Physiotherapy in improving the interincisal mouth opening in oral submucous fibrosis: Meta-analysis

Oral submucous fibrosis (OSMF) is a chronic, irreversible collagen metabolic disorder resulting in progressive reduction of mouth opening due to submucosal fibrosis. Currently, the benefit of interincisal mouth opening (IMO) has been attributed to physical therapy. This meta-analysis aimed to find evidence about effectiveness of physiotherapy in increasing of IMO.

Literature search was conducted in Scopus, Web of Science, and PubMed databases using "Oral submucous fibrosis", "OSMF", "OSF", "treatment", "treatment modalities", "physiotherapy devices", "mouth opening exercise device", "mouth opening", "mouth opening device", and "physiotherapy" search terms to find the relevant studies published till March 2024. Studies evaluating the effectiveness of physiotherapy alone or in combination in improvement of IMO pre-post intervention in OSMF patients were included. Random-effect analysis was carried out to obtain the pooled IMO. Heterogeneity and publication bias was assessed using the I ² and funnel plot. The main outcome variable was increase in IMO which was measured on linear scale.

20 studies included in meta-analysis. Physiotherapy alone was found to be effective in improving IMO (4 studies; MD 1.19 [0.18, 2.20]). Further, addition of physiotherapy along with ultrasound (US) (3 studies; MD 3.96 [1.50, 6.42]), medicinal therapy including herbal (13 studies; MD 8.35 [5.18, 11.51]) and surgery (8 studies; MD 21.84 [18.29, 25.38]) improves the IMO.

There is evidence of effectiveness of physiotherapy in improving the IMO. However, evidence need to be substantiated with stringent methodology which is lacking in most of studies.