title: Physiotherapeutic treatment improves oral opening in oral submucous fibrosis.
abstract: BACKGROUND
  In oral submucous fibrosis (OSF) fibrous bands and burning mucosal pain restrict oral opening to limit speech and eating. The pathogenesis of OSF remains unclear, while surgical and pharmacological treatments have limited success, and are often inaccessible in communities using areca nut where OSF is prevalent. Improved outcomes are reported for surgical treatment when followed by physiotherapy. We tested the hypothesis that physiotherapy alone can modify tissue remodelling in OSF to increase oral opening.
  
  
  METHODS
  Fifty-four Nepali OSF patients were managed for 4 months in three randomly assigned groups receiving either: five times daily physiotherapy by inter-positioning tongue spatulas between teeth and adding a new spatula every 5-10 days; local injection of hyaluronidase with steroids; or no active treatment.
  
  
  RESULTS
  More males presented with OSF than females (p < 0.05). All patients reported reduced opening and 47% had mucosal pain. Progressive mucosal involvement was always in the same order, starting with the soft palate, and then progressing to the fauces, unilateral buccal mucosa, bilateral buccal mucosa, floor of mouth and finally lip mucosa (p < 0.006). Physiotherapy improved oral opening (p < 0.0005), but not oral pain, while no clear improvement was seen in untreated patients as well as patients managed by injection.
  
  
  CONCLUSIONS
  We conclude OSF in the Nepali population progresses in a predictable pattern, and that physiotherapy is effective for increasing the oral opening. We further suggest physiotherapy can be readily used to improve OSF in communities with otherwise limited health resources.
authors.affiliation: The Cellular and Molecular Pathology Research Unit, Oral Pathology and Oral Medicine, The Faculty of Dentistry, The University of Sydney, Westmead Centre for Oral Health, NSW, Australia. scox@dentistry.usyd.edu.au
authors.forename: Stephen
authors.initials: S
authors.lastname: Cox
authors.forename: Hans
authors.initials: H
authors.lastname: Zoellner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000503:physiopathology*; D009390:Nepal; D009914:Oral Submucous Fibrosis / Q000503:physiopathology* / Q000628:therapy*; D026741:Physical Therapy Modalities / Q000295:instrumentation; D016059:Range of Motion, Articular; D055815:Young Adult
chemical_list: D006821:Hyaluronoglucosaminidase