Systemic Antioxidants in Management of Oral Submucous Fibrosis: A Systematic Review of Randomised Control Trials and Meta–analysis.

Abstract

Introduction: Antioxidants relieve the signs and symptoms of oral submucous fibrosis by decreasing the load of free radicals. Aim: The aim of this systematic review was to retrieve and analyse clinical studies investigating systemic antioxidants in the management of OSMF. Material and method: Literature was searched in electronic search engines from 1995 to 2015. The identified titles / abstracts were independently screened according to set criteria for selection of abstracts. The full -text articles retrieved were assessed for eligibility and the eligible studies were assessed for qualitative and quantitative evidence. 9 full text articles were selected and assessed for eligibility. 6 full text articles were eligible for qualitative and quantitative analysis. Meta -analysis was done for mouth opening. Results: The extracted data resulted in 207 subjects using systemic antioxidants. Meta -analysis of the combined data of the studies administering systemic antioxidants as a single entity or in combination with intralesional corticosteroids (n=121) as compared to other interventions (n=121) did not depict significant improvement in mouth opening (SMD = -1.446; 95% CI = -3.332 to -0.439) with significant test of heterogeneity (p = 0.0001 < 0.05). Meta -analysis of the combined data of all the interventional groups (n=207) and control groups (n=203) which depicted that systemic antioxidants as a single entity or in combination with intralesional steroids significantly improve mouth opening v/s controls (SMD = -1.235; 95% CI = -2.263to -0.206) with a significant test of heterogeneity (and p = 0.0001 < 0.05). Conclusion: Although the meta -analysis indicates that antioxidants appear to be effective in management of OSMF, the high degree of heterogeneity and limited amount of data in this systematic review and meta -analysis does not provide a credible evidence to support these observations.