Fibrosis oral submucous K13.5

Nutritive influences; chronic mucous membrane irritation, e.g. by chewing products of the Areka plant (chewing betel leaves and betel nuts - see betel nut below). When betel nuts are chewed together with some slaked lime, the alkaloid arecolin is converted into arecaidin. In patients with oral submucous fibrosis in lesional mucosa, arecolin is able to increase the mRNA expression of TIMP-1 (tissue inhibitor of metalloproteinases), an inhibitor of MMPs (metalloproteinases). This results in a disturbance of the balance of both enzyme systems with the consequence of an increased collagen content.

Slowly and progressively progressing mucous membrane disease. Initially, burning sensation when eating spicy food, recurrent inflammation, blisters, erosions and ulcers of the oral mucosa. In later stages, increasing epithelial atrophy, increasing induration of the connective tissue and scar-like stringy fibroses with spotty pigment loss.

In advanced stages, leukoplakia, trismus, gingival pigmentation, gingival fibrosis, uvula shrinkage, atrophic tonsils, among others.

1. Cunha-Gomes D et al (2003) Total oral reconstruction for cancer associated with advanced oral submucous fibrosis. Ann Plast Surgery 51: 283-289
2. Pindborg JJ, Sirsat SM (1966) Oral submucous fibrosis. Oral Surg Oral Med Oral Path 22: 401-414
3. Pindborg JJ (1947) Tobacco and gingivitis: I. Statistical examination of the significance of tobacco in the development of ulceromembranous gingivitis and in the formation of calculus. J Dent Res 26: 261-264
4. Shieh DH et al (2003) Augmented mRNA expression of tissue inhibitor of metalloproteinase-1 in buccal mucosal fibroblasts by arecoline and safrole as a possible pathogenesis for oral submucous fibrosis. Oral Oncol 39: 728-735
5. Reichart PA et al (2003) Oral precancerous conditions--an overview. Mouth Jaw facial screen 7: 201-207