Oral submucous fibrosis (OSMF) and its #Ayurveda approach

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Today's topic for discussion:  Oral submucous fibrosis (OSMF) and its #Ayurveda approach

Vd. Kinshuk Hirpara: No direct correlation of the disease OSMF is found in our classics. But  we find description of symptoms like difficulty in opening the mouth – Krichhen, vivrinoti mukham; burning sensation in mouth – Mukhadaha, Usha-

intolerance to spicy food - Tikshna asaha; dryness of mouth-Mukhasosha;

defective gustatory sensation- Arasagyata, Alparasagyata, Virasagyata;

ulceration of the oral mucosa-Mukhantargata Vrana ; Fibrosis-Vranavastu,

Durutha Vrana, but these all are present in scattered form. Mukharbuda - The

dreadful complication of OSMF finds a mention in our classics.

Sthanika Chikitsa:

i)Mukha dhavana: Cleaning the oral cavity with Kwatha of triphala, patha,

draksha and jati pallava with Madhu. (A.H.U)

ii)Pratisarana: It is a procedure wherein medicines are applied locally to

the part affected. Local application prevent or suppress the inflammatory reactions,  thereby preventing fibers by decreasing fibroblastic proliferation and deposition of  collagen . Pippali, lavana ,haridra, yashti madhu, Ela, madhu, laksha etc can used for this purpose.

iii)Kavala and gandusha : This can be done with tailas like haridradi taila,

yashtimadhu taila, jatyadi taila or even with madhu or gritha. This not only acts as

a biogenous stimulator-by accelerating cellular metabolism, increase blood

circulation and tissue vascularity (Courtesy dr suja banglore)

Vd. Prerak Shah: We consider tobacco chewing is major cause for OSMF. May be in time of Ayurveda, tobacco was not there?! That's why the condition was not much familiar.

Vd. Kinshuk Hirpara: Another research article on OSMF http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395929/

Dr Dipak Shirude: There is direct correlation with o s m f in Ayurved !! I have done clinical study and a kind of research years ago .. Find || maans sanghaat || in Sushrutas text .. We got sure results with Pratisaaran and Gandush chikitsa ..Systemic treatment  : Aarogyavardhini and other adjuvants is useful .. And of course .. Nidaan parivarjan is must ..

Shri Minoo parabia: At RMD Hospital. Vagaldhara. We used to receive scores of patient from all over the country. Not all but most of them had history of chewing things. My observation is, not only tobacco but any other thing, may be sopari/areca nut, clove kept at one particular site is the constant source of irritation resulting in to death of submucosal cell death. Buccal cavity has highest regeneration capacity turning out newer generations of cell every day. This active state needs constant supply of vit B and healthy nuclear material. Irritants cause mutation,  when inherited,  result in to cancerous growth. More dangerous were metastatic states. The treatment offered was........Kaval/gandush by Gaumutra. Solutions of Akakia,  trifala. Local Application of gairic, tume F mixed with honey.

Kanchnar, Abhrak bhasma, Annasaheb patrwardhan kadha based tab Carcinocare.

Or decoction it self. Panchgavya daily in the morning.  Diet restrictions.

Only cows milk, ghee. Jav/barley, unpolished rice, mung, papaya, pomegranate. Oat, were allowed. Flex seeds with paneer were given occasionally.

Success rate, if without metastasis,  was about 30%. Fresh water extract of giloy, kumarpathu,  bhoy pathri, bilipatra, tulsi was given every day.

Decoction of tulsi were refilled in earthen matkas every day for patients to drink. Raw water was not allowed. Symptomatic regimem like chhardiripu, hemogon, hemomore, Arogyavardhini, agnitundi vati. Bronchonil,  Asthacure, Bhallatak ghrit,  were used.

Vd. Dipam Tripathi: My 2 pt. Only 10% relife please suggest me good treatment?

Vd. Prerak Shah: It is not compulsory that all OSMF cases turn into cancer, but it is increasing all times.....as Parabia sir mentioned ..the cause is not only tobacco...but chewing / keeping any substance in mouth on one place and creating friction ....results in inflammation and ultimately ulcers...but developing submucous fibrosis is also threatening condition. Sometimes my patients with OSMF, dont have ulcers or inflammaiton...but they simply cant open the mouth, cant eat any solid food, mouth opening is hardly 5 mm, and sometimes painful too. Then it is very difficult to treat. Usually I go with oil gandush, local - external abhynag and svedana and nasya too.

Vd. Dhruti Kagrana: OSMF:-

On analyzing the disease condition with Ayurvedic approach, it seems to be nearer to Vata-Pittadominant chronic Sarvasara Mukharoga, Factors include

Areca nut chewing, Ingestion of chilies, Genetic and Immunologic processes, Nutritional deficiencies, and other factors.

After Koshthashuddhi(mild purgation) and Shodhana Nasya; Pratisarana(external application) with Madhupippalyadi Yoga,Kavala(gargling) with Ksheerabala Taila and internally Rasayana Yoga useful..

Vd. Ajay Pithiya: Supari - areca nut is main culprit to cause osmf..  As continous long term irritation on daily basis does not let to heal and thus fibrous tissue occura.  Secondly caustic (chuna) also cause irritation. Osmf can be called as chronic healed wound..  Sushrut has given 60 upkrama for better healing of wound...  I think we have to concentrate on that.. Local application nd treatment are must... Pratisharan …..Gandush or kaval is beneficial

Vd. Dipam Tripathi: In my pt....they all are tobbeco chewing whole day....

In treatment i give kshirbala oil gandush..Kshirbala 101 paki...nasya

Forpratisaran...yastimadhu, Arogyavardhini, satvbal tab....and ofcourse abhayng swedan....bt not gave me satisfaction

Shri Minoo parabia: The sclerosis coupled with calcification hardens mucosa so much that mouth can not open.

Vd. Mahesh Akani: I haveNo pt of OSMF but one time A pt . He is suffering with complete lock of jaw. Advised as Externaly lepan of Gobar, int Gomutra with water & cow's food yav, when it's comes from Gobar, it's became his food

  we seen good result

Vd. Ajay Pithiya: paper published in "AYU" journal by gujarat ayurved university

Oral submucous fibrosis (OSMF) is a chronic debilitating disease of the oral cavity characterized by inflammation and progressive fibrosis of the lamina propria and submucosa, that results in marked rigidity and eventually inability to open the mouth.

 It manifests as blanching and stiffness of the oral mucosa, trismus, burning sensation in the mouth, intolerance to eating hot and spicy foods, repeated vesicular eruption and ulceration of the buccal mucosa, palate and pillars, loss of gustatory sensation, etc.

Habit of betel nut and tobacco chewing, excessive consumption of chilies and spices, genetic susceptibility, immune mediated process, smoking, drinking alcohol coupled with dietary deficiencies are thought to be the causative factors

of the OSMF, but there is compelling evidence to implicate the habitual chewing of areca nut with the development of OSMF.

Probably involved pathogenesis is stimulation of fibroblast production, increased collagen synthesis due to areca nut alkaloids mainly arecoline along with stabilization of collagen structure by catechin and tannin contents of areca nut. Worldwide estimate of OSMF indicates that 2.5 million people are affected with most cases connected on the Indian subcontinents, especially southeast India.  An epidemiological assessment of the prevalence of OSMF among Indian villagers based on baseline data, recorded a prevalence of 0.2%  (n  =  10071) in Gujarat and 0.4%  (n  =  10287) in Kerala.  

The alarming fact is that there has been a drastic increase in the incidence of OSMF in the younger age group in India as Pan‑Masala and Gutka are easily available in most part of the country even to young children.

Bunty Gandhi: Is recurrent mouth ulceration is one of primary symptoms of OSF  ?

Dr. Hardik- MD: In OSMF 150gm pure alum powder + 75 gm rock salt + 10 gm (clove)syzygium aromaticum + 5 gm karpur (camphor) mix it closely and put it in glass bottle and early morning instruct to patient for scrubbing in mouth with this powder.  Before  this scrubbing gargling with 1 glass of hot water. Than scrub it with brush on gums and tooth. After scrubbing again gargling with 1 glass of hot water. Than tell to patient blow up his/her mouth for 5 to 10 minutes. Don't eat any thing for 1 hour after this mouth cleaning. Tell to patient strictly to avoid tobacco chewing or any bad habit…With this powder pt will get benefit after few weeks.

Dr. Pulastya Vora: I have got encouraging results with Irmedadi tailam

Vd. Piyush prajapati: I think that Fibrosis is exactly Kaph xay janya vaat vrudhhi condition.   Gandush of Decoction of black till added with Jaggery in TDS dose may help in OSMF..  Gandush is better than Kaval. Patient is also advised for some facial exercise which exactly work for maxilo mandibular muscle .  Patient can b suggested for Local Massage of Til Oil at night ..

Dr. J. T. Contractor: Rigidity in jaw joints & gum,due to excessive use of chewing tobacco/ Gurkha is Sub Mucus Fibrosis causes tightness in opening full mouth( hardly mouth opens a centimeter) difficulty in chewing food. Best way to make the jaw flexible by massaging it with oil preferably rectified caster oil mixed wth sweeten mint oil, glycerin can be used in place of caster oil, more than thrice a day, optimum result found in a month or so