Oral submucous fibrosis or OSMF is a chronic, progressive, irreversible and yet avoidable collagen metabolic disorder of the mouth caused by chewing tobacco and/or areca nuts in betel quid or its variants. It resembles scleroderma but is localised to the mouth. There is an associated increased risk of developing squamous cell carcinoma of the mouth.

It is predominantly seen in patients who chew betel quid or its variants such as gutkha (mitha pan), kiwam, zarda and pan masala. Sweetened versions of betel quid are sold to children as sweet supari, gua, mawa or mistee pan. Oral submucous fibrosis is most commonly seen in the age group of 20-40 yr olds. Compared to traditional betel quid, gutkha chewing tends to begin at a younger age and has a shorter time to the development of disease.

Clinical Features of OSMF

The first symptom of oral submucous fibrosis is a burning sensation in the mouth especially when eating spicy food, sometimes also with small blister formation. The mouth may feel dry with ulcers.

In later stages fibrosis develops :-

• Mouth cannot be opened as wide as normal, affecting eating and swallowing, speaking and dental hygiene.
• The cheeks feel thick and firm and cannot ‘puff out’.
• Lips become rubbery and thick with an elliptical shape.
• Tongue becomes smooth, white and cannot move easily.

Treatment for Oral SubMucous Fibrosis depends on the extent of the fibrosis.

• Patient is asked to stop the pan masala /beetle nut /smoking/tobacco chewing/ alcohol and spicy food.
• Patient is given corticosteroid injections into the fibrotic bands every week for 6-8 weeks. Hyaluronidase, an enzyme to breakdown connective tissue, may be mixed with the cortisone.
• Nutritional supplements are added and patient is advised mouth opening exercises.
• In advanced cases, surgery is recommended to ease mouth opening.
• Jaw stretching appliances may be given to the patient./li>