Oral submucous fibrosis is a chronic disease which is commonly found in patients in the Asian subcontinent and the Far East and is characterised by the build up of constricting bands of collagen in the cheeks and adjacent structures of the mouth. The precise cause is unknown but chewing of betel quid as well as other areca nut containing products, excessive use of chillies and spices, poor nutrition and vitamin and iron deficiency have been suggested.
Mucosal ulcers may occur at an earlier stage, whereas fibrous bands in the cheeks and lips, depigmented gums and a rubbery and deformed soft palate and blanched, leathery floor of the mouth are later developments. These changes can severely restrict mouth opening and tongue movement and cause problems with speech and swallowing whilst other symptoms include a burning sensation whilst eating spicy food, dry mouth and hearing loss.
Treatment options include iron and multivitamin supplements including lycopene, an extract of tomato, and a range of medicines (e.g. intralesional injection of steroids, hyaluronidase, human placenta extracts, chemotrypsin, pentoxifylline and collagenase). Surgery, including cutting of the fibrous bands and jaw muscles and joint, has been used for more extreme cases.
The review authors found two studies which evaluated the effectiveness of lycopene in conjunction with intralesional injections of a steroid, and pentoxifylline in combination with mouth stretching exercises and heat. These studies provided a limited amount of unreliable data which did not permit any firm conclusions to be made. There were no reports of toxicity but some side effects, which were mostly gastric irritation to pentoxifylline, were noted.
Future research should aim to provide evidence for people to make informed decisions about whether these treatments are effective and should also explore treatment plans which include patient education aimed at cessation of the chewing habit.