eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Oral Submucous Fibrosis: Follow-up

Author: Nektarios I Lountzis, MD, Staff Physician, Department of Dermatology, Geisinger Medical Center
Coauthor(s): Tammie Ferringer, MD, Teaching Staff, Departments of Dermatology and Pathology, Geisinger Medical Center; Nada MacAron, MD, Staff Physician, Department of Pathology, Emory University School of Medicine; Amy Howard, MD, Fellow, Department of Dermatopathology, Emory University
Contributor Information and Disclosures

Updated: Mar 25, 2009

Follow-up

Further Inpatient Care

  • Ensure nutritional intake is not compromised postoperatively.

Further Outpatient Care

  • Regular physical examinations, biopsy specimen analysis, and cytologic smear testing should be scheduled to detect oral dysplasia or carcinoma, especially in patients with severe oral submucous fibrosis.
  • Patients with surface leukoplakias require close follow-up monitoring and repeat biopsies.
  • Patients with dysplasias and carcinomas should receive routine treatment for these entities.53

Complications

  • Oral dysplasias and squamous cell carcinomas are complications of oral submucous fibrosis. In patients with oral submucous fibrosis, the risk of developing oral carcinoma is 7.6% over a 10-year period.3
  • If the palatal and paratubal muscles are involved in patients with oral submucous fibrosis, conductive hearing loss may occur because of functional stenosis of the eustachian tube.54
  • Patients with oral submucous fibrosis who require anesthesia for trismus correction, resection, and reconstructive (oncoplastic) surgery may have difficulty during laryngoscopy and intubation of the trachea.55

Prognosis

  • No treatment is effective in patients with oral submucous fibrosis, and the condition is irreversible.56 Reports claim improvement of the condition if the habit is discontinued following diagnosis at an early stage.46
  • Patients with oral submucous fibrosis have an increased risk of developing oral cancer. The malignant potential and the origin of cancer are attributed to the generalized epithelial atrophy associated with oral submucous fibrosis.56 Tobacco is the component of the quid believed to be most associated with cancer development. However, the carcinogenic property of the areca nut was discovered after noticing that cancer occurred in patients who chewed the nut without tobacco.21 In vitro, betel nut extracts increase the rate of cell division, reduce cell cycle time, induce DNA strand breaks, and induce unscheduled DNA synthesis.57 Whether the use of tobacco in addition to areca nuts is responsible for the increased risk of oral cancer is controversial because evidence is conflicting.58

Patient Education

  • Instruct patients regarding the importance of discontinuing the habit of chewing betel quid.
  • Inform patients that eliminating tobacco from the quid product may reduce the risk of oral cancer.
  • Instruct patients to avoid spicy foodstuffs.
  • Instruct patients to eat a complete and healthy diet to avoid malnutrition.
  • Instruct patients regarding maintaining proper oral hygiene and scheduling regular oral examinations.
  • Intervention studies and public health campaigns against oral habits linked to oral submucous fibrosis may be the best way of controlling the disease at the community level. Educate the community regarding the local adverse effects of chewable agents, which although not inhaled, are still not harmless.
  • For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. In addition, see eMedicine's patient education article Cancer of the Mouth and Throat.

Miscellaneous

Medicolegal Pitfalls

  • Lack of appropriate follow up for screening and periodic biopsy of suspicious regions of the oral mucosa can lead to missed early premalignant lesions and possible progression to cancer.

Special Concerns

  • Watch for signs that indicate malignant change, which include the following:
    • An unhealing ulcer in the lesion
    • Lesion undergoing red changes (erythroplakia)
    • A burning sensation in the mouth
    • An exophytic mass
    • A lump in the neck
    • Difficulty in chewing, swallowing, or speaking
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.



More on Oral Submucous Fibrosis

Overview: Oral Submucous Fibrosis
Differential Diagnoses & Workup: Oral Submucous Fibrosis
Treatment & Medication: Oral Submucous Fibrosis
Follow-up: Oral Submucous Fibrosis
References
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Further Reading

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Keywords

oral submucous fibrosis, OSF, Asian sideropenic dysphagia, atrophica idiopathica mucosa oris, oral disease, oral cancer, oral fibrosis, oral mucosal disease, oral soft tissue disease, sub-mucous fibrosis, betel nut chewing, Areca catechu, pan parag, gutka, gutkha, guttkha, guthka, betel nut, pan, betel quid, areca nut, mawa, mainpuri

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Contributor Information and Disclosures

Author

Nektarios I Lountzis, MD, Staff Physician, Department of Dermatology, Geisinger Medical Center
Nektarios I Lountzis, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Tammie Ferringer, MD, Teaching Staff, Departments of Dermatology and Pathology, Geisinger Medical Center
Tammie Ferringer, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and American Society of Dermatopathology
Disclosure: Nothing to disclose.

Nada MacAron, MD, Staff Physician, Department of Pathology, Emory University School of Medicine
Nada MacAron, MD is a member of the following medical societies: College of American Pathologists and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Amy Howard, MD, Fellow, Department of Dermatopathology, Emory University
Disclosure: Nothing to disclose.

Medical Editor

Alexa F Boer Kimball, MD, MPH, Associate Professor of Dermatology, Harvard University School of Medicine; Vice Chair, Department of Dermatology, Massachusetts General Hospital; Director of Clinical Unit for Research Trials in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital
Alexa F Boer Kimball, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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