Interventions for managing oral submucous fibrosis

Area of Science:

• Oral Medicine
• Oncology
• Evidence-Based Medicine

Background:

• Oral submucous fibrosis (OSF) is a chronic, progressive oral cavity disease causing mouth constriction, pain, and reduced function.
• Areca nut chewing is the primary risk factor for OSF, significantly impacting quality of life and increasing oral malignancy risk.
• This review updates previous findings on OSF management interventions, focusing on their benefits and harms.

Approach:

• Systematic review and meta-analysis of 30 randomized controlled trials (RCTs) involving 2176 adult participants with biopsy-confirmed OSF.
• Interventions included systemic, topical, and locally delivered drugs, surgical procedures, physiotherapy, and alternative therapies, compared against placebo or other treatments.
• Outcomes assessed included mouth opening, pain reduction, eating/swallowing function, quality of life, and adverse effects, with evidence certainty evaluated using GRADE.

Key Points:

• Antioxidants showed moderate-certainty evidence for improving mouth opening (interincisal distance) at 3-6 months and reducing burning sensation (VAS scores) up to and beyond 6 months.
• Low to very low-certainty evidence was found for other interventions like pentoxifylline and intralesional dexamethasone regarding mouth opening.
• Limited data exists on participant-reported functional outcomes (eating, speech) and the certainty of evidence for most interventions was low or very low.

Conclusions:

• Systemic antioxidants offer probable benefits for mouth opening and burning sensation in OSF patients.
• Insufficient evidence currently supports or refutes the effectiveness of most other tested interventions for OSF.
• High-quality, adequately powered RCTs with low risk of bias are crucial for establishing effective OSF management strategies, prioritizing participant-reported outcomes.