O

CONTENTS
Definition
Etiology Pathogenesis

Clinical findings
Diagnosis management

Definition:
An insidious chronic disease affecting any part of the

oral cavity and sometimes pharynx although ocassionally preceded by or associated with vesicle formation,it is always associated with juxtaepithelial inflammatory reaction followed by fibroelastic changes in the lamina propria,with epithelial atrophy leading to stiffness of oral mucosa and causing trismus and inability to eat.

Etiology
1)habitual chewing of areca nut. 2)genetic predisposition.

3)vit b12 deficiency or nutritional deficiency

4)collagen disorder. 5)chilly consumption. 6)tabacco chewing

Clinical findings:
Age & sex distribution:Between 20 to 40 yrs of age

affect both sexes.

Site distribution:buccal mucosa,lip,palate,palatal

fauces,uvula,tongue,labial mucosa,floor of the mouth.

Prodromal Symptoms:first sign is erythematous lesion

sometimes in conjugation with petechiae,pigmentation & vesicles.

 Burning sensation of the oral mucosa & it is aggravated by

spicy food. Hypersalivation or dryness of mouth may be seen. Late symptoms:trismus,difficulty in tongue protrusion,difficulty in swallowing,interference with speech.tongue mobility,decrease ability to open mouth. Reffered pain. Blanching of mucosa due to impairment of local vascularity.

FEATURES

GRADE I GRADE II GRADE III GRADE IV GRADE V CLINICAL INCIPIENT (mild)OSMF(moderate) (advanced (advanced GRADING OF ACCO.TO SEVERITY (very early stage) premaligna stage) nt&maligna nt changes) Burning sensation, dryness of mouth,vesic le or ulceration Burning sensation, dryness of mouth Burning sensation, dryness of mouth Burning sensation ,dryness of mouth All classical sing of OSMF& associated with leukoplakia and lichen planus

Symtoms

Spicy food

Irritation with spicy food

Irritation with spicy food

Irretation with spicy food

Irretation with spicy food

FEATURES

GRADE I INCIPIENT( very early stage)

GRADE II (mild)

GRADE III (moderate)

GRADE IV (advanced stage)

GRADE V (advanced premaligna nt&maligna nt changes)

Mucosal color

No change in mucosal color No fibrosis,band s palpable

Mucosa is blanched& Loses its sensation No clear-cut fibrotic bands

Blanched opaque leather like mucosa Vertical fibrotic bands on buccal mucosa making it stiff

Blanched opaque leather like mucosa Thick fibrosed bands occuring on both the buccal mucosa in retromolar area& Pterygomand ibular raphe Very little mouth

Fribrosis

Mouth opening

normal44m m

Slight restriction26

Considerable restriction15-

FEATURES

GRADE GRADE(mil GRADE(mo GRADE(ad 1INCIPIEN d) derate) vanced T(very early stage) stage) Tongue protrusion normal _ Tongue protrusion normal _ Not much affected Restricted tongue protrusion

GRADE(ad vanced premaligna nt&maligna nt changes)

Tongue

Eating&spe aking

Difficulty in Eating eating &speaking &speaking very much impaired Poor oral hygiene Very poor oral hygiene

Oral hygine

DIAGNOSIS:
Based on clinical characteristic

Based on patient report of a habit of betel quid chewing.

Blood chemistry & hematological variation. An international consensus has been reached where

atleast one of the following characteristics should be present: -palpable fibrous band -mucosal texture feel tough and leathery -blanching of mucosa together with histopathological features consistent with osmf.

MANAGEMENT.
Restriction of habit and behavioural therapy. Nutritional support.

Immuno modulatory drugs: systemic application of steroids.

Physiotherapy. Local drug delivery:local injection of corticosteroids &

placental extract in addition to hyaluronidase,collagenase & substance that decreases collagen formation. Combined therapy. Surgical management By laser,cryotherap,diathermy.

REACTION TO MECHANICAL TRAUMA

Morsicatio
Frictional hyperkeratosis

MORSICATIO
Morsicatio is instigated by habitual chewing
This parafuntional behavior is done unconsciously & is

therefore difficult to bring to an end. Most frequently seen in the buccal & lip mucosa.

 The prevalence has been reported to be in the range of

1.2 to0.5%. ETIOLOGY:neurological,psychological,dental.

 CLINICAL FEATURES
Age&sex:occurs at any age,lesion is three more

common among women. site:on buccal mucosa at the level of occlusion,lip, lateral border of tongue. appearence:there is lacerated&reddened area. Signs-rough on palpation

 DIAGNOSIS
Typical clinical appearance with typical

location. D/D-hairy leukoplakia,candidiasis.

 MANAGEMENT
Psycotherapy. Acrylic guard.

FRICTIONAL HYPERKERATOSIS
It is a white lesion observed in area of oral mucosa

subjected to increased friction caused by for eg. Food intake.

ETIOLOGY
It is observed in area subjected to increased abrasion Due to minor trauma

Smoking&alcohol consumption

CLINICAL FINDINGS
Mostly seen in edentulous areas of alveolar ridge that

are exposed to increased friction. Lesion is nonsymptomatic.

DIAGNOSIS
It is based on clinical features If doubtful biopsy is mandatory

MANAGEMENT
On the bases of etiology
No surgical intervention is indicated