SONAM PENJOR | Thimphu
Among the 278 cases of Oral Submucous Fibrosis (OSMF) reported in the country, Thimphu district had the maximum number with 59 cases.
This can be attributed to the larger population living in Thimphu, followed by Wangduephodrang with 48 reported cases while Gasa and Haa districts had the least cases.
OSMF is a chronic, insidious, scarring disease of the mouth, which leads to ulceration, blanching and ultimately limited mouth opening. It is a pre-cancerous condition and if left untreated might develop into oral cancer over time.
According to Oral Medicine Specialist of the Dental Department in Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Dr Gyan Prasad Bajgai said that the patients were clinically diagnosed by examining their mouth and by measuring their mouth opening (Inter-incisal height).
He said patients who had less than three fingers mouth opening (30 mm) and diagnosed as OSMF during the two and half year period from June 2018 to December 2020 were considered for the study.
Dr Gyan added that mouth opening is restricted in this disease along with pain and burning sensation in the mouth.
“These are the only reasons patients visit hospitals for care and support. The primary aim of the treatment is to increase mouth opening and render them asymptomatic while eating, such that the patients are able to live normal or near normal life,” Dr Gyan said.
The research conducted by Dr Gyan, including other two researchers on ‘Distribution of OSMF Cases and Malignant Transformation Rate among Bhutanese Patients Treated at JDWNRH’, states that more males were affected than females.
The malignant transformation (conversion into cancer) rate among these patients was 4.3 percent, which is quite similar to that of the region at 2 to 8 percent.
“Conversion into cancer was more common or likely among those who also had other habits like smoking, chewing tobacco and drinking alcohol along with chewing betel and betel products,” Dr Gyan said.
He added that the normal range of mouth opening differs from person to person, varying between 40-60 mm with an average between 35-55 mm which is equal to the width of three fingers.
It was found out that Thimphu had the highest proportion of OSMF cases and was almost equally distributed among genders. However, males displayed greater mouth opening than females. A majority, accounting to 77 percent of them, were in the age group 19-59 years.
The research also revealed that over 90 percent of the patients reported improvement without surgery while the malignant transformation rate was 4.3 percent. “It recommended screening in districts with a high burden of OSMF cases for early diagnosis and treatment.”
Dr Gyan Prasad said that betel nut and its products are the main etiological factors for development of OSMF.
Other factors are chillies, lime, tobacco, nutritional deficiencies such as iron and zinc, immunological disorders, collagen disorders, GERD, smoking or chewing tobacco, alcohol and certain syndromic diseases.
The South East Asian region has a higher prevalence of OSMF compared to other parts of the world which can be attributed to the habit of chewing betel nut and betel products.
In Bhutan, he said that it is customary to offer betel during functions and festivals, which is chewed by wrapping it in a betel leaf along with lime. However, Dr Gyan said there is limited data or studies about the topic in Bhutan.
Meanwhile, there is no effective and definitive treatment for OSMF, therefore, timely diagnosis and treatment is important for good prognosis of the disease.