An alternative pathogenetic pathway for oral submucous fibrosis (OSMF)

Oral submucous fibrosis is a potent pre-cancerous condition which occurs almost exclusively in Indians but cases have been reported from several countries. The definite aetiology of OSMF is still unknown and there is no known treatment for it. Chilles, tobacco use, vitamin deficiencies and betel quid chewing have been implicated. Ramanathan is of the view that OSMF seems to be the Asian version of sideropenic dysphagia. He suggests that OSMF appears to be an altered oral mucosa following prolonged period of chronic deficiency of iron and/or vitamin "B" complex especially folic acid. This changed state of the oral mucosa subsequently appears to develop more easily a hypersensitivity to oral irritants such as spices especially chillies and to the betel quid. We hold that the hypersensitivity caused by local irritants and the resultant persistent juxta epithelial inflammatory response noted in OSMF (in a host system already primed by an intrinsic genetic defect) act as the initiating factor leading to a defective inflammatory--reparative response, culminating in fibrotic healing. The role of iron and "B"complex together with others may be contributory (promotor) to this pre-existing pathologic response of the lamina propria.