HISTORY
The condition of oro -pharyngeal OSMF of oral cavity
was prevalent even in the days of Shushrutha (600
B.C).
Shushrutha, the greatest practitioner of ancient
medicine stated in his book "Shushrutha Samhita' a
condition called 'VIDARI' in his classification of
diseases of mouth and throat.
The features of which suit the symptomatology of
OSMF.
5.
First described among five East African women of
Indian origin under the term Atrophia idiopathica
(tropica) Mucosae Oris by Schwartz 1952
Joshi in 1953 is credited to be the first person who
described it and gave the present term “Oral submucous fibrosis”.
In the year 1954, Su. P. from Taiwan described similar
condition, which he called "Idiopathic Scleroderma of
mouth"
6. KEY WORDS
Quid has been defined as a substance or mixture of
substances placed in the mouth or chewed and
remaining in contact with the mucosa usually
containing one or both of the two basic ingredients
tobacco and/or areca nut in raw or any
manufactured or processed form (Zain et al., 1999).
A precancerous lesion is a morphologically altered
tissue in which oral cancer is more likely to occur
than in its apparently normal counterpart‟;
A precancerous condition is a generalized state
associated with a significantly increased risk of
cancer‟.
J Cancer Science & Therapy - Volume 1(2) : 072-077 (2009) - 075
8. The major areca nut alkaloids are arecoline, arecadine,
arecolidine, guyacoline and guacine.
The important flavonoid components in areca nut are
tannins and catechins.
These alkaloids undergo nitrosation and give rise to Nnitrosamine which may have cytotoxic effect on cells.
(Hoffmann et al., 1994)
Betel quid is placed in the buccal vestibule for ~15 min
to 1 hr & repeated 5-6 times a day which leads to
constant contact between mixture & mucosa.
The alkaloids from the quid are absorbed into the
mucosa and undergoes metabolism.
Microtrauma produced by the friction of coarse fibers of
areca nut also facilitates diffusion of the alkaloids into
the subepithelial connective tissue resulting in
juxtaepithelial inflammatory cell infiltration. (Chiang et
al., 2002).
9. Oral mucosa
Betel quid
Constant irritation
Chronic inflammation
Activated T cell and macrophages at the site
Increase in cytokines IL 6, TNF, Ifa, increase in growth factor TGFβ
11. COLLAGEN PRODUCTION PATHWAY
3 main events in this pathway activation of
procollagen, elevation of procollagen proteinase levels,
and upregulation of lysyl oxidase (LOX activity).
The genes COL1A2, COL3A1, COL6A1, COL6A3,
COL7A1 have been identified as definitive TGF-β
targets. (Rajalalitha & Vali, 2005).
Yi-Ting et al., 2009, found arecoline stimulated CTGF
production in buccal mucosal fibroblasts (BMFs)
12. UP-REGULATION OF LOX
The Cu content of areca nut is high & levels of
soluble Cu in saliva may rise in volunteers who
chew areca quid (Trivedy et al, 1997).
The enzyme Lysyl oxidase (LOX) is found to be
upregulated in OSMF.
The fibroblast in OSMF have not only increased
LOX activity but also specific growth characteristics.
This was evident with the reported cell doubling
time of 3.2 days for OSMF & 3.6 days for normal
fibroblasts (Ma et al., 1995).
13. “The Evaluation of serum copper & iron levels among
oral submucous fibrosis patients.”
50 cases and controls each were each tested for
serum copper & iron levels.
Conclusion: Copper levels increased & iron levels
decreased in study group in comparison to healthy
controls. Copper levels increased as clinical stage of
oral submucous fibrosis increased.
Tadakamadla J, Kumar S, Mamatha GP. Med Oral
Patol Oral Cir Bucal. 2011: 1; 16(7); e870-3.
14. COLLAGEN DEGRADATION PATHWAY
2 main events modulated by TGF which decreases
the collagen degradation are:
Activation of inhibitor of matrix metalloproteinase
gene TIMPs
Activation of plasminogen activator inhibitor PAI
gene.
15. PRECANCEROUS NATURE & MALIGNANT
TRANSFORMATION
First described by Paymaster in 1956.
Pindborg et al., 1984, put forward 5 criteria to prove
disease to be precancerous. These include, high
occurrence of OSMF in oral cancer patients, higher
incidence of SCC in patients with OSMF, histological
diagnosis of cancer without any clinical suspicion in
OSMF, high frequency of epithelial dysplasia and higher
prevalence of leukoplakia among OSMF.
Malignant transformation rate of OSMF was found to be
the range of 7-13%.
16. Areca nut/Betel nut
Mechanical trauma
to epithelium
Carcinogen acts as antigen
to keratinocytes
Carcinogen reaches
basal zone & affects
stem cells
Stem cells produce
iNOS
DNA DAMAGE
TGF-β
FGF
Stem cell
hypoproliferation
(Epithelial hypoplasia)
Sustained
DNA DAMAGE
Loss of rete
ridges
Dysplasia
Subepithelial
hyalinization
17. “Estimation of serum beta carotene levels in patients
with oral submucous fibrosis in India.”
45 cases & controls each were evaluated for their
serum beta carotene levels.
Results: Mean serum beta carotene levels were
found to be lower for cases than controls.
They concluded that beta carotene plays an important
role in the pathogenesis of OSMF, and that its level
decreases with disease progression.
Aggarwal A, Shetti A, Keluskar V, Bagewadi A. J Oral
Sci. 2011: 53(4); 427-431.
19. Progressive inability to open the mouth(trismus)
due to oral fibrosis & scarring.
Oral pain & a burning sensation upon consumption
of spicy foodstuffs.
Increased salivation
Change of gustatory sensation
Hearing loss due to stenosis of the eustachian
tubes
Dryness of the mouth
Nasal tonality to the voice
Dysphagia to solids (if esophagus is involved)
Impaired mouth movements
20. Intra-oral view showing: A. Marble-like appearance of soft palate, faucial pillars &
upper pharyngeal mucosa B. shrunken uvula, blanching of left buccal mucosa &
retromolar region, C. Fibrosis & depapillation of tongue, D. Blanching of right
buccal mucosa, E. Fibrosis & pigmentation of lower lip
23. Decreased hemoglobin levels
Decreased iron levels
Decreased protein levels
Increased erythrocyte sedimentation rate
Decreased Vitamin B complex levels
24. “Lipid profile in oral submucous fibrosis”
65 clinically diagnosed and histopathologically proven patients of
OSMF and 42 age and sex matched controls were studied. In
these samples serum lipids including: (i) Total cholesterol, (ii) LDL
cholesterol (LDLC), (iii) HDL cholesterol (HDLC) (iv) VLDL
cholesterol (VLDLC) (v) triglycerides (vi) Apo-A1 (viii) Apo-B and
(viii) LPa were analyzed.
A significant decrease in plasma total cholesterol, HDLC and ApoA1 was observed in patients with OSMF as compared to the
controls. Thus an inverse relationship between plasma lipid levels
and patients was found in OSMF.
Mehrotra R et al. Lipids in Health and Disease. 2009; 8: 29
25. STAGING
More CB et al. Classification system for Oral
submucous fibrosis. JIAOMR. 2012; 24(1): 24-29.
26. Pindborg JJ, 1989
Stage I: Stomatitis includes erythematous mucosa, vesicles, mucosal
ulcers, melanotic mucosal pigmentation & mucosal petechiae.
Stage II: Fibrosis occurs in healing vesicles & ulcers, which is the hallmark
of this stage.
- Early lesions show blanching of the oral mucosa.
- Older lesions include vertical & circular palpable fibrous bands in the
buccal mucosa & around the mouth opening or lips.
- This results in a mottled marble like appearance.
- Specific findings include reduction of mouth opening, stiff & small
tongue, blanched & leathery floor of the mouth, fibrotic & depigmented
gingiva, rubbery soft palate with decreased mobility, blanched &
atrophic tonsils, shrunken bud-like uvula & sunken cheeks not
commensurate with age or nutritional status.
Stage III: Sequelae of OSMF are as follows:
- Leukoplakia is found in more than 25% of individuals with OSMF.
- Speech & hearing deficit may occur because of involvement of tongue &
eustachian tube.
27. Nagesh & Bailoor (1993)
Stage I early OSMF: Mild blanching, no restriction in mouth
opening (normal distance between central incisor tips:
Males 35-45 mm, females 30-42 mm), no restriction in
tongue protrusion, cheek flexibility. Burning sensation on
taking spicy food or hot beverages.
Stage II moderate OSMF: Moderate to severe blanching,
mouth opening reduced by 33%, cheek flexibility also
demonstrably reduced, burning sensation also in absence
of stimuli, palpable bands felt. Lymphadenopathy either
U/L or B/L, anemia on hematological examination.
28. Khanna JN & Andrade NN (1995)
Group I:
- Very early cases: burning sensation in the mouth, acute
ulceration & recurrent stomatitis & not associated with
mouth opening limitation.
- Histology: Fine fibrillar collagen network interspersed with
marked edema, blood vessels dilated & congested, large
aggregate if plump young fibroblasts present with
abundant cytoplasm, inflammatory cells mainly consist of
PMNs with few eosinophils. The epithelium is normal.
29. Khanna JN & Andrade NN (1995)
Group II:
- Early cases: Buccal mucosa appears mottled & marble
like, widespread sheets of fibrosis palpable, interincisal
distance of 26 to 35 mm.
- Histology: Juxta-epithelial hyalinization present, collagen
present as thickened but separate bundles, blood vessels
dilated & congested, young fibroblasts seen in moderate
number, inflammatory cells mainly consist of PMNs with
few eosinophils & occasional plasma cells, flattening
or shortening of epithelial rete-pegs evident with
varying degree of keratinization.
30. Khanna JN & Andrade NN (1995)
Group III:
- Early cases: Moderately advanced cases- Trismus,
interincisal distance of 15-25 mm, buccal mucosa appears
pale firmly attached to underlying tissues, atrophy of
vermilion border, vertical fibrous bands palpable at the soft
palate, pterygomandibular raphe & anterior faucial pillars.
- Histology: Juxta-epithelial hyalinization present, thickened
collagen bundles, residual edema, constricted blood
vessels, mature fibroblasts with scanty cytoplasm &
spindle-shaped nuclei, inflammatory exudate which
consists of lymphocytes & plasma cells, epithelium
markedly atrophic with loss of rete pegs, muscle fibers
seen with thickened dense collagen fibers.
31. Khanna JN & Andrade NN (1995)
Group IVA:
- Advanced cases- severe trismus, interincisal distance of
less than 15 mm, thickened faucial pillars, shrunken
uvula, restricted tongue movement, presence of circular
band around entire lip & mouth.
Group IVB:
- Advanced cases- presence of hyperkeratotic leukoplakia
&/or squamous cell carcinoma.
-
Histology: Collagen hyalinized smooth sheet, extensive fibrosis,
obliterated the mucosal blood vessels, eliminated melanocytes,
absent fibroblasts within the hyalinized zones, total loss of epithelial
rete pegs, presence of mild to moderate atypia & extensive
degeneration of muscle fibers.
33. TREATMENT
Taneja L, Nagpal A, Vohra P, Arya V. Oral submucous
Fibrosis: An oral physician approach. J Innov Dent
2011; 1(3)
34. DISCONTINUATION OF HABIT & COUNSELING
Encouraged through education & advocacy.
Patient should be explained about the disease & its
possible malignant potential.
Thorough counseling should be given for deaddiction.
35. SUPPORTIVE CARE
Vitamins, iron & mineral rich diet should be advised
to patients with OSMF.
Intake of red tomatoes, fresh fruits & green leafy
vegetables should be included in the regular diet.
Green tea should be included in the diet chart.
Routine Hb levels followed by iron supplements
should be included in treatment plan.
36. “The Response of Oral Submucous Fibrosis to
Lycopene – A Carotenoid Antioxidant: A
Clinicopathological Study”
2000µg of Lycopene capsule was given orally twice daily
for 3 months to 12 patients.
Clinical and histological improvement was seen in various
parameters used in the study.
Gowda BBK et al. JCDR. 2011
37. MEDICAL MANAGEMENT
STEROIDS:
Inhibit proliferation of fibroblasts.
Release cellular proteases in the connective tissue
extracellular compartment.
Inhibit the inflammatory response.
38. HYALURONIDASE
Reduces burning sensation & trismus.
Acts by breaking down hyaluronic acid, lowers the
viscosity of intracellular substances.
Decreases collagen formation.
“The combination of steroids & hyaluronidase
shows better long-term results than either agent
used alone.” (Kakar, 1985).
39. “Efficacy of hydrocortisone acetate/hylauronidase vs
triamcinolone acetonide/hyaluronidase in the
treatment of oral submucous fibrosis” was evaluated.
1 group received hydrocortisone acetate (1.5 ml)/
hyaluronidase (1500 IU) weekly while other received
triamcinolone acetonide (10 mg/ml)/hyaluronidase
(1500 IU) at 15 days interval for 22 weeks.
No statistically significant difference was seen in both
groups.
Treatment regimen B was more convenient because
of lesser visits & less cost.
Indian J Med Res 2010:131;6655-669.
40. PLACENTAL EXTRACTS
It is an aqueous extract of human placenta that
contains nucleotides, enzymes, vitamins,
aminoacids & steroids.
It acts by “Biogenic stimulation”.
Its use is based on the method of “tissue therapy”
introduced by Filatov in 1933.
No contraindications & the results are found to be
lasting.
42. INTERFERON-GAMMA
Has immuno-regulatory effect, is a known antifibrotic cytokine.
Patients treated with IFN-γ experienced
improvement of symptoms.
“IFN-γ, through its effect of altering collagen
synthesis, appears to be a key factor to the
treatment of patients with OSMF, & intra-lesional
injections of the cytokine may have a significant
therapeutic effect on OSMF.” (Haque, 2001).
43. IMMUNE MILK
Immune milk is a kind of skimmed milk produced
from cows immunised with multiple human
intestinal bacteria.
It has good anti-inflammatory effect & contains
moderate amounts of Vit. A, C, B1, B2, B6, B12,
nicotinic acid, pantothenic acid, folic acid, iron,
copper & zinc.
Though chemically its identical to commercial milk
but it contains 20-30% higher concentration of IgG
type 1 antibody.
44. TURMERIC
Administration of turmeric powder offers protection
against benzopyrene induced increase in
micronuclei in circulating lymphocytes & it is an
excellent scavenger of free radical in vitro.
Turmeric oil & turmeric oleoresin both act
synergistically in vivo to offer protection against
DNA damage. (Hastak et al., 1997)
45. “Comparative study of the efficacy of curcumin & turmeric
oil as chemopreventive agents in oral submucous
fibrosis: a clinical and histopathological evaluation”
48 cases divided into 3 groups were given curcumin
capsules, turmeric oil & multinal capsules respectively.
Statistically significant improvement was seen clinical signs
& symptoms of cases treated with curcumin & turmeric
oil. Positive changes were also observed in the
histopathological examination of these groups.
Deepa Das A, Anita Balan, Sreelatha KT. JIAOMR. 2010; 22(2): 88-92.
46. OTHER THERAPIES
Injection of Gold, Vitamin A & Collagenase.
Vasodilator injection can be used.
Chemotherapeutic agents like topical bleomycin
can also be used in severe cases.
47. “Pentoxifylline therapy : A new adjunct in the
treatment of oral submucous fibrosis”
14 cases and 15 controls were included in the study.
Test cases were given 400mg pentoxifylline 3 times
daily for 7 months.
Significant improvement was seen in objective criteria
and subjective symptoms.
Rajendran R, Rani V, Shaikh S. Indian J Dent Res 2006;17:1908
48. ORAL PHYSIOTHERAPY
Muscle stretching exercises:
Includes forceful mouth opening with the help of
sticks ballooning of mouth, hot water gargling.
Forceful mouth opening with mouth gag & acrylic
surgical screw.
This is thought to put pressure on fibrous bands.
49. DIATHERMY
Microwave diathermy (Low current is used 20 Watts
x 2450 cycles) is useful in some early or moderately
advanced stages.
Acts by fibrinolysis of bands.
50. ULTRASOUND
It selectively raises the temperature in some well
circumscribed areas.
It is an efficient deep heating modality.
Most of the heat generated by ultrasound is due to
volume heating rather than structural heating.
Ultrasound used for therapeutic purpose has a
frequency of about 0.8-1 MHz and an intensity of
0.5-3 w/cm2.
51. “Physiotherapy for improving mouth opening & tongue
protrusion in patients with Oral Submucous Fibrosis
(OSMF) – Case Series.”
15 cases were treated with Ultrasound therapy, intensity
from 0.7- 1.5 W/cm2 consecutively for 6 days/week for 2
weeks.
The mean improvement in mouth opening was 6.26 mm &
reducing their intensity of burning sensation.
Vijayakumar M, Priya D. Intl J Pharmaceu Sci & Health
Care. 2013: 2(3); 50-57.
52. TREATMENT
Micronutrients and
minerals
TREATMENT DETAILS
Milk from immunized
cows
Vitamin A, B complex, C, D
and E, Fe, Cu, Ca, Zn, Mg, Se
& others
45g milk powder twice a day
for 3 months
Lycopene
8mg twice a day for 2 months
Pentoxyfilline
400mg 3 times a day for 7
months
Intralesional inj (0.01-10U/mL)
3 times a day for 6 months
Submucosal inj twice a week in
multiple sites for 3 months
Interferon gamma
Steroids
Auluck A, Rosin MP, Zhang L, Sumanth KN. Oral submucous fibrosis: a
clinically benign but potentially malignant disease: Report of 3 cases and
review of literature. J Can Dent Assoc 2008; 74; 735-740.
53. TREATMENT
TREATMENT DETAILS
Hyalase +
dexamethasone
Placental extracts
Turmeric
Chymotrypsin,
hyaluronidase and
dexamethasone
Alcoholic extracts of turmeric
(3g), turmeric oil (600 mg),
turmeric oleoresin (600 mg)
daily for 3 months
Chymotrypsin (5000 IU),
hyaluronidase (1500 IU) and
dexamethasone (4 mg), twice
weekly submucosal injections
for 10 weeks
Auluck A, Rosin MP, Zhang L, Sumanth KN. Oral submucous fibrosis: a
clinically benign but potentially malignant disease: Report of 3 cases and
review of literature. J Can Dent Assoc 2008; 74; 735-740.
54. SURGICAL TREATMENT
Simple excision of the fibrous bands.
Split-thickness skin grafting following bilateral temporalis
myotomy or coronoidectomy.
Nasolabial flaps & lingual pedicle flaps.
Surgery to create flaps is performed only in subjects in
whom tongue is not involved.
CO2 –LASER surgery offers advantage in alleviating the
functional restriction.
Cryosurgery- Liquid Nitrogen or Argon gas used preferably
as sprays through „cryoprobe‟ guided by MRI/USG. The
frozen tissue thaws & is either naturally absorbed by the
body or dissolves & forms a scab.
55. “The only way to keep
your health is to eat what you
don’t want, drink what you
don’t like and do what you’d
rather not.”