The atrophic epithelium in OSF has been attributed to the senescence of basal stem cell layer and the development of hyperplastic epithelium through senescence escape. Diagnosis
Classification
Oral submucous fibrosis is clinically divided into three stages:
Stage 1: Stomatitis
Stage 2: Fibrosis
a- Early lesions, blanching of the oral mucosa
b- Older lesions, vertical and circular palpable fibrous bands in and around the mouth or lips, resulting in a mottled, marble-like appearance of the buccal mucosa
Stage 3: Sequelae of oral submucous fibrosis
a- Leukoplakia
b- Speech and hearing deficitsKhanna and Andrade in 1995 developed a group classification system for the surgical management of trismus:
Group I:  Earliest stage without mouth opening limitations with an interincisal distance of greater than 35 mm. Group II:  Patients with an interincisal distance of 26–35 mm. Group III:  Moderately advanced cases with an interincisal distance of 15–26 mm. Fibrotic bands are visible at the soft palate, and pterygomandibular raphe and anterior pillars of fauces are present. Group IVA:  Trismus is severe, with an interincisal distance of less than 15 mm and extensive fibrosis of all the oral mucosa. Group IVB:  Disease is most advanced, with premalignant and malignant changes throughout the mucosa.tumor necrosis factor alpha and keratin 17 areinterdependent regulators, they could be used as diagnostic makers and a prognostic mirror of oral
submucous fibrosis cases

Treatment
Biopsy screening although necessary is not mandatory most dentist can visually examine the area and proceed with the proper course of treatment.
Pentoxifylline (Trental), a methylxanthine derivative that has vasodilating properties and increases mucosal vascularity, is also recommended as an adjunct therapy in the routine management of oral submucous fibrosis. IFN-gamma is antifibrotic cytokine which alters collagen synthesis and helps in OSF. Colchicine tablets 0.5 mg twice a day
Lycopene, 16 mg a day helps in improvement of OSFThe treatment of patients with oral submucous fibrosis depends on the degree of clinical involvement. If the disease is detected at a very early stage, cessation of the habit is sufficient. Most patients with oral submucous fibrosis present with moderate-to-severe disease. Severe oral submucous fibrosis is irreversible. Moderate oral submucous fibrosis is reversible with cessation of habit and mouth opening exercise. Current modern day medical treatments can make the mouth opening to normal  minimum levels  of 30 mm mouth opening with proper treatment. Research
Recently scientists have proven that intralesional injection of autologous bone marrow stem cells is a safe and effective treatment modality in oral sub mucosal fibrosis. It has been shown autologous bone marrow stem cell injections induces angiogenesis in the area of lesion which in turn decreases the extent of fibrosis thereby leading to significant increase in mouth opening. History
In 1952, T.Sheikh coined the term distrophica idiopathica mucosa oris to describe an oral fibrosing disease he discovered in five Indian women from Kenya. S.G. Joshi subsequently coined the termed oral submucous fibrosis (OSF) for the condition in 1953. See also
Cutaneous condition

References


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