Oral submucosal fibrosis is a chronic disease that is commonly found in patients in the subcontinent of Asia and the Far East and is characterized by the accumulation of constrictive bands of collagen in the cheeks and adjacent structures of the mouth. The precise cause is unknown, but the chewing of quid betel as well as other products containing areca nut, excessive use of peppers and spices, malnutrition and deficiency of vitamin and iron have been suggested.
Mucosal ulcers may occur in an earlier stage, while fibrous bands on the cheeks and lips, depigmented gums and a soft elastic and deformed palate and paled, leather floor of the mouth are later developments. These changes can severely restrict mouth opening and tongue movement and cause problems with speech and swallowing while other symptoms include a burning sensation while eating spicy food, dry mouth and hearing loss.
Treatment options include iron and vitamin supplements, including lycopene, a tomato extract, and a range of medications (for example, intralesional steroid injection, hyaluronidase, human placenta extracts, chemotrypsin, pentoxifylline, and collagenase). Surgery, including cutting fibrous bands and mandible muscles and joints, has been used for more extreme cases.
The review authors found two studies that evaluated the efficacy of lycopene in conjunction with intralesional injections of a steroid, and pentoxifylline in combination with stretching exercises in the mouth and heat. These studies gave a limited amount of unreliable data, which did not allow any firm conclusion to be made. There were no reports of toxicity, but some side effects, which were mainly 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 that include patient education aimed at cessation of the chewing habit.