Evaluation of multiple micronutrient supplementation in the management of oral submucous fibrosis in Karachi, Pakistan

Abstract

Oral submucous fibrosis (OSF) is an oral precancerous condition characterized by symptoms such as intolerance to spicy food, altered salivation, progressive difficulty in opening the mouth, and signs like vesiculation, ulceration, blanching, rigidity, and stiffening of the oral mucosa and depapillation and altered mobility of the tongue. It is seen mostly among people of Indian subcontinent origin. The major structural change is extensive fibroelastic scarring of the lamina propria and deeper connective tissues. A combination of micronutrients (vitamins A, B complex, C, D, and E) and minerals (iron, calcium, copper, zinc, magnesium, and others) was evaluated for its efficacy in controlling the symptoms and signs of OSF in 117 compliant subjects in Karachi, Pakistan, in a single-arm preliminary study. The subjects received supplementation for one to three years. Significant improvement in symptoms, notably intolerance to spicy food, burning sensation, and mouth opening, was observed at exit. The interincisor distance deteriorated in 11 subjects (10%) at exit; it was stable in 56 subjects (49%) and improved in 48 (41%). The mean interincisor distance was 19.1 +/- 10.8 (SD) mm at exit compared with 16.2 +/- 7.5 mm at baseline. A significant proportion of concomitant lesions like leukoplakia also regressed at exit. The major outcome from this study was a beneficial clinical response in subjects with OSF to multiple micronutrient intervention, which justifies its further evaluation in well-designed randomized controlled trials in other settings in South Asia.

A study on genetic polymorphism in Matrix Metalloproteinases-3 in oral submucous fibrosis patients and in healthy individuals

“…In our study the distribution of the individuals was based on the mean age which was 33.71 years. It was noted that the age group between 19 and 34 years were in majority in the study group, which was similar to studies by Rupak et al, Katharia et al and Maher et al [19][20][21]. More than 64% of cases were below 35 years of age in accordance with a study by Sinor et al [22].…”

A systematic review of medical interventions for oral submucous fibrosis and future research opportunities

“…Enrolled populations had a wide spectrum of OSF (i.e. from early to advanced), and yet stratification of the study group by OSF stage ⁄ severity rating was defined at baseline in only approximately half of the studies, most of these by reporting baseline mouth opening, although some studies grouped subjects by range of opening (Ariyawardana et al, 2005), (Maher et al, 1997) and (Lai et al, 1995), or by using various rating scales (Khanna and Andrade, 1995), (Gupta et al, 1992), (Talsania et al, 2009) and .…”

Recent Concepts of Etiopathogenesis and Management of Oral Submucous Fibrosis: A Review of Literature

“…[63] Another study by (Maher et al) evaluated the efficacy of combination of micronutrients (Vitamins A, B complex, C, D, and E) and minerals (iron, calcium, copper, zinc, magnesium, and others) in controlling the symptoms and signs of OSMF. [64] Significant improvement in symptoms, notably intolerance to spicy food, burning sensation, and mouth opening, was observed at exit. Borle et al, (18) reported that Vitamin A, 50,000 IU chewable tablets, if given once daily could cause symptomatic improvement.…”