Peripheral ossifying fibroma (POF) is a non-neoplastic enlargement of the gingival, which is one of the main
benign, reactive hyperplastic inflammatory lesions of the gingiva occurring in young adults. It has a very high
recurrence rate of around 7-45%. For this reason, a longer patient follow-up is very important in POF. Peripheral
ossifying fibroma comprises about 9% of all gingival growths. POF has similar clinical presentations with different
lesions which makes it difficult to reach at a correct diagnosis. In this article, we are reporting a case of peripheral ossifying fibroma (POF) in a 16-year-old female patient.
Key Words: Fibrous hyperplasia, Peripheral ossifying fibroma,
Peripheral Ossifying Fibroma-A case report with Cone Beam CT featuresiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Peripheral Ossifying Fibroma: A Case Reportiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Periodontitis is a chronic, slowly progressing disease which mainly results in the destruction of tooth supporting apparatus. Earlier it was classified as Chronic and Aggressive periodontitis with different clinical features and etiology. Current classification ( 2017) of periodontal disease involves periodontitis with is further divided into 4 stages and 3 grades depending on severity and rate of disease progression respectively. Diabetes meelitus and smoking are the validated risk factors for the progression of periodontitis.
A detailed description about endo perio interrelationship, including introduction, development and etiology, historical aspects, definition, classification, diagnosis, differential diagnosis, management, special consideration in management,controversies prognosis, conclusion.
Peripheral ossifying fibroma (POF) is a non-neoplastic enlargement of the gingival, which is one of the main
benign, reactive hyperplastic inflammatory lesions of the gingiva occurring in young adults. It has a very high
recurrence rate of around 7-45%. For this reason, a longer patient follow-up is very important in POF. Peripheral
ossifying fibroma comprises about 9% of all gingival growths. POF has similar clinical presentations with different
lesions which makes it difficult to reach at a correct diagnosis. In this article, we are reporting a case of peripheral ossifying fibroma (POF) in a 16-year-old female patient.
Key Words: Fibrous hyperplasia, Peripheral ossifying fibroma,
Peripheral Ossifying Fibroma-A case report with Cone Beam CT featuresiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Peripheral Ossifying Fibroma: A Case Reportiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Periodontitis is a chronic, slowly progressing disease which mainly results in the destruction of tooth supporting apparatus. Earlier it was classified as Chronic and Aggressive periodontitis with different clinical features and etiology. Current classification ( 2017) of periodontal disease involves periodontitis with is further divided into 4 stages and 3 grades depending on severity and rate of disease progression respectively. Diabetes meelitus and smoking are the validated risk factors for the progression of periodontitis.
A detailed description about endo perio interrelationship, including introduction, development and etiology, historical aspects, definition, classification, diagnosis, differential diagnosis, management, special consideration in management,controversies prognosis, conclusion.
Endo perio interrelation /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Case history is one of the most important step before planning and starting patient's treatment. It gives an overall picture of the patient's current and past dental status and his attitude towards treatment outcomes. It also gives the clinician the idea about the affordibility of the patient for the treatment so that alternate treatment options can be provided. It creates a initial good rapport between the clinician and the patient.
Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. It is no more a separate entity, as earlier it had Aggressive periodontitis as a differential diagnosis. According to the New Classification from the 2017 World Workshop on Periodontal and Peri- Implant Disease and Conditions, it is now classified further into stages and grades under Periodontitis.
Endo perio lesions /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
ENDO-PERIO LESION: DIAGNOSIS, PROGNOSIS AND DECISION-MAKING. Antonio Bonaccor...Anubhuti Singh
Presence of tooth with simultaneous lesions of endodontic and periodontal origin is a challenge to clinician as far as
Such infections are typically polimicrobial and therefore, interactions, both antagonistic and synergistic, between different strains and species would be expected
Combined endodontic periodontic treatment of a palatal groove/ dental implant...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Endo perio interrelation /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Case history is one of the most important step before planning and starting patient's treatment. It gives an overall picture of the patient's current and past dental status and his attitude towards treatment outcomes. It also gives the clinician the idea about the affordibility of the patient for the treatment so that alternate treatment options can be provided. It creates a initial good rapport between the clinician and the patient.
Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. It is no more a separate entity, as earlier it had Aggressive periodontitis as a differential diagnosis. According to the New Classification from the 2017 World Workshop on Periodontal and Peri- Implant Disease and Conditions, it is now classified further into stages and grades under Periodontitis.
Endo perio lesions /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
ENDO-PERIO LESION: DIAGNOSIS, PROGNOSIS AND DECISION-MAKING. Antonio Bonaccor...Anubhuti Singh
Presence of tooth with simultaneous lesions of endodontic and periodontal origin is a challenge to clinician as far as
Such infections are typically polimicrobial and therefore, interactions, both antagonistic and synergistic, between different strains and species would be expected
Combined endodontic periodontic treatment of a palatal groove/ dental implant...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
It is a planned professional conversation that enables the patient to communicate their symptoms , feeling and fear to the clinician, so that the nature of the patient’s real and suspected illness and mental attitudes may be determined.
Epithelial-Mesenchymal Transition: At the Crossroads of Development and Tumor...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Advanced Treatment of Oral Submucous Fibrosis by Dr. Amit T. SuryawanshiAll Good Things
This presentation is created by Face Art International Cosmetic Super speciality for “Patient education purpose”. This presentation is presented by Dr. Amit T. Suryawanshi (Oral & Maxillofacial plastic Surgeon, Dental Surgeon & Hair Transplant Specialist from University of Greifswald, Germany) at National & International level in the field of above mentioned Specialities. Hope this would somehow be helpful to you while making your presentations. All the best & your replies will be welcomed! Follow us for Future Journey towards betterment of Humanity.
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.
Contact us -
Email- amitsuryawanshi999@gmail.com
Cell phone- +91 9405622455
Face Art International Clinic Landline- +91 7758976097
For International Patients - Dial country code of India (+91)
Visit us at www.faceart-clinic.com for more information.
This trial aimed to evaluate the efficacy and safety of vitamin D supplementation on the residual moderate and deep pockets following nonsurgical periodontal therapy.
Abstract—This study was aimed to present a case report of a case of peripheral ossifying fibroma which is a rare case. This case was a 30 years non smoker male with the chief complaint of growth of gum tissue, moderately large in the mandibular posterior region. On intraoral examination, a peduncalated growth of 17 x 12 x 6 mm on marginal and attached gingiva with respect to tooth number 47 considerably hard in consistency and movable was seen. The lesion was erythmatous having a smooth non ulcerated surface. It was asymptomatic with no sign of pain. Intra oral periapical radiograph was taken which revealed slight erosion of crest of bone which was later confirmed during surgical excision. The possible reason of crestal bone erosion may be constant pressure of the growth. Differential diagnosis of irritation fibroma, pyogenic granuloma and peripheral giant cell granuloma was considered. However, clinical appearance and consistency was of a hard fibrous growth, which therefore led to a provisional diagnosis of peripheral ossifying fibroma or peripheral odontogenic fibroma.
Similar to Pentoxifylline therapy in the management of oral submucous (20)
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
Pentoxifylline therapy in the management of oral submucous
1.
2. INTRODUCTION
Oral submucous fibrosis is a common premalignant condition in the Indian
subcontinent.
It is caused by chewing areca nut and other irritants in various forms.
It is characterized by the progressive build up of constricting bands of
collagen in the cheeks and adjacent structures of the mouth which can
severely restrict mouth opening and tongue movement.
It also cause problems with speech and swallowing.
Its medical treatment is not yet fully standardized. In this study we compared
the efficacy of Pentoxifylline to placebo.
Aziz SR (2009). Lack of reliable evidence for oral submucous fibrosis treatments.
Evid Based Dent, 10, 8-9.
Fedorowicz Z, Chan Shih-Yen E, et al (2008). Interventions for the anagement of
oral submucous fibrosis. Cochrane Database Syst Rev, 4, CD007156.
3. Oral submucous fibrosis (OSF) is a chronic and potentially
malignant condition of the oral cavity. It is characterized by a
juxtraepithelial inflammatory reaction followed by
fibroelastic changes in the lamina propria and associated
epithelial atrophy. The disease affects most part of the oral
cavity as well as the upper third of the esophagus.
Areca nut, incriminated in the causation of OSF is often
wrapped in the leaf of a tropical creeper, Piper betle L.
commonly known as the betel leaf or paan The usage of
paan is widespread in the Indian subcontinent, mostly in the
Hindi speaking heartland of North and Central India.
Tilakratne WM, Klinikowski MF, Saku T, Peters TJ, Warnakulasuriya S. Oral submucous
fibrosis: Review on aetiology and pathogenesis. Oral Oncol. 2005;30:30–32.
4.
5. Jayavelu P., Medical Treatment Modalities of Oral Submucous
Fibrosis,NJIRM,2012,VOL 3(1)147-151
Clinical Grading: Grade I: Presence of only blanching of oral mucosa
without symptoms.
Grade II: Presence of blanching and burning sensation, dryness of the
mouth, Vesicles or ulcers in the mouth.
Grade III: Presence of blanching and burning sensation, dryness of the
mouth, vesicles or ulcers in the mouth with restriction of mouth opening
and palpable bands all over the mouth without tongue involvement.
Grade IV: Presence of blanching and burning sensation, dryness, of the
mouth, vesicles or ulcers in the mouth with restriction of mouth opening
and palpable bands all over the mouth with tongue involvement.
Grade V: Presence of all features of grade IV associated with chronic Ulcer
and histopathological proven carcinoma.
6. The assessment of blanching based on colour of mucosa:
Score
(0): Normal Pink colour Score
(1): Red or deep Pink colour Score
(2): Pale white colour Score
(3): Blanched white colour
7. The assessment of presence and absence of burning sensation: Score
(0): No burning sensation Score (1): Mild burning sensation Score
(2): Moderate Burning sensation Score
(3): Severe burning sensation.
The assessment of inter incisal distance (Mouth opening) grades:
Grade I : Mouth opening 36 mm (or) above
Grade II : Mouth opening 26 mm to 35 mm
Grade III: Mouth opening 16 mm to 25 mm Grade
IV: Mouth opening 6 mm to 15 mm
The assessment of tongue protrusion was based on the following grades:
Grade I : Beyond the border of Lower Lip.
Grade II : Within the Vermilion border of Lower Lip.
Grade III: Up to the incisal third of lower mandibular anteriors.
Grade IV: Cannot protrude, tongue within the floor of mouth
8. Treatment options include iron and multivitamin supplements including
lycopene - an extract of tomato,
and a range of medicines
e.g. intralesional injection of steroids,
hyaluronidase,
human placenta extracts,
chemotrypsin,
Pentoxifylline and collagenase.
Laser ablation and surgery, including cutting of the fibrous bands of the
jaw muscles and temporomandibular joint, has been used for more
extreme cases.
Mehrotra R, Chaudhary A, Pandya S, et al (2010). Correlation of addictive
factors, human papilloma virus infection and histopathology of oral submucous
fibrosis. J Oral Pathol Med, 39, 460-464
11. Pentoxyphylline/oxypentifylline
Pentoxifylline is a tri-substituted methylxanthine derivative, the biologic
activities of which are numerous.
It is termed as a “Rheologic modifier.”
It improves microcirculation and decreases platelet aggregation as well as
granulocyte adhesion.
It increases leukocyte deformability as well as inhibits neutrophil adhesion
and activation.
The medication also has antithrombin, antiplasmin activities and fibrinolytic
activity.
In addition, it causes degranulation of neutrophils, promotes natural killer cell
activity and inhibits T-cell and B-cell activation.
Samlaska CP, Winfield EA (1994). Pentoxifylline. J Am Acad Dermatol, 30, 603-21
12. Pentoxyphylline/oxypentifylline
An analogue to theophylline and a phosphodiesterase inhibitor,
It increases blood flow in ischaemic areas by reducing whole blood viscocity
and by increasing flexibility of RBCs
Well tolerated
Other indications- stroke, non-cerebrovascular insufficiency, transient
ischaemic attack, trophic leg ulcers, gangrene, non haemorrhagic stroke
Side effects – nausea, vomitting, dyspepsia, bloating
Dose- 400mg BD-TDS,
TRENTAL-400,
FLEXITAL-400mg SR tab,
300 mg/15 ml for slow i.v. inj
KD Tripathi Medical Pharmacology, 4th edi.- 537
14. Placebo/dummy medication
Latin word-’I SHALL PLEASE’
This is an innert substance which is given in the garb of medicine.
Limited role in practical therapeutics.
It works by psychological rather than pharmacological means and
often produces responses equivalent to the active drug.
Placebo reactors-individual easily responding to placebo
Used as a control device in clinical trials of drugs
To treat a patient who does not require active drug.
It induces physiologic responses like they can release endorphins in
brain causing analgesia.
Common placebo- lactose tablets
Distilled water inj.
KD Tripathi Medical Pharmacology, 4th edi.- 63-64
15. Pure- phrmacologically inert like lactose tab.
Impure- pharmacologic activity
Effective in treating the subjective responses
[pain of angina, cancer,headache and surgical wounds]
Therapeutic responses to placebo and to active drugs
may resemble to each other in magnitude and
duration.eg-pain relief and cough suppression afforded by
a placebo may parallel that of codeine
Side effects-nausia, drowsiness, sweating, xerostomia
1/3rd patient reacts to placebo
John A,,Enid A,pharmacology and therapeutics for Dentistry4th edi.46- 47
16. There are few controlled clinical trials in this area.
A comparative study was planned to assess the usefulness of
Pentoxifylline versus placebo in the treatment of OSMF.
Rajendran R, Rani V, Shaikh S (2006). Pentoxifylline therapy: A new adjunct in
the treatment of oral submucous fibrosis. Indian J Dent Res, 17, 190-98
17. Patients, 18 years of age and older, were enrolled in the study and written
consent was obtained.
Patients who had difficulty in chewing, had restricted mouth opening with the
presence of fibrous bands and had a histopatho-logically confirmed diagnosis of
OSMF were included.
Patients who refused scalpel biopsy as well as those with medical problems or
dental appliances such as orthodontic or other fixed prostheses that could
potentially interfere with the examination were not included in the study.
75 patients were enrolled in the study and out of these 62 patients came for
regular followup and took regular treatment, thus 13 patients were excluded.
All patients were examined with a conventional overhead examination light and
then divided randomly into the drug or placebo groups.
18. The demographic information of each patient,including age, gender and
history of tobacco use was obtained.
Detailed clinical examination was performed on each patient to assess the
site/size of the oral mucosal lesions and this was recorded on a standard
form.
All routine investigations including pre-treatment biopsy for confirmation of
histological diagnosis were done.
Biopsy samples, obtained under local anesthesia using the standard scalpel
technique, were analyzed by two pathologists who were blinded to the
clinical data.
Clinical assessment of maximal jaw opening was carried out monthly and
outcomes were expressed by measured change in the inter-incisor distance.
19. Group A (n=30) patients were given placebo (multivitamin) therapy.
Group B (n=32) patients were given Tab. Pentoxifylline 400 mg for a period of
7 mnths.
The drug Pentoxifylline was administered as an inductive regime for the initial
30 days at a reduced dosage of 2 tablets daily and then the dose was hiked to
3 tablets daily for 6 more months as per previous studies
20. Primary outcomes included:
(1) Resumption of normal eating, chewing and speech.
(2) Change or improvement in maximal jaw opening, measured
by the interincisal distance.
Secondary outcomes included
(1) Discomfort or pain as a result of the intervention: patient-
assessment using a validated pain scale.
(2) Hospital admission: length of stay.
(3) Quality of life and patient satisfaction as assessed by a
validated questionnaire.
21. Subjective improvement in symptoms:
1) Burning sensation in mouth;
2) Repeated vesiculation/ ulceration in oral mucosa;
3) Resumption of normal eating, chewing and speech.
Objective improvement in signs:
1) Trismus;
2) Ankyloglossia;
3) Vesicles/ Ulcers;
4) Fibrosis
22. Clinical follow-up of all the patients was carried out for 18
months and the findings were compared pre and post-
treatment.
Side effects of treatment, if any, were also investigated.
23. Results
37% of the patients - third decade
22%- second decade
20%-fourth decade of life.
The youngest patient seen was 16 years and the oldest was 70 years old.
The mean age of presentation was 35.1 years.
Male to female ratio was 4.29: 1.
Males - age group of 21 – 30 years,
Females - 41-50 years.
64% - habit of using panmasala or dohra (mixture of tobacco and slaked lime
– sold locally),
20% patients used pan masala or dohra with betel quid,
7% patients used betel quid with tobacco
6% - smokers.
24. Those who chewed areca nut in any form were habituated to 1 to
20 chews per day, (median 6.0) for a period of 1 to 25 years
(median 6 years).
Fibrosis was present in all patients.
The soft palate was involved in 100% of patients
buccal mucosa in 90%- unilateral-10%, bilateral-80%,
Retromolar trigone in 90% -unilateral-28%, bilateral-62%,
anterior faucial pillar in 80%- unilateral-16%, bilateral-62%,
Floor of mouth in 24 %, and tongue in 20% of patients
The participants did not complain of any discomfort or pain due to
therapy, nor were any of them admitted to the hospital.
The participants’ compliance was 62/75 (82%) for drug treatment.
25. Symptoms Group A Group B
1.Burning sensation
2.Vesicle/ulcer formation improvement
3.Total sign score
4.Mean improvement in trismus
5.Total symptom score
6.Mouth opening
7.Ankyloglossia
8.Fibrotic bands
9. Total Sign+symptom score
39.4%
35.5%
19.9%
15.4%
38.2%
6mm
22.6%
19.5%
25%
86.6%
84.1%
38.5%
35.7%
85.8%
10mm
39.3%
32.9%
49.2%
26. The difference between the group A and group B proved to be statistically
significant (p< 0.05) in total (i.e. symptom +sign) score.
16/32 patients in the treatment group came for long term (18months) follow-up
and revealed stable progress with none of them going back to chewing habits.
These symptoms were relatively mild in nature, lasted for 1-2 weeks and settled
on their own without cessation of drug or requiring medication.
Side effects Group A Group B
1.Dyspepsia & nausia
2.Bloating & flatus
3.Headache, vomitting, anxiety,remors
No side effects 24%
18%
2%
27. Discussion
Treatment for OSMF remains a challenge. It is said that once the disease has
developed, there is neither regression nor any effective treatment.
Consequently, improved oral opening and relief of symptoms form the main
objectives of treatment.
In general, the management modalities can be categorized into conservative
and surgical.
Aziz SR (2009). Lack of reliable evidence for oral submucous fibrosis treatments. Evid
Based Dent, 10, 8-9.
Jiang X, Hu J (2009). Drug treatment of oral submucous fibrosis: a review of the
literature. J Oral Maxillofac Surg, 67, 1510-1515
28. A recent study from the author’s group recommended the use of combination
of triamcinolone acetonide (10 mg/ ml)/ hyaluronidase (1500 IU) at 15 days
interval for 22 weeks.
This was more convenient to the patients because it required only weekly
injections, less daily dosing, better patients compliance, and improvement in
the sign score. (trismus, ankyloglossia, vesicle formation and fibrosis)
Singh M, Niranjan HS, Mehrotra R, et al (2010). Efficacy of hydrocortisone
acetate/ hyaluronidase versus triamcinolone acetonide/ hyaluronidase in the
treatment of oral submucous fibrosis. Indian J Med Res, 131, 659-669.
29. On the other hand, an earlier cochrane review on this subject
concluded that the paucity of data and poor methodological
quality of studies indicated a lack of reliable evidence for the
effectiveness of any specific interventions for the management
of this disease
Fedorowicz Z, Chan Shih-Yen E, et al (2008). Interventions for the management of
oral submucous fibrosis. Cochrane Database Syst Rev, 4, CD007156.
31. Fedorowicz Z, Chan Shih-Yen E, et al (2008). Interventions for the management of
oral submucous fibrosis. Cochrane Database Syst Rev, 4, CD007156
This article provides a basic review of OSF and focuses on nonsurgical
management.
OSF is an insidious disease affecting the oral cavity, pharynx and upper
digestive tract.
Its aetiology is directly linked to betel nut usage, which is common to
the Indian subcontinent, Far East and Pacific Rim. Betel nut usage is
thought to be the primary cause of the condition.
OSF's morbidity and mortality is associated with significant masticatory
dysfunction (trismus) and an increased risk of developing squamous
cell carcinoma, with a malignant transformation rate of 7–30%.
32. Indian studies indicate that over 5 million people in India suffer from
OSF (0.5% of the population of India).
It is estimated that, in addition, up to 20% of the world's population
use betel nut is some form, so the incidence of OSF is probably higher
than figures in the published literature suggest.
Currently, OSF is considered a public health issue in the Indian
subcontinent, UK and South Africa.
With the migration of peoples of the Indian subcontinent to all corners
of the world, the general practitioner will certainly encounter this
disorder at some point of their career.
33. In this review, Fedorowicz and colleagues did not identify any
randomised controlled trials of surgical procedures.
Only two studies examining nonsurgical treatment of OSF. One study
used lycopene in conjunction with intralesional injections of a
steroid, and the other pentoxifylline in combination with mouth-
stretching exercises and heat, and the review authors note that both
trials provided unreliable results.
The lack of good quality trials of medical and surgical procedures for
OSF is disappointing but unsurprising given that the largest burden of
this disease is found in under-resourced countries
34. Pandya S, Chaudhary AK, M Singh, et al (2009). Correlation of histo
pathological diagnosis with habits and clinical findings in oral sub-
mucous fibrosis. Head Neck Oncol, 1, 10.
Two hundred and thirty nine patients were studied, yielding a male
to female ratio of 6.8:1. Maximum patients were in the 21–30 years
age group with a marked male predominance.
Of these, 197 (82.4%) patients chewed areca nut/dohra, 14 (5.8%)
were smokers and 2 (0.8%) patients were habituated to alcohol.
89(37.2%) patients reported difficulty in opening of the mouth
(trismus). 51 (57.4%) patients were found to have stage II (2–3 cm)
trismus while rest had stage I and III.
The buccal mucosa was found to be the most commonly involved
site. On the basis of histopathological examination, 52(21.7%) were
classified as OSF grade I, 75(31.3%) patients as grade II and
112(46.8%) had grade III disease.
35. The widespread habit of chewing dohra/paan masala is a major
risk factor of OSF, especially in the younger age group.
In this study, an increase in histopathological grading was found
with severity and duration of addiction habit. However no
significant correlation was found between clinical staging and
histopathological grading.
36. Jiang X, Hu J (2009). Drug treatment of oral submucous fibrosis: a
review of the literature. J Oral Maxillofac Surg, 67, 1510-1515
Buccal mucosa was found the most commonly involved site in 66(20.8%) patients
followed by palate 37(17.7%) and the retromolar area 22(14.7%). Previous
reports also corroborated these findings. In this study, none of the patients were
reported with involvement of the larynx, pharynx or the esophagus.
Clinically, trismus is an important symptom of OSF.
In this study, 89 (37.2%) patients were found to have trismus of which, 16
(17.9%) had stage I, 51(57.3%) patients had stage II trismus followed by 22
(24.7%) of stage III.
He also reported that 75% males and 80% females with OSF patients had stage II
disease and suggested that this could be due to the fact that the majority of the
patients reported for treatment only after the onset of restriction in their ability
to open their mouths.
37. Rajendran R, Rani V, Shaikh S (2006). Pentoxifylline therapy: A new adjunct in the
treatment of oral submucous fibrosis. Indian J Dent Res, 17, 190-98
Rajendren et al reported that Pentoxifylline as an adjunct in OSMF
treatment and after 7 months trial and 6-12 months follow-up, the
patients showed improvement in signs and symptoms as compared
to controls.
They reported significant improvement in patients in the
experimental group as compared to patients in the control group.
There was improvement in objective criteria of mouth
opening, tongue protrusion, and relief from perioral fibrotic bands
and subjective symptoms of intolerance to spices, burning
sensation of mouth, tinnitus, difficulty in swallowing and difficulty
in speech with Pentoxifylline as compared to placebo.
All patients also received local heat therapy and underwentforceful
mouth stretching exercises