Dr Jay Deshmukh:- Oral submucous fibrosis is a disease of the oral cavity. It is a chronic debilitating condition that results in chronic inflammation and progressive fibrosis of the submucosal tissues. Oral submucous fibrosis results in marked rigidity of the oral cavity and ultimately inability to open the mouth. The buccal mucosa is the most commonly involved site, but any part of the oral cavity including the pharynx can be involved.
Why is it important to know about submucous fibrosis?
- This is a totally preventable disease. Besides this, it has enormous malignant potential. It is associated with Areca nut chewing. Betel nut chewing is very common in South East Asia and particularly in India. The habit of betel nut chewing in India dates back to thousands of years. A combination of betel nut, betel leaf, tobacco, slaked lime and some other components form a deadly mixture. This predisposes to submucous fibrosis and is particularly a pre-cancer condition.
What are the other ingredients and nomenclature of betel quid?
- Pan, Gutka, Pan masala, Pan Parag, Mawa, Kharra and Manipuri tobacco are prominent nomenclatures. All these can cause submucous fibrosis and their chronic consumption should be strictly avoided as this can lead to cancer.
What are the major symptoms of submucous fibrosis?
- Dr Jay Deshmukh:- Progressive inability to open the mouth due to oral fibrosis and scarring is quite common. Burning sensation in the mouth and severe pain on the consumption of spicy food is common. Excessive salivation, change of taste, hearing loss, dryness of mouth, nasal tone to the voice, difficulty in swallowing if the oesophagus is involved and impaired mouth movements like eating, whistling, blowing, sucking can all be affected.
What are the complications of submucous fibrosis?
- Dr Jay Deshmukh:- Oral dysplasias and squamous cell carcinomas are complications of submucous fibrosis. Risk of developing oral cancer is 8% over a 10 year period. If the palatal and paratubal muscles are involved in patients with oral submucous fibrosis, hearing loss can occur because of functional stenosis of Eustachian tube. There could be difficult during laryngoscopy and intubation of the trachea for anaesthesia. More than 25 % of individuals with submucous fibrosis develop leukoplakia which is a precancerous condition.
What is the role of ingestion of chillies?
- The role of chillies in the pathogenesis of submucous fibrosis is unclear. The incidence of submucous fibrosis in Mexico is lower despite increased dietary intake of chillies. Capsaicin in chillies is known to contribute to fibrosis in selected individuals.
What are the other promoting factors for submucous fibrosis?
- Iron deficiency anemia, vitamin B complex deficiency and malnutrition are promoting factors. The resulting atrophic oral mucosa is more susceptible to the effects of chillies and betel nuts. Some genetic factors are also responsible for submucous fibrosis.
Is there a sharp increase in the incidence of submucous fibrosis in India?
- Certainly, the incidence has increased ever since the pouches of pre-mixed tobacco and betel nuts are available. The incidence is ever rising since last decade. The incidence is high even in women from rural areas.
What are the problems faced by people with submucous fibrosis?
There is a progressive inability to open the mouth. This leads to difficulty in eating and deficiency in many nutritional factors. It can cause death as almost 8 % of individuals with submucous fibrosis can transform into oral cancer. No treatment is very effective in this condition.
How do you treat submucous fibrosis?
- There is no specific treatment. Antioxidants like some Vitamins and Zinc have been tried. Steroids in the form of ointments, gels, tablets and injections in the fibrotic areas have been tried with very limited success. Surgical intervention and laser therapy is also an important option.
Dr Jay Deshmukh:- Submucous fibrosis is a preventable disease. It is directly related to betel nut and tobacco chewing. The incidence is ever rising. Even school going children have started consuming gutkas and various pre-mixed pouches. Parents and teachers have a great responsibility for their children and students in this regard. For submucous fibrosis is a precancerous condition. One can certainly prevent it!
Author: Dr Jay Deshmukh
Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.
