Protecting Your Oral Health: Dr. Sai Praveen’s Advice on Preventing OSMF (Part 2)

Dr. Sai Praveen: As of now, there are no such natural remedies, but research is going on regarding immunized milk, as they are trying to employ some anti-cancer antibodies into the milk which we get. So, usually they call it immunized milk, which is also being tried. I can't say that it is also natural, but we rarely have some natural ingredients to treat this. We need to go for allopathy, for managing.

Dr. Sai Praveen: There are around five stages of oral submucous fibrosis. In the initial stage, there will be just a burning sensation and a marble white appearance of the mucosa. In such a situation, we can advise a drug by name SM Fibro, which is an antioxidant, so it can be used provided the patient should quit the habit. 

In the second and third stages, where you can see fibrous band formation. In such cases, you need to go for intralesional injections. Intralesional injections mean that we need to inject a corticosteroid, such as dexamethasone, with a dosage of 4mg, and dexamethasone should be mixed with hyaluronidase with the dosage of 1400 international units, and we need to mix these two things and inject it at the site. So, you need to inject at the fiber site. So usually you can use a normal syringe, or you can go with an insulin syringe. I feel that an insulin syringe is far more comfortable than using a regular syringe. So one can inject the materials, the proposed medication intralesionally. 

The purpose of using these two drugs is that the steroid is anti-inflammatory. So, this dexamethasone, what we are giving will reduce the inflammation that is present, and next, the hyaluronidase will destroy the collagen, or fibrous bands that have been deposited. So, as there is a reduction in inflammation, and also breakdown of fibers, there will be reduced burning sensation, and also increased mouth opening. That is the reason why we combine these two drugs and give them intralesionally. 

If it is in the 4th stage, there will be pretty much restricted mouth opening, say something around 10 to 15mm. In such situations, we need to go for laser therapy. We can use a laser for cutting down the fibers in the oral cavity. We can also use cryo liquid/ cryogen liquid/ nitrous oxide liquid, or a cryo gun to destroy these fibers so that we can increase the mouth opening. 

In the 5th stage, some say that it is cancer or a few say that it is ready to develop into cancer. So in such situations, we need to go for chemotherapy for Stage five. So for the four stages we'll be treating it regularly.

Dr. Sai Praveen: Mouth opening exercises are also advised. Usually, these mouth opening exercises are advised post treatment. So after treatment, we will be suggesting the patient to go for mouth opening exercises. So one can advise them to take tongue blades, so the regular ice cream sticks that are available in the market, so they can tie with the help of a band, and they can regularly use those tongue blades to improve their mouth opening. There are also certain devices readily available in the market. One can go through and use it. So we suggest tongue glides in our clinic or our professional clinic, which is readily available. So mouth opening exercises will also benefit the patient, but this benefit is only after taking the treatment.

Dr. Sai Praveen: In my knowledge, I usually prefer diode lasers or soft tissue lasers. So the wavelength that I am using is 910 nanometers, diode lasers. So I usually prefer diode lasers and within a wavelength range of 910 nanometers. Few people are using the wavelength of more. But it is better. Most of the studies are about the 910 nanometer Diode Laser only.

I will be telling you treatment charges, both for intra-lesional injections and also the lasers. So usually for intralesional injections, it will not be finished in one sitting. So intralesional injections will be given in divided doses. So one has to take it four times in a month, like every week, he has to get these intralesional injections. So, one may charge around 2000 to 3000 rupees, depending upon the area of practice, so they may charge around 2000 to 3000 every sitting, for intralesional injections. Likewise, one has to attend for four sittings. Laser fibrotomy is done in one sitting itself. Usually it costs around 10,000 for a patient for laser fibrotomy.

Dr. Sai Praveen: These cases are encountered very often, regularly across two cases in a month. and most of the patients are reluctant to appear for the treatment. They will be just coming for two to three settings, and they will be just leaving, or they will be just vanishing, like into the thin air. So it is said that it is better to come for the whole treatment protocol and get it done, and follow the post-treatment instructions as far as possible, so it could benefit the patient.

Dr. Sai Praveen: Usually, one thing we need to be careful when we are going with the private practice and also in the college setup. First thing we need to get a consent form. So, usually I will be starting the treatment protocol once the patient accepts all my terms and conditions. Like he should attend all the sittings, he should take all the instructions, and he should follow them. I also will be in contact with one of his family members, like his wife or his children, or if it is a woman, her husband or their children, whoever is concerned with them. So I will be regularly talking to them. So my first instruction is to quit the habit. If the patient is not ready or willing to quit the habit, then I am not going to start the treatment protocol at all. So first thing, he should stop the habit. So for that, I will be confirming it with his relatives who are majorly concerned with the health of the subject. And next, I will be taking a consent form so that he needs to attend for all the sittings, if at all, I'm not responsible for reverting back. So that's the thing. These are the two things that I follow in my practice.

Dr. Sai Praveen: No, there is no insurance company to cover the condition.

Dr. Sai Praveen: Yes, research is still going on in this field for getting a better treatment option. As I said, we can just increase the mouth opening of about three to four mm, in a lot of cases. But the treatment options are also very limited. We cannot completely revert back. There are still research going on. Some researchers say that we need to cut off the complete set of oral mucosal epithelium so that fresh epithelium might grow, or a few of them are like just exercising the Buccinator muscle itself, so that mouth opening will be drastically increased. Few are like going with cutting the temporalis muscle attachment. These are all surgical interventions, and coming to pharmacological interventions, placental extracts were also being used. So the ones that are extracted from the placenta can also be used for treating this. Ayurvedic medications are also being tried, like curcumin, which has potent antioxidant activity, but still, it is not successful as of what I know.

Dr. Sai Praveen: No, there are no such medications. If the patient is addicted to tobacco or smoking habit, then they will be given some nicotine replacement therapy, but there is no such areca nut replacement therapy to date. It is just dependent upon our motivation to the patient. We just need to motivate the patient and we need to make him stop. There are no such drugs that will stop the addictive habit of the patient.. It's just his will power to stop the habit, or his relatives force, or the nearby people force him to stop the habit.

Dr. Sai Praveen: I have friends who are working in government dental colleges, they can get treatment done. But even in that government dental College, they need to get their own medication. There are two government sectors here, one is the government dental colleges, and another one is the government hospital sectors. So, the hospital sector people are not doing it. I am working in academics, being in a private Dental College, we are getting people from government dental hospitals, also only government Dental College people were doing treatment, provided a person should take his medication by himself. The doctor will try to give it in a piece of prescription pad. You need to buy it from outside, and he can take it there so that they can treat him with it.