A 47year-old female patient came to the department with complaint of burning sensation on having spicy food since two years. Visual analogue score was 6 for burning sensation. patient gives history of eating arecanut 2-3times per day since two years. On intra-oral examination, pale, blanched appearance of right and left buccal mucosa extending anterior-posteriorly from the retro-commissure area up to the retro -molar area and superior-inferiorly extending from approximately 5 mm above and below the line of occlusion. Marble stone appearance of mucosa with generalized tobacco stains on teeth and hard palate was also observed. Vertical bands were palpable in the buccal mucosa with respect to molar region on right side and the retro-molar area. perioral bands were palpable with respect to the mandibular labial mucosa. Uvula was shrunken and tongue movements was normal. Mouth opening was 35mm (Figure 1, Figure 2, Figure 3 ).

Figure 1

Figure 2

Figure 3

Based on the clinical findings a provisional diagnosis of STAGE II Oral Sub mucous Fibrosis (classification according to Khanna JN et al6 ) was made.

Patient was referred to oral and maxillofacial surgery for further treatment. Incisional biopsy was done and was send for histopathological evaluation. On the basis of Histopathological findings the final diagnosis was Oral Sub mucous Fibrosis with mild dysplasia.

A 40 year old male patient came to the department with a chief complaint of reduced mouth opening since 6 months. The patient stated that his mouth opening has gradually reduced over the last six months. The patient stated that he developed a burning sensation in the mouth on consuming spicy and coarse food in the past three months. Visual analogue score was 4 for burning sensation. The patient gives history of gutkha chewing with slaked lime since 6 years. On oral examination multiple white keratotic patch was present on the commissure of the lip of left buccal mucosa measuring approximately 2x2cm in size with generalized melanosis surrounding mucosa appeared normal. Single fibrous Vertical bands were palpable in the buccal mucosa with respect to left posterior molar region . Uvula was shrunken. Tongue movements was normal (Figure 4, Figure 5, Figure 6 ).

Figure 4

Figure 5

Figure 6

Based on the clinical findings a provisional diagnosis of STAGE II Oral Sub mucous Fibrosis with leukoplakia of left buccal mucosa (classification according to Khanna JN et al 6). Incisional biopsy was taken. On the basis of histopathological findings the final diagnosis was oral submucous fibrosis with mild dysplasia.

A 47year-old male patient brought to the department with complaint of burning sensation in mouth on having spicy food since two years. There was a history of eating arecanut 4-6times per day for the last one year. On Intra Oral examination, pale, blanched appearance of floor of the mouth , right and left buccal mucosa extending from the retrocommisural area up to the retro molar area anterior posteriorly and superior inferiorly from approximately 5 mm above and below the line of occlusion. Marble stone appearance of mucosa was also observed with generalized tobacco stains on teeth and hard palate. Vertical bands were palpable in the right and left buccal mucosa with respect to left and right posterior molar region and the retro-molar area. Perioral band were palpable with respect to the maxillary and mandibular labial mucosa. Uvula was shrunken tongue movements was restricted. Based on the clinical findings a provisional diagnosis of STAGE II Oral Sub mucous Fibrosis was made. Incisional biopsy was taken. On the basis of Histopathological findings the final diagnosis was Oral Sub mucous Fibrosis with mild dysplasia (Figure 7, Figure 8, Figure 9 )

Figure 7

Figure 8

Figure 9

Patent counselling was done and was advised to quit the habit and the capsule of SM fibro was prescribed once daily for 3 months. Treatment given-intralesional injection Hyaluronidase twice a month

The patient was on follow up for 3 months. The vas score for burning sensation was reduced to 1 and there was resolution of the lesion and reduction in palpable bands

In 1956, Paymaster first estimated the OSMF's malignant potential rate to be 7–13%. A recent study predicted that 2-8% of cases with OSMF that progress to squamous cell carcinoma (SCC) are malignant. In India and other south-east Asian nations, the frequency of OSMF varies from 0.2-1.2%. With production and import totalling 622,260 and 80,419 tonnes, respectively, in the fiscal year 2013–2014, India is both the greatest consumer and producer of areca nuts. In India, where betel nut, betel leaf, and tobacco use are more common, mouth cancer is more likely to occur, is more prevalent, and is associated with higher morbidity and mortality 3, 15 .

Primary prevention has been proved to be achievable and effective in decreasing the incidence of OSMF, thus efforts must be undertaken in that regard 18.