Interventions for managing oral submucous fibrosis – Commentary to a systematic review

Oral submucous fibrosis (OSMF) is a chronic, debilitating condition characterized by fibrosis of the oral mucosa, leading to restricted mouth opening, impaired chewing, and speech difficulties. Although its exact causes are not fully understood, factors such as betel nut chewing, nutritional deficiencies, genetic predisposition, and consumption of spicy foods are thought to contribute. A recent update by Jones et al. (2023) [1] of the Cochrane Review titled “Interventions for managing oral submucous fibrosis” included 30 randomised controlled trials (RCTs), with 28 added since the initial 2008 review. The primary focus was on evaluating patient-reported outcomes (PROs) for managing OSMF, such as improvements in eating, chewing, and speech. However, only four studies measured these outcomes; most focused on inter-incisal distance and burning sensation intensity. Moderate-certainty evidence showed that antioxidants improved these parameters, but no other interventions demonstrated consistent benefits compared to non-active controls. Adverse effects were reported in half of the studies, with poor reporting of participant demographics and limited use of rigorous methodologies, such as proper blinding and allocation concealment. Additionally, surgical interventions, evaluated in four studies, posed high complication risks. The review underscores the urgent need for robust research to better understand OSMF pathogenesis and identify effective interventions. Standardising trial designs, prioritising PROs alongside objective measures, and conducting preclinical studies to explore mechanisms of action are critical. Furthermore, prevention through education and cultural shifts away from areca nut use remains essential in reducing the burden of OSMF globally.