Physiotherapeutic treatment improves oral opening in oral submucous fibrosis

Abstract

We conclude OSF in the Nepali population progresses in a predictable pattern, and that physiotherapy is effective for increasing the oral opening. We further suggest physiotherapy can be readily used to improve OSF in communities with otherwise limited health resources.

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

“…Only four studies (Rajendran et al, 2006;Kumar et al, 2007;Jirge et al, 2008;and Cox and Zoellner, 2009) met our criteria for an RCT [including the two (Rajendran et al, 2006) and (Kumar et al, 2007) previously reported in the Cochrane review], and all were single center studies. There was one other prospective controlled study that lacked randomization (Lin and Lin, 2007).…”

“…There was one RCT evaluating the effectiveness of physical therapy (Cox and Zoellner, 2009) and three RCTs evaluating the effectiveness of medical interventions: pentoxifylline (Rajendran et al, 2006), lycopene (Kumar et al, 2007) and levamisole with anti-oxidants (Jirge et al, 2008). Evaluation by the working group of the published data from these four RCTs using the GRADE criteria identified significant limitations with each report and challenged the conclusions reached by the authors (Table 3).…”

“…Clinical research methodology has evolved rapidly in some parts of the world, yet elsewhere there is neither the experience, nor the necessary infrastructure, (Lai et al, 1995), (Cox and Zoellner, 2009) Splints or other devices (including postsurgery) (Patil and Parkhedkar, 2009), (Nayak et al, 2009), (Le et al, 1996), (Huang et al, 2008) Microwave diathermy (Gupta et al, 1980), (Gupta et al, 1992) Oral submucous fibrosis, medical management AR Kerr et al (Borle and Borle, 1991), (Kumar et al, 1991) Vitamin A and vitamin B complex (Khanna and Andrade, 1995) Vitamin B complex (Lai et al, 1995) Vitamin B complex (with iodine injection) (Gupta et al, 1992) Vitamins A, B complex, C, D and E plus minerals iron, copper, zinc, magnesium and others (Maher et al, 1997) Ferrous fumarate (Borle and Borle, 1991) Zinc (Kumar et al, 1991) Antioxidants (b-carotene, vitamins A, C and E, zinc, copper, manganese and selenium) (Jirge et al, 2008) Glucosidorum tripterygii totorum, vitamins A and E, nicotinic acid (Liu et al, 1999) Tea pigment, vitamins A, B complex, D and E (Li and Tang, 1998) Lycopene (Kumar et al, 2007) Placental extract (Kakar et al, 1985), (Gupta and Sharma, 1988), …”

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

“…[93] [94] Stephen Cox & Hans Zoellner conducted a clinical trial of physiotherapeutic treatment to improve oral opening in oral submucous fibrosis in the Nepali population and suggested that physiotherapy is effective for increasing the oral opening and can be readily used to improve OSF in communities with otherwise limited health resources. [95] Talsania JR et al evaluated the efficacy of Laser with follow-up physiotherapy to reduce trismus in OSMF and concluded that Diode laser is a less expensive and an alternative method in Asian population as it requires less hospital stay and less follow up as compared to other surgical methods. [96] CO2 lasers are predefined rather than a scalpel or technique involving multiple tiny incisions for surgical relief of limited oral aperture because the laser beam spontaneously seal all the blood vessels, allowing the surgeon perfect visibility and accuracy in excising fibrous tissue.…”

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“…2,3 As the etiology of the disease is not singlet, many treatment modalities have been tried and validated in the literature. 4 Steroids, antioxidants, enzymes like collagenase 5 , chymotrypsin 6 , and hyaluronidase 6,7 , placental extracts 8 , Interferon-γ 9 , lycopene 10 , peripheral vasodilators 11,12 , levamisole 13 , immune milk 14 , physiotherapy 15,16 and surgical modalities 17,18,19 have been cited in the literature, yet they have been palliative and proven to be of minimal benefit. Although intralesional steroids have shown improvement, but are associated with significant discomfort, pain and infection at the injection site and reduction in mouth opening over a period of follow-up as rebound fibrosis is often precipitated as mechanical and chemical injuries in the oral mucosa heal by fibrosis.…”