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Tang J, Liu J, Zhou Z, Cui X, Tu H, Jia J, Chen B, Dai X, Liu O. Oral submucous fibrosis: pathogenesis and therapeutic approaches. Int J Oral Sci 2025; 17:8. [PMID: 39890798 PMCID: PMC11785813 DOI: 10.1038/s41368-024-00344-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 11/14/2024] [Accepted: 12/24/2024] [Indexed: 02/03/2025] Open
Abstract
Oral submucous fibrosis (OSF), characterized by excessive deposition of extracellular matrix (ECM) that causes oral mucosal tissue sclerosis, and even cancer transformation, is a chronic, progressive fibrosis disease. However, despite some advancements in recent years, no targeted antifibrotic strategies for OSF have been approved; likely because the complicated mechanisms that initiate and drive fibrosis remain to be determined. In this review, we briefly introduce the epidemiology and etiology of OSF. Then, we highlight how cell-intrinsic changes in significant structural cells can drive fibrotic response by regulating biological behaviors, secretion function, and activation of ECM-producing myofibroblasts. In addition, we also discuss the role of innate and adaptive immune cells and how they contribute to the pathogenesis of OSF. Finally, we summarize strategies to interrupt key mechanisms that cause OSF, including modulation of the ECM, inhibition of inflammation, improvement of vascular disturbance. This review will provide potential routes for developing novel anti-OSF therapeutics.
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Affiliation(s)
- Jianfei Tang
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-Maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China
| | - Junjie Liu
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-Maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China
| | - Zekun Zhou
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-Maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China
| | - Xinyan Cui
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-Maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China
| | - Hua Tu
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-Maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China
| | - Jia Jia
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-Maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China
| | - Baike Chen
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-Maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China
| | - Xiaohan Dai
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-Maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China.
| | - Ousheng Liu
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-Maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China.
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Pal S, Sharma D, Yadav NP. Plant leads for mitigation of oral submucous fibrosis: Current scenario and future prospect. Oral Dis 2024; 30:80-99. [PMID: 36565439 DOI: 10.1111/odi.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/25/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
The aim of this review is to enumerate medicinal plants and their bioactive compounds that may become potential leads in the mitigation of oral submucous fibrosis (OSMF) in the forthcoming future. It is focused on pathophysiology, risk factors, current treatment regimen, potential plant leads, and future therapies for OSMF. Data were extracted from a vast literature survey by using SciFinder, Web of Science, Google Scholar, and PubMed search engines with relevant keywords. Upon literature survey, we found that the phytochemical 'arecoline' present in the areca nut is the main causative agent of OSMF condition. Currently, OSMF is treated by immunomodulatory and anti-inflammatory agents such as corticosteroids, enzymes (hyaluronidase, chymotrypsin, and collagenase), anti-inflammatory mediators (isoxsuprine and pentoxifylline), dietary supplements (vitamins, antioxidants, and micronutrients), and anti-fibrotic cytokines like interferon-gamma that provides short-term symptomatic relief to OSMF patients. However, some plant leads have been proven effective in alleviating symptoms and mitigating OSMF, which ultimately improves the quality of OSMF patients' life. We concluded that plant drugs like lycopene, curcumin, Aloe vera, colchicine, and Glycyrrhiza glabra are effective against OSMF in various in vitro and/or clinical studies and are being used by modern and traditional practitioners.
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Affiliation(s)
- Sarita Pal
- Bioprospection and Product Development, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow, India
| | - Disha Sharma
- Bioprospection and Product Development, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow, India
| | - Narayan Prasad Yadav
- Bioprospection and Product Development, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow, India
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Jones A, Veale B, Li T, Aggarwal VR, Twigg J. Interventions for managing oral submucous fibrosis. Cochrane Database Syst Rev 2024; 2:CD007156. [PMID: 38415846 PMCID: PMC10900301 DOI: 10.1002/14651858.cd007156.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Oral submucous fibrosis (OSF) is a chronic disease of the oral cavity that causes progressive constriction of the cheeks and mouth accompanied by severe pain and reduced mouth opening. OSF has a significant impact on eating and swallowing, affecting quality of life. There is an increased risk of oral malignancy in people with OSF. The main risk factor for OSF is areca nut chewing, and the mainstay of treatment has been behavioural interventions to support habit cessation. This review is an update of a version last published in 2008. OBJECTIVES To evaluate the benefits and harms of interventions for the management of oral submucous fibrosis. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 5 September 2022. SELECTION CRITERIA We considered randomised controlled trials (RCTs) of adults with a biopsy-confirmed diagnosis of OSF treated with systemic, locally delivered or topical drugs at any dosage, duration or delivery method compared against placebo or each other. We considered surgical procedures compared against other treatments or no active intervention. We also considered other interventions such as physiotherapy, ultrasound or alternative therapies. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. participant-reported resumption of normal eating, chewing and speech; 2. change or improvement in maximal mouth opening (interincisal distance); 3. improvement in range of jaw movement; 4. change in severity of oral/mucosal burning pain/sensation; 5. ADVERSE EFFECTS Our secondary outcomes were 6. quality of life; 7. postoperative discomfort or pain as a result of the intervention; 8. participant satisfaction; 9. hospital admission; 10. direct costs of medication, hospital bed days and any associated inpatient costs for the surgical interventions. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included 30 RCTs (2176 participants) in this updated review. We assessed one study at low risk of bias, five studies at unclear risk of bias and 24 studies at high risk of bias. We found diverse interventions, which we categorised according to putative mechanism of action. We present below our main findings for the comparison 'any intervention compared with placebo or no active treatment' (though most trials included habit cessation for all participants). Results for head-to-head comparisons of active interventions are presented in full in the main review. Any intervention versus placebo or no active treatment Participant-reported resumption of normal eating, chewing and speech No studies reported this outcome. Interincisal distance Antioxidants may increase mouth opening (indicated by interincisal distance (mm)) when measured at less than three months (mean difference (MD) 3.11 mm, 95% confidence interval (CI) 0.46 to 5.77; 2 studies, 520 participants; low-certainty evidence), and probably increase mouth opening slightly at three to six months (MD 8.83 mm, 95% CI 8.22 to 9.45; 3 studies, 620 participants; moderate-certainty evidence). Antioxidants may make no difference to interincisal distance at six-month follow-up or greater (MD -1.41 mm, 95% CI -5.74 to 2.92; 1 study, 90 participants; low-certainty evidence). Pentoxifylline may increase mouth opening slightly (MD 1.80 mm, 95% CI 1.02 to 2.58; 1 study, 106 participants; low-certainty evidence). However, it should be noted that these results are all less than 10 mm, which could be considered the minimal change that is meaningful to someone with oral submucous fibrosis. The evidence was very uncertain for all other interventions compared to placebo or no active treatment (intralesional dexamethasone injections, pentoxifylline, hydrocortisone plus hyaluronidase, physiotherapy). Burning sensation Antioxidants probably reduce burning sensation visual analogue scale (VAS) scores at less than three months (MD -30.92 mm, 95% CI -31.57 to -30.27; 1 study, 400 participants; moderate-certainty evidence), at three to six months (MD -70.82 mm, 95% CI -94.39 to -47.25; 2 studies, 500 participants; moderate-certainty evidence) and at more than six months (MD -27.60 mm, 95% CI -36.21 to -18.99; 1 study, 90 participants; moderate-certainty evidence). The evidence was very uncertain for the other interventions that were compared to placebo and measured burning sensation (intralesional dexamethasone, vasodilators). Adverse effects Fifteen studies reported adverse effects as an outcome. Six of these studies found no adverse effects. One study evaluating abdominal dermal fat graft reported serious adverse effects resulting in prolonged hospital stay for 3/30 participants. There were mild and transient general adverse effects to systemic drugs, such as dyspepsia, abdominal pain and bloating, gastritis and nausea, in studies evaluating vasodilators and antioxidants in particular. AUTHORS' CONCLUSIONS We found moderate-certainty evidence that antioxidants administered systemically probably improve mouth opening slightly at three to six months and improve burning sensation VAS scores up to and beyond six months. We found only low/very low-certainty evidence for all other comparisons and outcomes. There was insufficient evidence to make an informed judgement about potential adverse effects associated with any of these treatments. There was insufficient evidence to support or refute the effectiveness of the other interventions tested. High-quality, adequately powered intervention trials with a low risk of bias that compare biologically plausible treatments for OSF are needed. It is important that relevant participant-reported outcomes are evaluated.
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Affiliation(s)
- Adam Jones
- Oral Surgery, School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Benjamin Veale
- Oral and Maxillofacial Surgery, Airedale General Hospital, Keighley, UK
| | - Tiffany Li
- Oral and Maxillofacial Surgery, Leeds Teaching Hospitals, Leeds, UK
| | - Vishal R Aggarwal
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Joshua Twigg
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Department of Restorative Dentistry, Leeds Dental Institute, Leeds, UK
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Chen X, Xie H, Guo J. Drug treatment for oral submucous fibrosis: an update. BMC Oral Health 2023; 23:748. [PMID: 37828490 PMCID: PMC10568776 DOI: 10.1186/s12903-023-03488-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE The aim of this review is to evaluate the different medicinal interventions available for the management of oral submucous fibrosis (OSF). MATERIALS AND METHODS We conducted a comprehensive electronic search on PubMed, Web of Science, and Cochrane Library databases for articles related to OSF patients treated with medications from December 2011 to September 2022. GRADE system was used to evaluate the evidence quality. The reporting of the systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The main outcomes were the improvement of maximum mouth opening, burning sensation, cheek flexibility, and tongue protrusion. RESULTS Twenty-nine randomized controlled trials (RCTs), five clinical trials (CCTs) were included, and the use of drugs for OSF treatment were evaluated. Drugs like steroids, hyaluronidase, pentoxifylline, lycopene, curcumin, dpirulina, aloe vera, omega3, oxitard, allicin, colchicine have been used. It was found that drugs with evidence high quality were salvia miltiorrhiza combined with triamcinolone acetonide, lycopene, pentoxifylline, curcumin, and aloe vera, and those with evidence moderate quality were allicin, colchicine, omega 3, and oxitard. CONCLUSION Based on the results of our comprehensive analysis, for long-term treatment, we found lycopene with low side effects, whereas for relieving the symptoms of severe burning sensation, aloe vera is the most effective. Although the recent review has made some progress, drug therapy for OSF remains unclear, and more high-quality RCTs are needed to identify better treatments for OSF.
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Affiliation(s)
- Xueru Chen
- Department of Pharmacy, Changsha Stomatological Hospital, Changsha, 410006, China
- School of Stomatology, Hunan University of Chinese Medicine, Changsha, 410006, China
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Hui Xie
- Department of Pharmacy, Changsha Stomatological Hospital, Changsha, 410006, China
- School of Stomatology, Hunan University of Chinese Medicine, Changsha, 410006, China
| | - Jincai Guo
- Department of Pharmacy, Changsha Stomatological Hospital, Changsha, 410006, China.
- School of Stomatology, Hunan University of Chinese Medicine, Changsha, 410006, China.
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, 410208, China.
- Changsha Stomatological Hospital, No. 389 Youyi road, Tianxin district Changsha, Hunan, China.
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Koul D, Arora S, Sangle A, Desai T, Inamdar ZAF. Management of Oral Sub Mucous Fibrosis Using Three Different Flaps: Superficial Temporal, Nasolabial Flap, Buccal Fat Pad Flap Along with Active Physiotherapy- A Comparative Study. Indian J Otolaryngol Head Neck Surg 2023; 75:1376-1385. [PMID: 37636608 PMCID: PMC10447861 DOI: 10.1007/s12070-022-03410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/07/2022] [Indexed: 02/16/2023] Open
Abstract
To assess the efficacy of different flaps along with active physiotherapy for comprehensive management of OSMF. A total of 33 patients of oral submucous fibrosis were admitted and surgically treated. All patients were diagnosed with bilateral oral submucous fibrosis of buccal mucosa. All the patients had advanced oral sub mucous fibrosis with interincisal distance less than 20 mm. Eleven patients were treated with buccal pad of fat, eleven with nasolabial flap and eleven patients were treated with temporo-parietal fascia flap. Physiotherapy was started from the 5th postoperative day and the patients were followed regularly for one year to measure maximum interincisal distance. There was a significant corelation between post-operative mouth opening and regular physiotherapy, exercise and quitting of the habit irrespective of type of reconstruction flap used. On the basis of the result obtained from this study, significant improvement in mouth opening was seen in patients who performed aggressive physiotherapy irrespective of the flap used. Thus we conclude along with the surgical treatment, post-operative physiotherapy and cessation of habit are of equal importance for good prognosis in OSMF patients.
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Affiliation(s)
- Deepak Koul
- Department of Oral and Maxillofacial Surgery, M A Rangoonwala College of Dental Sciences and Research Center, Pune, India
| | - Shilpa Arora
- Department of Oral and Maxillofacial Surgery, M A Rangoonwala College of Dental Sciences and Research Center, Pune, India
| | - Amit Sangle
- Department of Oral and Maxillofacial Surgery, M A Rangoonwala College of Dental Sciences and Research Center, Pune, India
| | - Tehseen Desai
- Department of Oral and Maxillofacial Surgery, M A Rangoonwala College of Dental Sciences and Research Center, Pune, India
| | - Zahid Afzal F. Inamdar
- Department of Oral and Maxillofacial Surgery, M A Rangoonwala College of Dental Sciences and Research Center, Pune, India
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6
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Gondivkar SM, Yuwanati M, Sarode SC, Gadbail AR, Gondivkar RS. Heterogeneity of outcome measures in the clinical trials of treatment for oral submucous fibrosis-Systematic review. Oral Dis 2023; 29:873-879. [PMID: 34967956 DOI: 10.1111/odi.14121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 12/14/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This systematic review was performed to evaluate the range of outcome measures used in interventional trials for oral submucous fibrosis (OSF). MATERIALS AND METHODS PubMed, Scopus, and Cochrane databases were searched to identify randomized controlled trials (RCTs) published from 2004 to 2018 about OSF treatment. All the outcome measures and measurement methods mentioned in the trials were extracted and analyzed. RESULTS Out of 120 published papers, 12 RCTs that met the inclusion criteria were included. A total of 38 single outcome measures and 29 composite outcome measures were considered under four different outcome domains, of which clinical symptoms and clinical response were the most commonly used. The linear measurement of mouth opening (11 trials; 91.66%) and Visual Analogue Scale (10 trials, 83.33%) were the predominant measurement methods. CONCLUSIONS This systematic review highlights the high heterogeneity in outcome measures in therapeutic RCTs of OSF. This lack of widely agreed standard outcome measures in OSF is a great concern as it prevents the comparison of studies and meta-analyses to gather evidence. There is a dire need of establishing a core outcome set for reporting in the future clinical trials that may help facilitate treatment choice for OSF to improve life quality of patients.
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Affiliation(s)
- Shailesh M Gondivkar
- Department of Oral Medicine & Radiology, Government Dental College & Hospital, Nagpur, India
| | - Monal Yuwanati
- Department of Oral Pathology & Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Sachin C Sarode
- Department of Oral Pathology & Microbiology, Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. PatilVidyapeeth, Pune, India
| | - Amol R Gadbail
- Department of Dentistry, Indira Gandhi Government Medical College & Hospital, Nagpur, India
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Rai A, Qazi S, Raza K. In Silico Analysis and Comparative Molecular Docking Study of FDA Approved Drugs with Transforming Growth Factor Beta Receptors in Oral Submucous Fibrosis. Indian J Otolaryngol Head Neck Surg 2022; 74:2111-2121. [PMID: 36452628 PMCID: PMC9702157 DOI: 10.1007/s12070-020-02014-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022] Open
Abstract
Abstract Oral sub-mucous fibrosis (OSMF) is a severe crippling malignant disorder which affects the oral mucosa. The transforming growth factor beta (TGF-β) is one of the cytokines involved with the cell proliferation, cell growth and apoptosis. Several traditional and synthetic medications have been tried in OSMF. This study attempts to identify the FDA approved drugs (including both synthetic and herbal medications) with least side effects, highest efficacy and robust dynamic mechanism for the treatment of OSMF. A ligand library comprising of FDA approved drug compounds was prepared using ChEMBL database. Molecular docking was carried out using GOLD suite 5.2.2. The docked complexes which had the highest binding affinities and lowest energy were deployed to a molecular dynamic simulation using MDweb server. Further, SwissADME was used to study ADME, physicochemistry, drug-likeness, pharmacokinetics and medicinal chemistry friendliness properties. Our docking results suggest that ligands-Curcumin, Curcumin Pyrazole and Demethoxycurcumin, which are all herbal in nature, have a better binding affinity and the best docking scores for both TGF-β type I and TGF-β type II receptors. The molecular dynamics study discerns that the structures have become more stable with less energy. The pharmacokinetics and pharmacodynamics analysis, physicochemical properties and toxicity prediction suggest that Curcumin is the optimal lead compound and holds the potential to be used as an effective drug for the treatment of OSMF. Curcumin, a FDA approved herbal compound, can be used as an effective drug for the treatment of OSMF. Graphic Abstract
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Affiliation(s)
- Arpita Rai
- Oral Medicine & Radiology, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, India
| | - Sahar Qazi
- Department of Computer Science, Jamia Millia Islamia, New Delhi, 110025 India
| | - Khalid Raza
- Department of Computer Science, Jamia Millia Islamia, New Delhi, 110025 India
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Birur PN, Patrick S, Warnakulasuriya S, Gurushanth K, Raghavan SA, Rath GK, Chaturvedi P, Chandru V, Mathew B, Prabhash K, Gurudath S, Mukhia N, Sunny SP, Mehrotra R, Vivek V, Patil S, Kumar GS, Fasalkar S, Pratima R, Kuriakose MA. Consensus guidelines on management of oral potentially malignant disorders. Indian J Cancer 2022; 59:442-453. [PMID: 36412324 DOI: 10.4103/ijc.ijc_128_21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Oral cancer is usually preceded by oral potentially malignant disorders (OPMDs) and early detection can downstage the disease. The majority of OPMDs are asymptomatic in early stages and can be detected on routine oral examination. Though only a proportion of OPMDs may transform to oral squamous cell carcinoma (OSCC), they may serve as a surrogate clinical lesion to identify individuals at risk of developing OSCC. Currently, there is a scarcity of scientific evidence on specific interventions and management of OPMDs and there is no consensus regarding their management. A consensus meeting with a panel of experts was convened to frame guidelines for clinical practices and recommendations for management strategies for OPMDs. A review of literature from medical databases was conducted to provide the best possible evidence and provide recommendations in management of OPMDs.
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Affiliation(s)
- Praveen N Birur
- Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences; Oral Cancer Screening Program, Biocon foundation, Bengaluru, Karnataka, India
| | | | | | - Keerthi Gurushanth
- Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Shubhasini A Raghavan
- Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Goura K Rath
- Department of Radiation Oncology, B.R. Ambedkar Institute Rotary Cancer Hospital, AIIMS, Delhi, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra; Center for Cancer Epidemiology, Tata Memorial Center, Mumbai, International Federation of Head and Neck Oncologic Societies, Bengaluru, Karnataka, India
| | | | - Babu Mathew
- Community Oncology, Regional Cancer Center, Trivandrum, Kerala, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shubha Gurudath
- Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Nirza Mukhia
- Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Sumsum P Sunny
- Head and Neck Oncology, Mazumdar Shaw Cancer Center, Bengaluru, Karnataka, India
| | - Ravi Mehrotra
- India Cancer Research Consortium, Rollins Institute of Public Health, Emroy University, Atlanta, GA, United States
| | - V Vivek
- PMS College of Dental Science and Research, Trivandrum, Kerala, India
| | - Shankargouda Patil
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, Jazan University, Saudi Arabia
| | | | | | - Rao Pratima
- Biocon Foundation, Bengaluru, Karnataka, India
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9
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Sabbaghzadegan S, Golsorkhi H, Soltani MH, Kamalinejad M, Bahrami M, Kabir A, Dadmehr M. Potential protective effects of Aloe vera gel on cardiovascular diseases: A mini-review. Phytother Res 2021; 35:6101-6113. [PMID: 34355443 DOI: 10.1002/ptr.7219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 06/18/2021] [Accepted: 07/04/2021] [Indexed: 11/06/2022]
Abstract
Cardiovascular diseases (CVDs) comprise the most prevalent causes of morbidity and mortality in both men and women worldwide. CVDs are associated with several risk factors such as hyperlipidemia, diabetes mellitus, hypertension, obesity, tobacco smoking and an unhealthy diet. Currently, in addition to the use of related pharmacological treatments in the management of CVDs, the investigation of other suitable healthcare approaches for these disorders such as the identification of herbal medicines has been considered in the scientific communities. Aloe vera (L.) Burm.f. is a perennial medicinal plant. The innermost leaf layer of this plant contains transparent gel, which is used as food. Pre-clinical studies have shown several biological activities of A. vera gel (AVG), including antidiabetic, lipid-lowering, antioxidant, antiinflammatory, hepatoprotective, and immunomodulatory effects. Other pharmacological activities of AVG such as anti-fibrotic, anti-hypertensive, and anti-atherosclerotic effects have been reported. Moreover, several clinical studies have demonstrated the ameliorating effects of AVG on some markers of CVDs risk factors. Thus, this study was conducted to review clinical trials besides in vitro and in vivo studies on the cardiac beneficial effects of AVG. However, further high-quality studies are needed to firmly establish the clinical efficacy of the plant.
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Affiliation(s)
- Saeideh Sabbaghzadegan
- School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran.,Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Haide Golsorkhi
- School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran.,Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Kamalinejad
- Department of Pharmacognosy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Dadmehr
- School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran.,Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
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10
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Sarode SC, Gondivkar S, Gadbail A, Sarode GS, Yuwanati M. Oral submucous fibrosis and heterogeneity in outcome measures: a critical viewpoint. Future Oncol 2021; 17:2123-2126. [PMID: 33858194 DOI: 10.2217/fon-2021-0287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Sachin C Sarode
- Department of Oral Pathology & Microbiology, Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune, 411018, Maharashtra, India
| | - Shailesh Gondivkar
- Department of Oral Medicine & Radiology, Government Dental College & Hospital, Nagpur, 440003, Maharashtra, India
| | - Amol Gadbail
- Department of Dentistry, Indira Gandhi Government Medical College & Hospital, Nagpur, 440018, Maharashtra, India
| | - Gargi S Sarode
- Department of Oral Pathology & Microbiology, Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune, 411018, Maharashtra, India
| | - Monal Yuwanati
- Department of Oral Pathology & Microbiology, Saveetha Dental College & Hospitals, Saveetha Institute of Medical & Technical Sciences, Saveetha University, Chennai, 600077, India
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11
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Song EJ, Españo E, Nam JH, Kim J, Shim KS, Shin E, Park YI, Lee CK, Kim JK. Adjuvanticity of Processed Aloe vera gel for Influenza Vaccination in Mice. Immune Netw 2020; 20:e31. [PMID: 32895618 PMCID: PMC7458799 DOI: 10.4110/in.2020.20.e31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 12/01/2022] Open
Abstract
The effectiveness of current influenza vaccines is considered suboptimal, and 1 way to improve the vaccines is using adjuvants. However, the current pool of adjuvants used in influenza vaccination is limited due to safety concerns. Aloe vera, or aloe, has been shown to have immunomodulatory functions and to be safe for oral intake. In this study, we explored the potential of orally administered processed Aloe vera gel (PAG) as an adjuvant for influenza vaccines in C57BL/6 mice. We first evaluated its adjuvanticity with a split-type pandemic H1N1 (pH1N1) Ag by subjecting the mice to lethal homologous influenza challenge. Oral PAG administration with the pH1N1 Ag increased survival rates in mice to levels similar to those of alum and MF59, which are currently used as adjuvants in influenza vaccine formulations. Similarly, oral PAG administration improved the survival of mice immunized with a commercial trivalent influenza vaccine against lethal homologous and heterologous virus challenge. PAG also increased hemagglutination inhibition and virus neutralization Ab titers against homologous and heterologous influenza strains following immunization with the split-type pH1N1 Ag or the commercial trivalent vaccine. Therefore, this study demonstrates that PAG may potentially be used as an adjuvant for influenza vaccines.
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Affiliation(s)
- Eun-Jung Song
- Department of Pharmacy, Korea University College of Pharmacy, Sejong 30019, Korea.,Department of Veterinary Medicine, College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - Erica Españo
- Department of Pharmacy, Korea University College of Pharmacy, Sejong 30019, Korea
| | - Jeong-Hyun Nam
- Department of Pharmacy, Korea University College of Pharmacy, Sejong 30019, Korea.,Division of Viral Disease Research, Center for Infectious Disease Research, National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju 28159, Korea
| | - Jiyeon Kim
- Department of Pharmacy, Korea University College of Pharmacy, Sejong 30019, Korea
| | | | | | - Young In Park
- Department of Pharmacy, Korea University College of Pharmacy, Sejong 30019, Korea
| | - Chong-Kil Lee
- Department of Pharmaceutics, College of Pharmacy, Chungbuk National University, Cheongju 28644, Korea
| | - Jeong-Ki Kim
- Department of Pharmacy, Korea University College of Pharmacy, Sejong 30019, Korea
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12
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Rao NR, Villa A, More CB, Jayasinghe RD, Kerr AR, Johnson NW. Oral submucous fibrosis: a contemporary narrative review with a proposed inter-professional approach for an early diagnosis and clinical management. J Otolaryngol Head Neck Surg 2020; 49:3. [PMID: 31915073 PMCID: PMC6951010 DOI: 10.1186/s40463-020-0399-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/01/2020] [Indexed: 12/24/2022] Open
Abstract
Oral Submucous fibrosis (OSMF) has traditionally been described as "a chronic, insidious, scarring disease of the oral cavity, often with involvement of the pharynx and the upper esophagus". Millions of individuals are affected, especially in South and South East Asian countries. The main risk factor is areca nut chewing. Due to its high morbidity and high malignant transformation rate, constant efforts have been made to develop effective management. Despite this, there have been no significant improvements in prognosis for decades. This expert opinion paper updates the literature and provides a critique of diagnostic and therapeutic pitfalls common in developing countries and of deficiencies in management. An inter-professional model is proposed to avoid these pitfalls and to reduce these deficiencies.
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Affiliation(s)
- Naman R. Rao
- Harvard Medical School, Harvard University, Boston, MA USA
| | - Alessandro Villa
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, MA USA
- Harvard School of Dental Medicine, Boston, MA USA
| | - Chandramani B. More
- Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University, Vadodara, Gujarat India
| | - Ruwan D. Jayasinghe
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Alexander Ross Kerr
- Department of Oral and Maxillofacial Pathology, Radiology and Medicine, NYU College of Dentistry, New York, NY USA
| | - Newell W. Johnson
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland Australia
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13
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Use of Aloe Vera and Turmeric Paste as a Supplementary Medicine in Oral Submucosal Fibrosis: A Pilot Study. Indian J Otolaryngol Head Neck Surg 2019; 71:883-886. [PMID: 31742088 DOI: 10.1007/s12070-019-01599-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/17/2019] [Indexed: 11/27/2022] Open
Abstract
Oral submucosal fibrosis is the major health issue affecting 2.5 million Indian population under the age of 40 years. All the available treatments give only symptomatic relief which is short lived.The incidence of Oral submucosal fibrosis still rising alarmingly and there is a dire need to search for an effective and safe remedy because of lack of present therapies to either provide a complete cure or treating the patients at the cost of adverse effects. A total of 140 clinically diagnosed patients with Oral submucosal fibrosis (diagnosed on the basis of reduction in interincisal distance on maximum mouth opening and palpable fibrous bands involving oral mucosa) within the age range of 18-50 years with decreased interincisal opening were selected (time period 1.5 year). These patients were given Inj. Triamcinolone (40 mg) and Inj Hyaluronidase every 21 days. Pt was divided in 2 groups (each containing both males and females) those receiving Triamcinolone ointment alone BD (control) and those receiving Triamcinolone ointment BD along with turmeric & aloe vera paste combination (test). A statistically significant improvement was seen in both burning sensation and mouth opening in both males and females. The result of the study shows that the synergistic action of these herbs results in higher efficacy and highly potent Oral submucosal fibrosis treatment.
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14
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Al-Maweri SA, Ashraf S, Lingam AS, Alqutaibi A, Abdulrab S, Alaizari N, Halboub E. Aloe vera in treatment of oral submucous fibrosis: A systematic review and meta-analysis. J Oral Pathol Med 2018; 48:99-107. [DOI: 10.1111/jop.12789] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/10/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Sadeq Ali Al-Maweri
- Department of Oral Medicine and Diagnostic Science; Al-Farabi Colleges; Riyadh Saudi Arabia
| | - Sajna Ashraf
- Department of Oral Medicine and Diagnostic Science; Al-Farabi Colleges; Riyadh Saudi Arabia
| | - Amara Swapna Lingam
- Department of Oral Medicine and Diagnostic Science; Al-Farabi Colleges; Riyadh Saudi Arabia
| | - Ahmed Alqutaibi
- Department of Prosthodontics; Ahram Canadian University; Cairo Egypt
| | - Saleem Abdulrab
- Department of Restorative Dental Sciences; Al-Farabi Colleges; Riyadh Saudi Arabia
- Primary Health Care Corporation; Doha Qatar
| | - Nader Alaizari
- Department of Oral Medicine and Diagnostic Science; Al-Farabi Colleges; Riyadh Saudi Arabia
| | - Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences; College of Dentistry; Jazan University; Jazan Saudi Arabia
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15
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Affiliation(s)
- Yan Gao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
| | - Kit Ieng Kuok
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
| | - Ying Jin
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
| | - Ruibing Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
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16
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More CB, Gavli N, Chen Y, Rao NR. A novel clinical protocol for therapeutic intervention in oral submucous fibrosis: An evidence based approach. J Oral Maxillofac Pathol 2018; 22:382-391. [PMID: 30651684 PMCID: PMC6306594 DOI: 10.4103/jomfp.jomfp_223_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Oral submucous fibrosis (OSMF) is a chronic, progressive, debilitating, scarring and crippling disorder of the oral cavity. It is a potentially malignant oral disease which predominantly affects people of South and Southeast Asia, especially Indian subcontinent, where chewing of areca nut and its commercial preparation is rampant. However, due to increase in immigration of people from the Indian subcontinent, the health professionals in many developed countries do come across this disease very often. Since decades, many treatment modalities are suggested and studied using medicines, surgery and physiotherapy, with varying degrees of benefit, but none have been able to cure this disease completely, and hence, it has become a challenging condition. The present article emphasizes on various therapeutic interventions used till date to curb the menace of this disease and the principal author with his vast academic research and clinical experience in treating this disease has proposed the stage-wise treatment regimen for OSMF. The current article is an attempt to compile the available treatment, its current status and future perspectives, so as to assist early intervention of the disease with evidence-based approach. This article will ignite the research minds of dental clinician, oral medicine specialist, otolaryngologist and general physician in treating OSMF.
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Affiliation(s)
- Chandramani Bhagwan More
- Department of Oral Medicine and Maxillofacial Radiology, K.M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
| | - Nishma Gavli
- Department of Oral Medicine and Maxillofacial Radiology, K.M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
| | - Youbai Chen
- Department of Plastic and Reconstructive Surgery, Chinese PLA General Hospital, Beijing, China.,Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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17
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Clinicobiochemical evaluation of turmeric with black pepper and nigella sativa in management of oral submucous fibrosis—a double-blind, randomized preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:705-712. [DOI: 10.1016/j.oooo.2016.07.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/08/2016] [Accepted: 07/25/2016] [Indexed: 11/17/2022]
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18
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Effectiveness of Long Term Supervised and Assisted Physiotherapy in Postsurgery Oral Submucous Fibrosis Patients. Case Rep Dent 2016; 2016:6081905. [PMID: 27885345 PMCID: PMC5112303 DOI: 10.1155/2016/6081905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
Oral submucous fibrosis is one of the leading potentially malignant disorders prevailing in India. A number of conservative and surgical treatment options have been suggested for this potentially malignant disorder (Arakeri and Brennan, 2013). While the role of physiotherapy has been highlighted in the conservative management, its importance in postsurgical cases to avoid scar contracture and subsequent relapse has not been given due importance in the literature. The following is a case report of a male patient surgically treated for OSMF (oral submucous fibrosis) and meticulously followed up for recalls and physiotherapy. The constant supervision and motivation for physiotherapy along with the constant assistance helped achieve satisfying results.
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Nair GR, Naidu GS, Jain S, Nagi R, Makkad RS, Jha A. Clinical Effectiveness of Aloe Vera in the Management of Oral Mucosal Diseases- A Systematic Review. J Clin Diagn Res 2016; 10:ZE01-7. [PMID: 27656587 PMCID: PMC5028429 DOI: 10.7860/jcdr/2016/18142.8222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/23/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Aloe vera is well known for its medicinal properties which lead to its application in treating various diseases. Its use in treating oral lesions has not been much documented in literature. AIM Although, systematic reviews on aloe vera and its extracts have been done earlier, but in relation to oral diseases this is the first systematic review. The aim of the present systematic review was to compile evidence based studies on the effectiveness of Aloe vera in treatment of various oral diseases. MATERIALS AND METHODS Computerized literature searches were performed to identify all published articles in the subject. The following databases were used: PUBMED [MEDLINE], SCOPUS, COCHRANE DATABASE, EMBASE and SCIENCE DIRECT using specific keywords. The search was limited to articles published in English or with an English Abstract. All articles (or abstracts if available as abstracts) were read in full. Data were extracted in a predefined fashion. Assessment was done using Jadad score. RESULTS Fifteen studies satisfied the inclusion criteria. Population of sample study ranged from 20 patients to 110 patients with clinically diagnosed oral mucosal lesions. Out of 15 studies, five were on patients with oral lichen planus, two on patients with oral submucous fibrosis, other studies were carried on patients with burning mouth syndrome, radiation induced mucositis, candida associated denture stomatitis, xerostomic patients and four were on minor recurrent apthous stomatitis. Most studies showed statistically significant result demonstrating the effectiveness of Aloe vera in treatment of oral diseases. CONCLUSION Although there are promising results but in future, more controlled clinical trials are required to prove the effectiveness of Aloe vera for management of oral diseases.
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Affiliation(s)
- Gopakumar Ramachandran Nair
- Ex-Professor and Head, Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
| | - Giridhar Seetharam Naidu
- Professor, Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
| | - Supreet Jain
- Senior Lecturer, Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
| | - Ravleen Nagi
- Senior Lecturer, Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
| | - Ramanpal Singh Makkad
- Senior Lecturer, Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
| | - Abhishek Jha
- Senior Lecturer, Department of Preventive and community Dentistry, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
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20
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Anuradha A, Patil B, Asha VR. Evaluation of efficacy of aloe vera in the treatment of oral submucous fibrosis - a clinical study. J Oral Pathol Med 2016; 46:50-55. [PMID: 27314762 DOI: 10.1111/jop.12463] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Oral submucous fibrosis is a chronic disease, treatment of which has largely been symptomatic. Aloe vera has immunomodulatory, anti-inflammatory, wound healing, antioxidant, and antineoplastic activities. All such properties of aloe vera suggest the possibility of its use in the management of oral submucous fibrosis. METHODS Seventy-four patients of oral submucous fibrosis were randomly divided into 2 groups. Group A patients were treated with systemic (juice) and topical aloe vera (gel) for 3 months. Group B patients were treated with intralesional injection of hydrocortisone and hyaluronidase for 6 weeks with antioxidant supplements for 3 months. Patients were assessed for reduction in burning sensation and increase in mouth opening, cheek flexibility, and tongue protrusion at an interval of 1, 2, and 3 months. RESULTS Both the groups showed statistically significant improvements in all the study parameters at the end of study period (P < 0.001). The clinical response to aloe vera was comparable to that of intralesional injections of hydrocortisone and hyaluronidase with antioxidant supplementation. CONCLUSION The study concludes that aloe vera can be an alternative, safe, and effective treatment regime in the management of oral submucous fibrosis. Long-term follow-up studies with larger sample size are recommended.
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Affiliation(s)
- Ardra Anuradha
- Department of Oral medicine & radiology, The Oxford College and Hospital, Bangalore, India
| | - Bharati Patil
- Department of Oral medicine & radiology, The Oxford College and Hospital, Bangalore, India
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21
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Warnakulasuriya S, Kerr AR. Oral submucous fibrosis: a review of the current management and possible directions for novel therapies. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:232-41. [PMID: 27422422 DOI: 10.1016/j.oooo.2016.02.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 01/28/2016] [Accepted: 02/16/2016] [Indexed: 12/24/2022]
Abstract
This literature review addresses the attempted interventions for the management of oral submucous fibrosis. The literature supports the use of several medical interventions, including micronutrients, antioxidants, proteolytic enzymes, immune modulators (mainly steroids), and agents to promote blood flow. However, the numbers of reported randomized controlled trials are limited. Therefore, no recommendation can be made for any specific intervention. Until now, no single molecular pathway has been identified that is either necessary or sufficient for the development of fibrosis. This has been a bar for any molecular-targeted therapies. Because areca nut (an ingredient of betel quid) plays a major etiologic role in oral submucous fibrosis, cessation of areca nut use remains pivotal in the management of this disorder.
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Affiliation(s)
| | - A Ross Kerr
- New York University College of Dentistry, New York, NY, USA
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22
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Singh N, Hebbale M, Mhapuskar A, Ul Nisa S, Thopte S, Singh S. Effectiveness of Aloe Vera and Antioxidant along with Physiotherapy in the Management of Oral Submucous Fibrosis. J Contemp Dent Pract 2016; 17:78-84. [PMID: 27084867 DOI: 10.5005/jp-journals-10024-1806] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Oral submucous fibrosis (OSMF) is a well-established precancerous condition affecting the oral mucosa. It is a disease that causes significant morbidity (in terms of loss of mouth function as tissues become rigid and mouth opening becomes difficult) and mortality (when transformation into squamous cell carcinoma occurs). AIM The aim of the study is to compare the efficacy of Aloe vera with antioxidant when given along with physiotherapy in the management of OSMF. MATERIALS AND METHODS Forty patients presenting with clinical signs and symptoms of OSMF were included for the study after informed consent. Group A included 20 patients who received Aloe vera gel (forever living gel) along with physiotherapy. Group B included 20 patients who received antioxidant capsules twice daily for 3 months along with physiotherapy exercises four times in a day. The following parameters, that is, burning sensation, mouth opening, tongue protrusion and cheek flexibility were recorded at each visit. RESULTS Majority of the participant enrolled were in the age range of 30 to 35 years. Improvement in all the parameters was seen with the individuals receiving Aloe vera gel in comparison to antioxidants. CONCLUSION So, Aloe vera being a soothing, simple and safe mode of treatment along with proper habit restriction can be considered to be an effectual protocol in the management of OSMF. The analgesic effects of Aloe vera with the physiotherapy exercises provide better results in reducing burning sensation and improving mouth opening, tongue protrusion and cheek flexibility in comparison to antioxidants.
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Affiliation(s)
- Nisha Singh
- Postgraduate Student, Department of Oral Medicine and Radiology, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune 411043 Maharashtra, India, Phone: +8554857898, e-mail:
| | - Manjula Hebbale
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth Deemed University, Dental College and Hospital Pune, Maharashtra, India
| | - Amit Mhapuskar
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth Deemed University, Dental College and Hospital Pune, Maharashtra, India
| | - Shams Ul Nisa
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth Deemed University, Dental College and Hospital Pune, Maharashtra, India
| | - Shameeka Thopte
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth Deemed University, Dental College and Hospital Pune, Maharashtra, India
| | - Saumya Singh
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth Deemed University, Dental College and Hospital Pune, Maharashtra, India
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23
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Srivastava A, Agarwal R, Chaturvedi TP, Chandra A, Singh OP. Clinical evaluation of the role of tulsi and turmeric in the management of oral submucous fibrosis: A pilot, prospective observational study. J Ayurveda Integr Med 2015; 6:45-9. [PMID: 25878464 PMCID: PMC4395929 DOI: 10.4103/0975-9476.146563] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/30/2014] [Accepted: 03/01/2014] [Indexed: 11/24/2022] Open
Abstract
The aim of the present study was to investigate the clinical efficacy of herbal medicines (1 gm tulsi and 1 gm turmeric mixed in glycerine base) for the treatment of oral submucous fibrosis (OSMF). Forty-one patients in the age group of 17- 56 years without any systemic complications were included in the study. The patients were treated with medicines, which were to be applied 3-4 times a day. Blood samples were collected before and after treatment to screen for any systemic changes due to these medications. Burning sensation and mouth opening were recorded before and after treatment. Patients were followed up on monthly subsequent visits for three months. Changes in the burning sensation on visual analogue scale (VAS) scale and difference in the mouth opening were analyzed statistically. A statistically significant improvement was seen in both burning sensation and mouth opening. Tulsi and turmeric offers a safe and efficacious combination of natural products available for symptomatic treatment of OSMF.
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Affiliation(s)
- Adit Srivastava
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rahul Agarwal
- Department of Oral and Maxillofacial Pathology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - T P Chaturvedi
- Department of Orthodontics, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Akhilesh Chandra
- Department of Oral and Maxillofacial Pathology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - O P Singh
- Department of Kayachikitsa, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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24
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Abstract
Oral submucous fibrosis (OSF) is a premalignant condition caused by betel chewing. It is very common in Southeast Asia but has started to spread to Europe and North America. OSF can lead to squamous cell carcinoma, a risk that is further increased by concomitant tobacco consumption. OSF is a diagnosis based on clinical symptoms and confirmation by histopathology. Hypovascularity leading to blanching of the oral mucosa, staining of teeth and gingiva, and trismus are major symptoms. Major constituents of betel quid are arecoline from betel nuts and copper, which are responsible for fibroblast dysfunction and fibrosis. A variety of extracellular and intracellular signaling pathways might be involved. Treatment of OSF is difficult, as not many large, randomized controlled trials have been conducted. The principal actions of drug therapy include antifibrotic, anti-inflammatory, and antioxygen radical mechanisms. Potential new drugs are on the horizon. Surgery may be necessary in advanced cases of trismus. Prevention is most important, as no healing can be achieved with available treatments.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | | | - Fareedi Mukram Ali
- Departments of Oral and Maxillofacial Surgery, SMBT Dental College, Sangamner, Maharashtra, India
| | - Kishor Patil
- Departments of Oral Pathology and Microbiology, SMBT Dental College, Sangamner, Maharashtra, India
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25
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Yardimci G, Kutlubay Z, Engin B, Tuzun Y. Precancerous lesions of oral mucosa. World J Clin Cases 2014; 2:866-872. [PMID: 25516862 PMCID: PMC4266835 DOI: 10.12998/wjcc.v2.i12.866] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 08/28/2014] [Accepted: 09/23/2014] [Indexed: 02/05/2023] Open
Abstract
Precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years, are consists of a group of diseases, which should be diagnosed in the early stage. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant transformation rate. Oral lichen planus is one of the potentially malignant disorders that may be seen in six different subtypes including papular, reticular, plaque-like, atrophic, erosive, and bullous type, clinically. Atrophic and erosive subtypes have the greater increased malignant transformation risk compared to another subtypes. Although there are various etiological studies, the etiology of almost all these diseases is not fully understood. Geographically, etiologic factors may vary. The most frequently reported possible factors are tobacco use, alcohol drinking, chewing of betel quid containing areca nut, and solar rays. Early diagnosis is very important and can be lifesaving, because in late stages, they may be progressed to severe dysplasia and even carcinoma in situ and/or squamous cell carcinoma. For most diseases, treatment results are not satisfactory in spite of miscellaneous therapies. While at the forefront of surgical intervention, topical and systemic treatment alternatives such as corticosteroids, calcineurin inhibitors, and retinoids are widely used.
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