A girl aged 6 years reported with her mother to the Department of Oral Medicine and Radiology of a Tertiary Care Dental Hospital with the chief complaint of inability to open mouth along with a burning sensation of mucosa while taking spicy food for 6 months. The medical history was non-contributory. The patient reported a habit of chewing areca nut 3 to 4 times a day for the past 4 years. A long-standing history of chewing areca nut was present in her grandmother who infused this habit in her granddaughter not knowing the harmful effects of the same. General physical examination was non-contributory. Extraoral examination revealed a restricted mouth opening of 9 mm. Intraoral examination revealed blanching of upper and lower labial mucosa, bilateral buccal mucosa, and palate. There was depapillation of the anterior dorsal surface of the tongue (). The tongue movements were restricted and tongue protrusion was 28.52 mm. Vertically thick fibrous bands were palpable on bilateral buccal mucosa, pterygomandibular raphe, hard and soft palate. Positive history of chewing areca nut along with clinical findings led to a provisional diagnosis of OSMF.\nAn incisional biopsy was performed from the right buccal mucosa and histopathological examination showed parakeratinized stratified squamous epithelium with a short blunt to flattened rete ridges with stromal tissue composed of densely bundled collagen fibers, and juxtaepithelial hyalinization (). The overall picture was suggestive of highly advanced OSMF.\nThe patient and her mother were counseled regarding the adverse effects of chewing areca nut and the potential to cause oral cancer. The patient was advised to stop chewing areca nut. She was treated with sesame oil pulling for 5 minutes daily along with topical application of triamcinolone acetonide (0.1%) and curcumin tablet 300 mg once daily. The patient was given a sesame oil sachet and was instructed to perform oil pulling every day on an empty stomach by emptying the entire 10 mL of oil and swishing it in the mouth for at least 5 minutes without swallowing the oil. This was followed by spitting the oil and brushing the teeth. The patient was refrained from eating anything for at least 30 minutes. The patient was followed up at a regular interval of 1 month up to 6 months followed by follow-up at an interval of 3 months thereafter. She has stopped chewing areca nuts and showed improvement in symptoms. After 3 years of follow-up, the mouth opening is 22.29 mm () and tongue protrusion is 33.39 mm (). Patient is still under follow-up.
A 12-year-old boy presented with difficulty in mouth opening () and burning sensation on consumption of spicy food since last 8 months. Maximum interincisal distance was 11 mm, which has increased significantly after conservative management (). The patient gave a history of chewing tobacco and betel nut pouches 20–30 per day since 6 years. On intraoral examination, vertical and circular fibrous bands were palpable over lower lip, upper lip, labial and buccal mucosa.\nHistopathologically, H&E-stained section showed collagen fibres were arranged in separate bundles with dense inflammatory infiltrate, also showed juxtaepithelial hyalinisation.