This document summarizes a study comparing the efficacy of pentoxifylline to placebo in the treatment of oral submucous fibrosis (OSF). OSF is a premalignant condition characterized by fibrosis of the oral cavity and restricted mouth opening. The study included 62 patients with OSF who were randomly assigned to receive either pentoxifylline or a placebo for 7 months. Outcomes including symptoms, mouth opening, and fibrosis were assessed. The results showed greater improvement in symptoms and signs for the pentoxifylline group compared to the placebo group, with few side effects reported. The study concluded that pentoxifylline may be an effective treatment for OSF.
Antibiotics used in dentistry
Terminologies
History
Classification of antibiotics
Principles of antibiotics use
Commonly used antibiotics
Drug interaction
Drug combination
Antibiotic resistance
Summary
Dental Management Of Patient With Thalassemia.pptxIbrahim Muneim
this seminar prepared by me to help and inform the reader more about dental management of patient with thalassemia in clinical work
thank you for your time and reading my paper
Antibiotics used in dentistry
Terminologies
History
Classification of antibiotics
Principles of antibiotics use
Commonly used antibiotics
Drug interaction
Drug combination
Antibiotic resistance
Summary
Dental Management Of Patient With Thalassemia.pptxIbrahim Muneim
this seminar prepared by me to help and inform the reader more about dental management of patient with thalassemia in clinical work
thank you for your time and reading my paper
A PowerPoint presentation on "NSAIDS" suitable for reading by UG and PG Medical/Paramedical students of Pharmacology and Pharmacy sciences. This Ppt. is prepared for academic purpose only and already presented to my students in one of the theory classes of mine.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
AIDS is defined as a condition indicative of a defect in cell-mediated immunity occurring in a person with no known cause for immunodeficiency other than the presence of HIV.
CDC defined AIDS as
“The occurrence of one or more group of life-threatening opportunistic infections, malignancies, neurologic diseases and other specific illness in patients with HIV infection or with CD4 counts less than 200/cu mm”
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.
A PowerPoint presentation on "NSAIDS" suitable for reading by UG and PG Medical/Paramedical students of Pharmacology and Pharmacy sciences. This Ppt. is prepared for academic purpose only and already presented to my students in one of the theory classes of mine.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
AIDS is defined as a condition indicative of a defect in cell-mediated immunity occurring in a person with no known cause for immunodeficiency other than the presence of HIV.
CDC defined AIDS as
“The occurrence of one or more group of life-threatening opportunistic infections, malignancies, neurologic diseases and other specific illness in patients with HIV infection or with CD4 counts less than 200/cu mm”
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.
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 All Good Things
Advanced Treatment of Oral Submucous Fibrosis by Dr. Amit T. Suryawanshi (MDS). We have mentioned all advanced treatments according to International standards and protocols needed for Oral Submucous Fibrosis.
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.
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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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,
LSTR 3mix MP important efficacy particularly antibacterial and periapical le...Dr.Aklaqur Rahman Chayon
Author:-
Dr Nurjahan Afsary
BDS(DU),Post graduation training in
Conservative dentistry.Dhaka dental College.
Consultant dental surgeon at AR DENTAL Maxillofacial care Research and training center ,N oral health and dental care.
Co-author:-
Dr Aklaqur Rahman BDS(Dhaka dental College)
LSTR 3mix MP important efficacy particularly antibacterial and periapical lesions during conservative treatment in the dentistry like RCT and other endodontics management;Case Studies
Dystonia is the manifestation of involuntary lasting severe muscle contractions, which lead to rhythmic and atypical movements in different parts of the body. Dystonia is the most common movement disorder next to Parkinson’s disease (PD) and essential tremor (ET). Oro Mandibular Dystonia (OMD) is considered as a focal dystonia involving mouth, jaw, and tongue, manifested by involuntary muscle contractions producing repetitive, patterned movements of the involved structures. The diagnosis of OMD is purely clinical and is to be differentiated thoroughly from the conditions mimicking the signs. Since it presents in various forms and severities it further renders the management a multidisciplinary approach with variable treatment outcomes. The following is a clinical diagnostic case report of oromandibualar dystonia with presenting signs and symptoms, history and examination characteristic of the condition.
Dystonia is the manifestation of involuntary lasting severe muscle contractions, which lead to rhythmic and atypical movements in different parts of the body. Dystonia is the most common movement disorder next to Parkinson’s disease (PD) and essential tremor (ET). Oro Mandibular Dystonia (OMD) is considered as a focal dystonia involving mouth, jaw, and tongue, manifested by involuntary muscle contractions producing repetitive, patterned movements of the involved structures. The diagnosis of OMD is purely clinical and is to be differentiated thoroughly from the conditions mimicking the signs. Since it presents in various forms and severities it further renders the management a multidisciplinary approach with variable treatment outcomes. The following is a clinical diagnostic case report of oromandibualar dystonia with presenting signs and symptoms, history and examination characteristic of the condition
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.
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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!
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Pentoxifylline therapy in the management of oral submucous
1.
2. INTRODUCTION
Oral submucous fibrosis is a common premalignant condition in the Indian
subcontinent.
According to ‘sushruta’[600 BC]- vidhari
Schwartz[1952]- atropica idiopathic mucosae oris
Also called as idiopathic scleroderma of mouth and idiopathic palatal fibrosis
or sclerosing stomatitis.
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 OSMF 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 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
8. 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.
Malignant transformation of OSMF is 7- 13% and the incidence
over a 10 yr period is approximately 8%.
9. 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
12. 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
13. 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
15. 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
16. 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
17. 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
18. 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.
19. 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.
20. 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
21. 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.
22. 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
23. 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.
24. 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.
25. 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.
26. 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%
27. 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%
28. 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
29. 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.
30. 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.
32. 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%.
33. 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.
34. 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
35. 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.
36. 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.
37. 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.
38. 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