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Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 11-15

Incidence rate of oral submucous fibrosis (OSMF) and its etiology in patients visiting Government Dental College and Hospital, Jamnagar (GDCH, Jamnagar)

1 Professor and Head, Oral Medicine and Radiology, GDCH, Jamnagar, Gujarat, India
2 Tutor, Oral Medicine and Radiology, GDCH, Jamnagar, Gujarat, India
3 Internee, Oral Medicine and Radiology, GDCH, Jamnagar, Gujarat, India

Date of Web Publication7-Aug-2018

Correspondence Address:
R N Jha
Professor and Head, Oral Medicine and Radiology, GDCH, Jamnagar, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-6486.238789

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Objectives: To assess the incidence rate of OSMF and its etiology in patients attending OPD at GDCH, Jamnagar.
Material and Methods: The diagnosis of OSMF was based on clinical examination and evaluating patients “signs and symptoms.
Results: The total number of patients affected by OSMF in this time duration was 268. Out of these, 230 (85.82%) were male, while 38 were female (14.18%). Therefore, male: female (M:F) ratio was 6:1. 104 males in the age group of 21-30 years constituted a single majority.
Conclusion: This study reveals that the incidence rate of OSMF in patients visiting GDCH, Jamnagar was 1%. Males were more affected than females. It was seen that the major etiological factors in the development of OSMF was areca nut and gutkha usage by the patients.

Keywords: Incidence rate, OSMF, OPD

How to cite this article:
Jha R N, Kalyani P B, Savarkar S V. Incidence rate of oral submucous fibrosis (OSMF) and its etiology in patients visiting Government Dental College and Hospital, Jamnagar (GDCH, Jamnagar). J Integr Health Sci 2014;2:11-5

How to cite this URL:
Jha R N, Kalyani P B, Savarkar S V. Incidence rate of oral submucous fibrosis (OSMF) and its etiology in patients visiting Government Dental College and Hospital, Jamnagar (GDCH, Jamnagar). J Integr Health Sci [serial online] 2014 [cited 2023 Jun 4];2:11-5. Available from: https://www.jihs.in/text.asp?2014/2/1/11/238789

  Introduction Top

Oral submucous fibrosis is an “insidious chronic disease affecting any part of the oral cavity and sometimes the pharynx, occasionally preceded by vesicle formation, always associated with fibrous bands and juxtaepithelial inflammatory reaction followed by a fibroelastic change of lamina propria with epithelial atrophy leading to stiffness of oral mucosa, trismus and inability to eat.”[1],[2],[3],[4]

The WHO definition for an oral precancerous condition stated as “A generalized pathological state of the oral mucosa associated with a significant increased risk of oral cancer”, gives an appropriate description of OSMF.

It is a chronic, progressive, scarring disease, that predominantly affects people of South-East Asian origin.[1],[5] The condition was prevalent in the days of Sushruta (600 B.C.), a great practitioner of ancient medicine, where he described this condition as ‘Vidhari’. After a lapse of many years, Schwarz (1952) was the first person to bring this condition back into limelight. He described this condition as “atrophic idiopathic mucosae oris”.[5],[6] Later in 1953, Joshi from Bombay (Mumbai) redesignated this condition as oral submucous fibrosis, implying predominantly its histologic nature.[1],[5],[9]

The prevalence rate of oral submucous fibrosis in India, Burma (Myanmar) and South Africa ranges from 0 to 1.2%. In India the overall incidence in about 0.2% to 0.5%[1],[4]. It is seen among 0.2-1.2% of urban population attending dental clinics in India.[7]

  Methodology Top

Type of study: Cross-sectional study

Duration of study: Feb-13 to Jan-14 (1 year)

Hospital based study: All patients attending OPD at GDCH, Jamnagar during period of 1 year (Feb-13 to Jan-14).

Sample size: 26,823 patients attending OPD at oral medicine and diagnosis department, GDCH, Jamnagar were examined for OSMF. Among them, 268 patients displayed clinical features of OSMF.

A pre-tested, semi-structured proforma has been used for collecting information from the patients. Written consent of each patient was taken after explaining purpose of the study. Proforma consisted of two components: socio-demographic status and clinical features of the patients.

Inclusion criteria: 1) Clinical features-burning sensation of mouth on intake of hot beverages and spicy food, vesicle formation and ulceration, gradual reduction in mouth opening, limitation in tongue movement and white fibrous bands are palpable. 2) Patient “s consent

Exclusion criteria: 1) Absence of clinical features 2) Patient “s unwillingness to give consent 3) Unsupportive or medically compromised patient

Patients having OSMF were categorized into 5 age groups:

1st: 11-20 years; 2nd: 21-30 years; 3rd:31-40 years; 4th: 41-50 years; 5th: >50 years

The armamentarium consisted of sterile mouth mirror, straight and curved explorers, kidney tray, disposable latex gloves, disposable mouth mask and a 6 inch ruler with mm markings.

The questionnaire included the basic socio-demographic variables of all patients along with presence of habit of areca nut or gutkha chewing or having spicy food, symptoms like burning sensation in mouth on intake of hot and spicy food, and altered salivation.

Clinical examination showed blanching and stiffness of oral mucosa and soft palate, palpable bands chiefly in buccal mucosa, and sometimes vesicle formation and ulceration.

  Results Top

Out of the total OPD of26823 patients coming to GDCH, Jamnagar during Feb-2013 to Jan-2014, the incidence rate of patients affected by OSMF was 268 (1%).

[Table 1] shows that most affected age group was 21 – 30 years age group amongst both males (38.80%) and females (5.97%). [Table 2] indicates that the greatest proportion of OSMF patients (58.58%) had a habit of chewing areca nut alone or in form of gutkha. [Table 3] is an eye opener that patients in whom mouth opening was reduced to less than 20 mm constituted the highest proportion (63.43%) of patients having OSMF who visited GDCH, Jamnagar. [Table 4] depicts that 98.50% of the patients complained of burning sensation in the mouth as well as restricted mouth opening. On clinical examination, fibrous bands were palpable in 98.13% of the patients.
Table 1: Grading system for OSMF

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Table 2: Distribution of subjects having OSMF according to their age and sex

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Table 3: Distribution of adverse oral habits in OSMF patients (multiple response)

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Table 4: Distribution of subjects affected by OSMF according to their clinical grades and mouth opening

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Table 5: Distribution of OSMF subjects according to their signs and symptoms in different grades

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  Discussion Top

There is compelling evidence to implicate the habitual chewing of areca nut with the development of OSMF. It occurs predominantly in the Indian subcontinent where the habit is more prevalent.[1] In our study also amongst the patients affected by OSMF the frequency of areca nut chewers was greater while gutkha (combination of areca nut and tobacco) chewers contributed next to areca nut chewers.

The alkaloid present in areca nut, Arecoline, is converted to arecadaine, which stimulates fibroblastic activity in oral mucosa resulting in excessive collagen deposition seen in OSMF.[2],[5],[7] This finding proves the major etiological factor in OSMF to be areca nut chewing habit in various forms, which is addictive and psychoactive in nature. Evidence from other studies shows that areca nut chewing suppresses hunger and reduces appetite during working hours or until people find time to have food. Sullivan and his colleagues found that people chewed it to get energy rather than for its psychotropic effects. But nevertheless, areca nut is the 4th most addictive substance in the world and is associated with a dependence syndrome.[8] This habit was seen especially in young males as they got exposed to these products at an early age through their friends and colleagues, or resorted to it in a hope to overcome stress and tension. Financial independence also acted as a contributing agent.[2]

Several factors have been implicated as predisposing factors without ruling out a single etiology, that include apart from areca nut and gutkha (containing areca nut and tobacco) usage, chilli consumption, nutritional deficiency, genetic susceptibility, autoimmunity and altered salivary composition.[2],[5],[9] Capsaicin is an active ingredient of chillies, which causes slight inflammation of oral mucosa. Hence, people experienced a burning sensation in their mouth while eating spicy food, which could be easily eaten by them previously.[2],[5]

The present study showed a greater fraction of patients in 21-30 years and 31-40 years age groups. Similar findings regarding higher male: female ratio was reported in several other studies- eg. Those by Anuradha P. and Mishra G (2011)[10], Afroz N and his colleagues (2006)[11] - 4:1, S Sunder Raj, Sharma R and their co-workers (2012)[12] – 4.3:1, Dave RP (1987)[13] – 2.3:1, Tupkar JV, Bhavthankar JD, Mandale MS (2007)[2] – 11.6:1.

Clinical grading of patients showed shocking results that people visited GDCH, Jamnagar only after OSMF had progressed to an advanced stage and they experienced difficulty in chewing food, majority of them having reached to grade IV stage. This is similar to the study by Tupkar JV and his colleagues (2007) having majority patients in grade II and grade III categories.[2]

The signs and symptoms seen here were also in accordance with Tupkar JV and his colleagues' study (2007), where burning symptoms on eating hot and spicy food as well as restricted mouth opening were present in 97.02% patients. Even white fibrous bands were present in 97.02% patients. Most frequent site involved was buccal mucosa, followed by soft palate, lips and tongue. Tongue involvement was seen at a later stage, especially among grade IV patients.[2]

  Conclusion Top

This comprehensive study showed that the incidence rate of OSMF in patients visiting GDCH, Jamnagar was 1%, which is significantly high. Males in 2nd decade of their life were mainly affected. Majority of these patients were habituated to chewing areca nut alone, or in combination with tobacco. Gutkha chewing habit came next in line to areca nut chewing habit, pointing towards the glaring fact of its increasing popularity among youngsters and young adults due to peer influence, desire to experiment or stress. Intake of spicy food was also a significant contributing factor.

This calls for a dire need to conduct oral health care programs especially for youngsters and young adults about the ill-effects of areca nut consumption in all available forms, and to discourage them from doing so by making them aware of its manifestations.

  References Top

Shafer, Hine, Levy . Benign and malignant tumors of the Oral Cavity. Shafer “s textbook of Oral Pathology. 6th Edition. Elsevier publications p.96  Back to cited text no. 1
Tupkar JV, Bhavthankar JD, Mandale MS. Oral Submucous Fibrosis (OSMF): A study of 101 cases. JIAOMR. 2007;19(2):311-18  Back to cited text no. 2
B Vijay Kumar. Role of Antioxidants in the treatment of oral submucous fibrosis: A clinical and histopathological study. JIAOMR. 2009;21(4):179-83  Back to cited text no. 3
Dr Reddy S, Kamath VV, Satelur K, Y Komali, Krishnamurthy SS. Image analyses of collagen types and thickness in OSMF stained with picrosirius red under polarizing microscope. J Indian Dent Assoc. 2013;5(2):123-27  Back to cited text no. 4
Ghom AG. Textbook of Oral Medicine. 2nd edition. Jaypee publications. p. 217-8  Back to cited text no. 5
More CB, Gupta S, Joshi J, Verma SN. Classification System for Oral Submucous Fibrosis. JIAOMR. 2012;24(2):130-32  Back to cited text no. 6
Ashok L. Red and White Lesions. Textbook of Oral Medicine Oral Diagnosis and Oral Radiology. 2nd Edition. Elsevier publications.p.159  Back to cited text no. 7
Singh P, Gharote H, Nair P, Hegde K, Saawarn N, R Guruprasad. Evaluation of Cachexia in Oral Submucous Fibrosis. JIAOMR. 2012;24(2):130-32  Back to cited text no. 8
Ganiga CS, Sahana S. Correlation between the Functional and Histological Staging of Oral Submucous Fibrosis. JIAOMR. 2012;22(3): 133-35  Back to cited text no. 9
Anuradha P, Mishra G. Prevalence of oral submucous fibrosis among people in periurban areas of Lucknow city, UP. JIAPHD. 2011(18):121-30  Back to cited text no. 10
Afroz N, Hasan SA, Naseem S. Oral submucous fibrosis : A distressing disease with malignant potential. Indian J Community Med. 2006;31(4):270-77  Back to cited text no. 11
  [Full text]  
Sharma R, S Sunder Raj, Mishra G, Reddy YG, Shenava S, Narang P. Prevalence of Oral Submucous Fibrosis in Patients visiting Dental College in Rural Area of Jaipur, Rajasthan. JIAOMR. 2012;24(1):1-4  Back to cited text no. 12
Dave RP. Oral Submucous fibrosis: A clinical and etiological study. JIDA. 1987;59(2):46-51  Back to cited text no. 13


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

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