Oral submucous fibrosis is a chronic debilitating disease of the oral cavity characterized by inflammation and progressive fibrosis of the submucosal tissues (lamina propria and deeper connective tissues). Oral submucous fibrosis results in marked rigidity and an eventual inability to open the mouth.The buccal mucosa is the most commonly involved site, but any part of the oral cavity can be involved, even the pharynx.

The condition is well recognized for its malignant potential and is particularly associated with areca nut chewing, the main component of betel quid. Betel quid chewing is a habit practiced predominately in Southeast Asia and India that dates back for thousands of years. The mixture of this quid, or chew, is a combination of the areca nut (fruit of the Areca catechu palm tree, erroneously termed betel nut) and betel leaf (from the Piper betel, a pepper shrub), tobacco, slaked lime (calcium hydroxide), and catechu (extract of the Acacia catechu tree).

Lime acts to keep the active ingredient in its freebase or alkaline form, enabling it to enter the bloodstream via sublingual absorption. Arecoline , an alkaloid found in the areca nut, promotes salivation, stains saliva red, and is a stimulant.

Symptoms of oral submucous fibrosis include the following:

  • Progressive inability to open the mouth (trismus) due to oral fibrosis and scarring
  • Oral pain and a burning sensation upon consumption of spicy foodstuffs
  • Increased salivation
  • Change of gustatory sensation
  • Hearing loss due to stenosis of the eustachian tubes
  • Dryness of the mouth
  • Nasal tonality to the voice
  • Dysphagia to solids (if the esophagus is involved)
  • Impaired mouth movements (eg, eating, whistling, blowing, sucking)
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