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Oral Submucous Fibrosis Follow-up

  • Author: Nektarios I Lountzis, MD; Chief Editor: William D James, MD  more...
Updated: Aug 11, 2014

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.[59]

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

Further Inpatient Care

See the list below:

  • Ensure nutritional intake is not compromised postoperatively.


See the list below:

  • 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.[60]
  • 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.[61]


See the list below:

  • No treatment is effective in patients with oral submucous fibrosis, and the condition is irreversible.[62] Reports claim improvement of the condition if the habit is discontinued following diagnosis at an early stage.[50]
  • 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.[62] 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.[22] In vitro, betel nut extracts increase the rate of cell division, reduce cell cycle time, induce DNA strand breaks, and induce unscheduled DNA synthesis.[63] 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.[64, 65]

Patient Education

See the list below:

  • 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 eMedicineHealth's Cancer Center. In addition, see eMedicineHealth's patient education article Cancer of the Mouth and Throat.
Contributor Information and Disclosures

Nektarios I Lountzis, MD Consulting Staff, Advanced Dermatology Associates, Ltd, Lehigh Valley Health Network

Nektarios I Lountzis, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, American Contact Dermatitis Society, International Society of Dermatopathology

Disclosure: Nothing to disclose.


Nada Macaron, MD Consultant Pathologist, Institute of Pathology and Laboratory Medicine, Sheikh Khalifa Medical city, UAE

Nada Macaron, MD is a member of the following medical societies: College of American Pathologists, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Amy Howard, MD Fellow, Department of Dermatopathology, Emory University

Disclosure: Nothing to disclose.

Tammie Ferringer, MD Dermatopathology Section Head, Dermatopathology Fellowship Director, 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, American Society of Dermatopathology, International Society of Dermatopathology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

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, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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