Oral Submucous Fibrosis (OSMF) Etiology

Oral Submucous Fibrosis (OSMF) Etiology
Epidemiological data and intervention studies suggest that areca nut is the main aetiological factor for OSF (Pindborg et al, 1984; Seedat & Van Wyk, 1988; Sinor et al, 1990; Maher et al, 1994; Murti et al 1995; Merchant et al, 1997; Shah & Sharma, 1998; Yang et al, 2001; Farrand et al, 2001; IARC, 2004; Jacob et al, 2004). Other etiological factors suggested are chillies, lime, tobacco, nutritional deficiencies such as iron and zinc, immunological disorders, and collagen disorders. Extensive research is being done on the Indian supari.
Areca nut:
The term areca nut is used to denote the unhusked whole fruit of the areca nut tree and term betel nut is used exclusively to refer to the inner kernel or seed which is obtained after removing husk. The betel nut has psychotropic and anti helminthic property due to presence of areca alkaloids. Four alkaloids have been conclusively identified in biochemical studies, arecoline, arecaidine, guvacine & guvacoline, of which arecoline is the main agent. These alkaloids have powerful parasympathetic properties which produce euphoria and counteract fatigue.
Nitrosation of arecoline leads to the formation of areca nut specific nitrosamine namely nitrosoguvacoline, nitrosoguvacine and 3-methyl nitrosominopropionitrile, which alkylate DNA. Metabolism of these areca nut specific nitrosamine lead to formation of cyanoethyl, which binds with o’methyl guanine in DNA. Prolonged exposure to this irritant leads to malignant transformation.
Recently suggested pathogenesis of oral submucous fibrosis is by dual action of areca nut. It is suggested that arecoline not only stimulates fibroblastic proliferation and collagen synthesis but also decreases it’s breakdown. This suggests that arecoline is the active metabolite in fibroblast stimulation.
Areca and slaked lime :
In a habitual betel nut chewer, oral submucous
fibrosis may be caused by the amount of tannic acid contained in the betel nut, the influence of mixed calcium powder and the conditional action of arecoline content in betel nut, affecting the vascular supply of oral mucosa and causing neurotropic disorder .This view was further supported by the finding that, addition of slaked lime Ca(OH)2 to areca nut in pan facilitates hydrolysis of arecoline to arecaidine (more potent than arecolin) making this agent available in the oral environment.
Tobacco & Lime:
These are known irritants and causative factors in oral malignancy. They may act as local irritants. The commercially freeze dried products such as Pan masala, Gutka and Mawa (areca, tobacco and lime) have high concentrates of areca nut per chew and appear to cause OSF more rapidly than by self prepared conventional betel quid which contain smaller amounts of areca nut. (Shah & Sharma, 1998; Sinor et al, 1990).
Chillies:
The use of chillies (Capsicum annum and
Capsicum frutescence) has been thought to play an etiological role in oral submucous fibrosis. Capsaicin, which is vanillylamide of 8-methyl-6-nonenic acid, is the active ingredient of chillies, play an etiological role in oral submucous fibrosis (Rajendran, 1994).
Nutritional deficiency:
A subclinical vitamin B complex deficiency has been suspected in cases of OSF with vesiculations and ulcerations of oral cavity. The deficiency could be precipitated by the effect of defective nutrition due to impaired food intake in advanced cases and may be the effect, rather than the cause of the disease (Rajendran, 1994).
Defective iron metabolism:
Microcytic hypochromic anemia with high serum iron has been reported in submucous fibrosis (Rajendran, 1994).
Collagen disorders:
Oral submucous fibrosis is thought to be a localized collagen disease of oral cavity. It is linked to scleroderma, rheumatoid arthritis, Duputreyen’s contracture and intestinal fibrosis. A link between scleroderma and oral submucous fibrosis has also been suspected on the basis of similarity of histologi- cal characteristics (Tsai et al, 1999; Tilakratne et al, 2005)
Immunological disorders:
Raised ESR and globulin levels are indicative of immunological disorders. Serum immunoglobulin levels of IgA, IgG and IgM are raised significantly in oral submucous fibrosis. These raised levels suggest an antigenic stimulus in the absence of any infection. Circulating autoantibodies are also present in some cases of oral submucous fibrosis

[@wafflewaffle1463]

That angry helminthus is so cute 😁

[@dr.polyphonixmuzik5558]

Thanx sir ......make video on treatment and management of osmf plz

[@rishikchithaluri]

Simple and Super explanation Sir 👍

[@Hay_Tex_]

How can capsaicin cause fibrosis if it fights against fibrin?

[@shubhampandey529]

Hindi me video banao bhai.... Itni English aati to gutkha nhi khate..

[@rahuljaiswal1413]

Advice medicine

[@rahuljaiswal1413]

Pls sir