The known etiological factors for causation of Oral Submucous Fibrosis such as as ingestion of chilies, genetic and immunologic processes, nutritional deficiencies are now ruled out. Recent trend was towards arecanut chewing habit, where Arecoline, an active alkaloid found in arecanut which stimulates fibroblasts to increase production of collagen is also now ruled out. But very recently Areca nuts have also been shown to have a high copper content, and chewing areca nuts for 5-30 minutes significantly increases soluble copper levels in oral fluids. This increased level of soluble copper supported the hypothesis as an initiating factor in individuals with Oral Submucous Fibrosis. But a recent article entitled "Estimation of copper in saliva and areca nut products and its correlation with histological grades of oral submucous fibrosis" published in Journal of Oral Pathology & Medicine concludes that "Despite high copper content in areca nut products, the observations yielded a negative correlation with different histological grades of OSF. This further raises a doubt about the copper content in areca nut as an etiological factor for this crippling disease." Then what causes Oral Submucous Fibrosis???
It is the alkaloids present in Arecanut, mainly arecoline.
chewing of betel quid containing areca nut is the risk factor. It also depends on quintit and friquency in a day. Pathogenesis is believed to involve juxta-epithelial inflammatory reaction and fibrosis in the oral mucosa, probably due to increased cross-linking of collagen through up-regulation of lysyl oxidase activity. Arecoline, which is an alkaloid stimulats the formation of fibrosis, or the build up of collagen and decreases collagen degradation.
Study done by us has shown that immunological component ,nutritional definitely acts as a cofactor in further progression of the disease.
Areca nut, genetic predisposition and underlying immunological component.
actually it is the areca content of supari, areca nut. there are multiple factors, add to these the genetic factors. so copper content alone cannot decide the severity of osmf.
Dear Dr. Faraz Mohammed
Though there are multi factors associated with OSMF, one etiological factor which is clinically established is arecanut chewing
current concepts of oral submucous fibrosis may not support the use of arecanut and may associate osmf with elevated copper content in oral fluids. In our day to day practice, we come across most of the osmf cases associated with arecanut just like how we see more cases of leukoplakia associated with use of tobacco either in smoking or in smokeless form though idiopathic leukoplakia has also been reported.
With my clinical experience I would like to state that osmf is definetely associated with arecant and the elevation of copper content is connected to it
@ Dr. Umamaheshwari T.N,
Article Estimation of copper in saliva and areca nut products and it...
Please see the following RG links.
Article Oral submucous fibrosis: an update
Article Pathogenesis of oral submucous fibrosis
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