In 2009, Cox, et. al., conducted study about Oral submucous fibrosis (OSF) which is a debilitating condition characterized by fibrous bands and painful mucosal burning, which severely restrict oral opening, impeding speech and eating. OSF predominantly affects communities where the consumption of areca nut is common, and its exact cause remains uncertain. Current treatment options, including surgery and medications, often offer limited success and are not easily accessible in such communities. However, recent reports suggest improved outcomes when surgical intervention is followed by physiotherapy. In this study, we aimed to investigate whether physiotherapy alone could bring about positive changes in tissue remodeling, thereby increasing oral opening in OSF patients.

A total of fifty-four Nepali patients diagnosed with OSF were enrolled in this study and randomly assigned to one of three groups. The first group received physiotherapy, consisting of the daily placement of tongue spatulas between the teeth, with a new spatula added every 5-10 days. The second group received local injections of hyaluronidase with steroids, while the third group received no active treatment.

Our findings revealed a higher prevalence of OSF in males compared to females (p < 0.05). Among the patients, all reported reduced oral opening, and 47% experienced mucosal pain. Notably, mucosal involvement followed a consistent pattern, commencing with the soft palate and progressing sequentially to the fauces, unilateral buccal mucosa, bilateral buccal mucosa, floor of the mouth, and finally the lip mucosa (p < 0.006). Physiotherapy demonstrated a significant improvement in oral opening (p < 0.0005) but did not alleviate oral pain. In contrast, no marked improvement was observed in untreated patients or those treated with injections.

This study concludes that OSF progression in the Nepali population follows a predictable pattern, with physiotherapy proving effective in increasing oral opening. Furthermore, our findings suggest that physiotherapy can serve as a viable and accessible intervention for improving OSF outcomes in communities with limited access to healthcare resources, particularly in regions where areca nut use is prevalent. This research offers hope for individuals suffering from OSF by presenting a cost-effective and practical treatment option that can be easily implemented.

Reference: Cox, S., & Zoellner, H. (2009). Physiotherapeutic treatment improves oral opening in oral submucous fibrosis. Journal of oral pathology & medicine, 38(2), 220-226.