Ayurvedic Management of Oral Submucous Fibrosis

ABSTRACT

Oral health is a major concern for the whole world. As it has the major health burden for the various counties in their lifetime which cause pain, discomfort, disfigurement, and sometimes even death. According to WHO it is estimated that 3.5 billion people are affected with oral diseases. There is one such disorder known as the oral submucous fibrosis is also an oral disorder which we will be discussing about in this article, we will also be looking on the ayurvedic aspect of this disease and its treatment in ayurveda

INTRODUCTION

It is a chronic and premalignant condition of the oral cavity which can affect any part of the oral cavity and also can affect the pharynx. It is associated with the inflammation of the juxta epithelial inflammatory reaction which is then followed by fibroelastic changes and epithelial atrophy which causes the stiffness of the oral cavity leads to trismus and inability to eat. This condition is preceded by the formation of the vesicles which can then become malignant growths. It can also occur with the characteristics like reduced movement and loss of papillae of the tongue, and leathery texture of the oral mucosa. In 1996 it was estimated 2.5 million people were affected with the oral submucous fibrosis. In India it is estimated that 0.2- 2.3 % males and 1.2- 4.6% females.

CLASSIFICATION

It is clinically divided into three types of stages:

Stage 1- Inflammation of oral mucosa (stomatitis)

Stage 2- Stage of fibrosis (tissue of oral mucosa starts blanching and later buccal mucosa looks like marble

Stage 3– It is a sequel of fibrosis of oral mucosa

• First leukoplakia
• Deficits of speech and hearing

There’s one more system of classification which was proposed by Khanna and Andrade in 1995 for the surgical management of trismus

• GROUP 1– in this stage there is intrinsical distance of mouth opening is 35 mm it is an earliest stage in which there is no limitations of mouth opening
• GROUP 2- patients have intrinsical distance of 25-35mm
• GROUP 3– it has an intrinsic distance of 15-26 mm, fibrotic bands can be seen in the soft palate.
• GROUP 4A– in this stage there is severe trismus it has less than 15mm of intrinsical distance
• GROUP 4B– it is the most advanced stage which has premalignant and malignant changes in the mucosa.

CAUSES OF THE ORAL SUBMUCOUS FIBROSIS

The substances which have the high concentrations of the areca nut like paan masala, gutka, sweet supari, betel quid  are the main causes of the oral submucous fibrosis other causes which can also cause this disorder are like

• Certain immunological diseases
• Extreme climatic conditions like extreme cold and extreme hot climate
• Prolonged deficiency of the different vitamins and iron in the diet

SYMPTOMS OF THE ORAL SUBMUCOUS FIBROSIS

There is a leathery feel of the oral cavity with the palpable fibrotic band and after the disease advances the oral cavity gets stiff and blanched. Some other symptoms are like:

• Recurrent ulceration of oral cavity
• Dryness of the mouth
• Ear pain and deafness
• Nasal voice
• Shrunken uvula like a bud
• Stiffening of the lips
• Thinning of the lips
• Oral mucosa is getting pigmented
• Burning sensation and severe dryness of the oral mucosa
• Mouth opening is decreased with the decreased movement of the tongue.

DIAGNOSIS

Diagnosis can be made clinically on the basis of classification. All the stages show different types of features and doctors can easily diagnose the oral submucosa disease in every stage.

AYURVEDIC CORRELATION

Ayurveda has mentioned many many mukha rogas (oral disease) but this disease cannot be correlated with any disorder of mouth but some symtoms which are mentioned in scattered form can be correlated according to the ayurveda like difficulty in opening the mouth krichhen vivroni mukhan (ashtang/21/59)  mukhadaha, usha (burning senstation of mouth) tikshna asaha (spicy food intolerance) , mukha antragata vrana (ulcers of mouth) durudha vrana (fibrosis)(sush/ch/1/84,90)  all the symptoms can be found in different aspects of the moth diseases. This disease mainly can be related to the vata pitta dominant and can come under the classification of the sarvasara mukha rogas (disease affecting whole oral cavity)

TREATMENT

Different approaches are used for the treatment for the treatment of this disorder like:

CONSERVATIVE TREATMENT

• Ceasing the use of tobacco
• Less usage of spicy food and chilly
• Oral hygiene care
• Vitamins like A, B complex,  C and iron should be added in the diet
• Ceasing the use of alcohol, hot fluids, tea and coffee.

MEDICAL TREATMENT

Many drugs can be prescribed for the treatment of the oral submucous fibrosis which are:

• Chewing pellets of hydrocortisone (Efcorlin)
• Injection of lignocaine and hyaluronidase
• Submucosal injection of hydrocortisone
• Surgical treatment can be done when the intrinsic distance become less than 2mm.
• Pentoxifylline can be used for the treatment as this increases the dilation of vessels.

AYURVEDIC TREATMENT

As this is a disease of the predominant doshas vata and pitta which are aggravated at the place of kapha so the treatment would be according to that. Diseases which are associated with the mouth can be treated with the help of procedures like kawal and gandush (medication filled in mouth), oral medications, nasya (herbal nasal drops), dhoompan (inhalation of medicated smoke) etc. and the herbs which will pacify the vata and pitta dosha will be used for the treatment of oral submucous fibrosis

TREATMENT FROM PLANET AYURVEDA

Planet ayurveda is having medications which are able to treat the oral disorders, and this oral submucosa disorder can also be treated with the medications of planet ayurveda as they are specifically made for diseases like oral submucous fibrosis. These medications are made under the pure and hygienic environment and are standardized by the ayurvedic experts. These medications are free from any chemicals, fillers and preservatives.

MEDICATIONS WHICH CAN BE USED ARE

• Curcumin capsules
• Ashwagandha capsules
• Chandraprabha vati
• Kanchnaar guggul
• Gum care powder
• Irimedadi oil
• Coral calcium complex
• Arjun saar

1. Curcumin capsules

These capsules are filled with the extracts of the curcumin (Curcuma longa) which is known as a very good antioxidant and it removes free radicals from the body which are responsible for the cancerous growth in any part of the body. It is also responsible for the starting stage in which there are ulcers and inflammation as this acts as the anti-inflammatory.

Dose– 2 capsules twice with warm water after meals

2. Ashwagandha capsules

These capsules contains extracts of ashwagandha (Withania somnifera) this medication acts as a rejuvenator and helps in the healing of the inflammation and it also have antioxidant properties, it also pacifies the vata and pitta dosha.

Dose– 2 capsules twice with warm water after meals

3. Chandraprabha vati

it is a medication in tablet form which contains many herbs like shilajit (asphaltum), guggul (Commiphora mukul), karpoor (Cinnamomum camphora), vacha (Acorus calamus), chavya (Piper chaba) etc. there are 37 ingredients in this formulation it is beneficial for many disorder and mainly it removes toxins from the body through the urine and purifies blood, it is also a rasayanic composition which helps in formation of new healthy cells and it removes the free radicals from the body which can cause malignancy.

Dose – 2 tablets twice daily with warm water after meals

4. Kanchnaar guggul

These tablets are made up of kanchnar bark (Bauhinia variegata), triphala, trikatu,varuna (Crataeva religiosa) this medication is mainly used for any abnormal growths in the body. The malignant growths which are grown in the mouth and the fibrosis can be treated with the help of this medication.

Dose – 2 tablets twice daily with plain water after meals

5. Gum care powder with Irimedadi oil

This powder is made up of Zingiber officinale, Terminalia chebula, Cyperus rotundus acacia catechu etc which are helpful for any inflammation in the gums and prevent bleeding.

6. Irimedadi oil

Irimedadi oil has base oil of sesame oil and herbs which are added to the oil is irimeda chal (bark of Acacia farnesiana) with some other herbs this oil is used for disorders related to the oral cavity. It possesses different properties.

Usage – These two can be mixed and gargled for a while

7. Coral calcium complex

This medication is made up of praval pishti (coral), akik pishti (agate), jawar mohra pishti (an ayurvedic herb) etc. this medication is very good for the treatment of cancer

Dose -1 capsule twice daily

8. Arjuna saar

This medication is helpful for the dilation of vessels which will help in reduction of the fibrosis and increase the blood flow of the oral mucosa. It contains arjuna (Terminalia arjuna), amla (Indian gooseberry) in the form of juice.

Usage– Rinsing mouth for 2-3 minutes with this after massage with gum care powder.