Management Strategies for Oral Submucous Fibrosis- An Update

There are plentiful management trials in Oral Submucous Fibrosis (OSMF), such as drugs, herbs, and Chinese medicines, but none proved to be entirely successful. So in this review, there are different management strategies tried in the management of OSMF, mechanism of action, and the dosage regimen.


INTRODUCTION
Oral submucous fibrosis (OSMF) is a chronic disease associated with significant functional morbidity and an increased risk for malignancy. OSMF predominantly affects the Asian population and Asian migrants living in other parts of the World [1].
But in most of the research the management of OSMF was based on Clinical, Histopathological and fuctional staging proposed by several authors [2]. Collagenase [17] once a week for 6 weeks 1 ml of collagenase (1% solution) mixed with 1 ml of xylocaine Intralesional

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Borneol [18] Anti-fibrosis activity inhibits fibroblasts mitosis, collagen, and TIMP-1 production and can be used as a penetration enhancer [18]. Nylidrin hydrochloride [19] Nylidrin relaxes and dilates the blood vessel ensures more excellent blood supply to ischemic tissues with little or no change in the blood pressure and heart rate [19].
3 times daily for 7 months 400mg Oral

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Buflomedial hydrochloride [21] The mechanism is through vasodilation, mild anticoagulant properties, immune modulation, and antioxidant properties have been reported [1]. Immune milk [25] It contains a highly active antiinflammatory compound that suppressed the experimentally induced inflammation in animal models. Gold, Iodine and Arsenotyphoid [31] With the surgical cutting of bands, Large Internal doses and Injection respectively 29. Glucosidorum tripterygii totorum, vitamin A and E, nicotinic acid [32] The main action is by eliminating the deficiency status and normalizes the cellular activity to prevent pathological mechanisms like carcinogenesis [1].

Habit Counseling
The first and foremost treatment plan in OSMF is strict discontinuance of habit with motivation and intense councelling session for educating and creating awareness about the disease and its malignant potential [5].

Basic Regimen
The second line of approach for the management of OSMF is the nutritional supplementation like Vitamins and Iron. It has been observed in a study that majority of the OSMF patients has Vitamin B12 and Iron deficiency due to inability to eat [6].

Medical Management
The management of OSMF has significant challenges for treatment options. Even Though several options are available still an established treatment regimen is lacking. So such treatment options available are discussed in

Physiotherapy
Physiotherapy over the affected area to generate heat and mouth opening has been tried. A study in 2009 conducted on Fifty-four Nepali OSMF patients was managed for four months by randomly assigning them to 3 groups. The first group of patients in the physiotherapy group were asked to do jaw exercises five times a day in which tongue spatulas were placed passively between anterior teeth, spatula number determined by comfortable mouth opening. An extra spatula was added every fifth day, but the spatula was tried on the tenth day in case of pain. The patient was subjected to analgesics 30 minutes before exercise to reduce the pain. The second group was treated with local injection of steroids, and the third group received no active treatment.
The patients subjected to physiotherapy improved mouth opening compared to the other two groups [37].

Surgical Treatment
This form of modality is usually suggested during the severe form of OSMF and when the other forms of modality are unsuccessful. The common method of excision is scalpel which is considered to be the preparatory step for surgical treatment. Different surgical procedures tried are intraoral (tongue, palate, buccal fat pad), extraoral (temporal fascia, nasolabial), distant flaps, grafts, muscle myotomies and oral stents etc. Further a systematic review stated that the choice of procedure depends on the operator. [38].

Laser
A systematic review by Gondivkar SM et al. from various databases found that studies with Laser were used for stage II and III OSMF patients. Even though different Laser types and parameters were considered, all studies showed improvement in mouth opening ranging between 6.84mm to 23.7mm. Further two studies showed improvement in tongue protrusion, check flexibility, and reduction in burning sensation [39].

CONCLUSION
The treatment of OSMF is still not satisfactory. Therefore, further clinical trials with newer modalities and combinations are required to manage this potentially malignant disorder and to prevent its malignant transformation.

CONSENT
It is not applicable.

ETHICAL APPROVAL
As per international standard or university standard ethical approval has been collected and preserved by the authors.