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 Table of Contents  
Year : 2019  |  Volume : 10  |  Issue : 4  |  Page : 679-681  

Oral submucous fibrosis in a 5 year old child

1 Department of Oral Medicine and Radiology, Meghna Institute of Dental Sciences, Nizamabad, Telangana, India
2 Department of Pediatric and Preventive Dentistry, Meghna Institute of Dental Sciences, Nizamabad, Telangana, India

Date of Web Publication27-May-2020

Correspondence Address:
Harshavardhan Talla
Department of Oral Medicine and Radiology, Meghna Institute of Dental Sciences, Nizamabad, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ccd.ccd_898_18

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Oral submucous fibrosis (OSMF) is one of the potentially malignant disorders (PMDs), predominantly observed in adults with a habit of chewing areca nut. A rapid increase in the use of commercially available nicotine products, especially among the children and adolescents, is a reason for consequential concern. Nicotine products remain to be the chief etiological factor, which increases the susceptibility of the oral mucosa to different kinds of PMDs irrespective of the age groups. Here is a case report of oral submucous fibrosis in a 5-year-old child, highlighting a strong association of areca nuts in the causation of OSMF.

Keywords: Areca nut, nicotine, oral submucous fibrosis, potentially malignant disorder

How to cite this article:
Talla H, Ravindranath Reddy P V, Mudavath M, Bathina T. Oral submucous fibrosis in a 5 year old child. Contemp Clin Dent 2019;10:679-81

How to cite this URL:
Talla H, Ravindranath Reddy P V, Mudavath M, Bathina T. Oral submucous fibrosis in a 5 year old child. Contemp Clin Dent [serial online] 2019 [cited 2020 Jul 12];10:679-81. Available from:

   Introduction Top

Oral submucous fibrosis (OSMF) is a chronic, progressive, potentially malignant disorder (PMD), which is characterized by fibroelastic changes in the lamina propria. This condition gradually leads to the stiffening of the oral mucosa followed by reduced mouth opening.[1] Even though many etiologic factors play a vital role in the progression of OSMF, areca nut remains to be the primary causative agent. Surveys that have been conducted in different academic institutions of India revealed that around 13%–50% of school-going children were chewing areca nuts in various forms.[2],[3]

Updated literature gives evidence of very few pediatric cases of OSMF among which the youngest patient was a 4-year-old girl, reported by Hayes in the year 1985.[4]

Our case report of OSMF in a 5-year-old girl draws attention to the increasing use of commercially available nicotine and areca nut products among children. The flavor and appealing packages are attracting the younger generation, and a lack of awareness of its adverse effects is resulting in a higher occurrence of PMDs among them.

   Case Report Top

A 5-year-old girl was reported to the outpatient department with a chief complaint of limited mouth opening for 3 months. A history of burning sensation of her mouth on taking hot and spicy food for 6 months followed by a gradual reduction in the mouth opening to the present size was given. On taking a personal history, her grandparents revealed that the girl had a habit of eating mud when she was 3 years old. Her grandparents, being chronic tobacco chewers, started giving her betel nut to make her stop eating mud. The girl eventually stopped the habit, but she replaced it with chewing areca nut.

On examination, the cheeks were shrunken and the mouth opening was reduced to an interincisal distance of 15 mm [Figure 1]. Generalized pallor and blanching were observed on either side of the buccal mucosa, upper and lower labial mucosa, and hard and soft palate [Figure 2], giving a marble-like appearance. The tongue movements were restricted. On palpation, the oral mucosa was thick and leathery with difficulty in retracting the cheeks and lips. Thick fibrous bands were palpable on either side of the buccal mucosa and on the upper and lower labial mucosa.
Figure 1: Reduced interincisal distance of 15 mm

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Figure 2: Generalized pallor and blanching on both the buccal mucosa and labial mucosa

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Hematological investigations were done to rule out anemia, and a provisional diagnosis of OSMF Pindborg Stage II was given. The patient was also subjected to ultrasonographic examination, which revealed masseter muscle hypertrophy. Biopsy was not suggested considering the age of the patient and a strong evidence of the clinical diagnosis.

The patient and her grandparents were counseled to immediately stop the habit of areca nut and consume food which is free from chilies and spices. An initial treatment of complete oral prophylaxis was done. They were advised to use 0.1% Kenocort cream twice daily, multivitamin syrup, 5 ml of diluted tulasi water thrice daily, and physiotherapy using ice cream spatula for three to five times a day, until the patient experiences discomfort.

With the help of an experienced pedodontist and a prosthodontist, a mouth-exercising device was fabricated and given to the patient. The device was advised, primarily targeting an improvement in the texture, consistency, and elasticity of the buccal mucosa. Parents were trained regarding the use of that device. Follow-up is being done for every 1 month for 4 months.

The mouth-exercising device consisted of extraoral and intraoral acrylic plates joined together with a helical loop made up of 19 gauge wire.[5] The wire was attached to the convex surface of the extraoral plate and concave surface of the intraoral plate, giving a spring action. The patient was asked to squeeze or stretch the buccal mucosa in between the two plates (larger plate extraorally and smaller plate intraorally) until she experiences discomfort. In this case, the patient was advised to exercise for a minimum of 20 min (10 min on each side) thrice daily unless she elicits discomfort or in case of any tissue injury [Figure 3].
Figure 3: Mouth-exercising device

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The patient has shown a remarkable improvement after 4 months of extensive conservative therapy with a 5 mm increase in the interincisal distance (20 mm in total). There was a slight improvement in the elasticity of the buccal mucosa. The treatment plan was continued, and the patient is under follow-up.

   Discussion Top

Oral submucous fibrosis is one of the predominantly seen PMDs of the oral mucosa, with areca nut being the chief etiological factor.[6] Epidemiological data and experimental studies suggest that the incidence is more among the Asians, with a maximum number of cases reported in India. Even though the disease is more commonly seen among adults with a chronic habit of chewing tobacco, an increased usage of areca nut in school-going children has been reported in many countries such as London, Micronesia, Taiwan, Pakistan, and India, which is making them susceptible to OSMF.

The data available on the occurrence of OSMF in children are very less with a total of sixteen cases updated in the literature. A recent survey conducted among high school children in Karachi found that the incidence and prevalence of OSMF in school-going children were around 6.6% and 8.8%, respectively.[7] Till date, there is no silver bullet for the treatment of oral submucous fibrosis, and people being unaware of the adverse effects of tobacco are consuming it in higher quantities which is being reflected in more cases of PMDs reported in various countries every year.

   Conclusion Top

The present case report clearly states that there is no specific age predilection for the condition, and even children are prone to OSMF, substantiating that the chief etiological factor is chewing areca nut in different forms. Prevention is the only cure, which can be achieved by increasing awareness about the detrimental effects of chewing tobacco and its products.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Pindborg JJ, Sirsat SM. Oral submucous fibrosis. Oral Surg Oral Med Oral Pathol 1966;22:764-79.  Back to cited text no. 1
Ahmad MS, Ali SA, Ali AS, Chaubey KK. Epidemiological and etiological study of oral submucous fibrosis among gutkha chewers of Patna, Bihar, India. J Indian Soc Pedod Prev Dent 2006;24:84-9.  Back to cited text no. 2
[PUBMED]  [Full text]  
Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology 2003;8:419-31.  Back to cited text no. 3
Hayes PA. Oral submucous fibrosis in a 4-year-old girl. Oral Surg Oral Med Oral Pathol 1985;59:475-8.  Back to cited text no. 4
Patil PG, Patil SP. Novel mouth-exercising device for oral submucous fibrosis. J Prosthodont 2012;21:556-60.  Back to cited text no. 5
Sinor PN, Gupta PC, Murti PR, Bhonsle RB, Daftary DK, Mehta FS, et al. A case-control study of oral submucous fibrosis with special reference to the etiologic role of areca nut. J Oral Pathol Med 1990;19:94-8.  Back to cited text no. 6
Oakley E, Demaine L, Warnakulasuriya S. Areca (betel) nut chewing habit among high-school children in the commonwealth of the Northern Mariana Islands (Micronesia). Bull World Health Organ 2005;83:656-60.  Back to cited text no. 7


  [Figure 1], [Figure 2], [Figure 3]


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