EVALUATION OF MULTIPLE MICRONUTRIENT SUPPLEMENTATION IN THE MANAGEMENT OF ORAL SUBMUCOUS FIBROSIS IN KARACHI, PAKISTAN

Oral submucous fibrosis (OSF) is an oral precancerous condition charac terized by symptoms such as intolerance to spicy food, altered salivat ion, progressive difficulty in opening the mouth, and signs like vesic ulation, ulceration, blanching, rigidity, and stiffening of the oral m ucosa and depapillation and altered mobility of the tongue. It is seen mostly among people of Indian subcontinent origin. The major structur al change is extensive fibroelastic scarring of the lamina propria and deeper connective tissues. A combination of micronutrients (vitamins A, B complex, C, D, and E) and minerals (iron, calcium, copper, zinc, magnesium, and others) was evaluated for its efficacy in controlling t he symptoms and signs of OSF in. 117 compliant subjects in Karachi, Pa kistan, in a single-arm preliminary study. The subjects received suppl ementation for one to three years. Significant improvement in symptoms , notably intolerance to spicy food, burning sensation, and mouth open ing, was observed at exit. The interincisor distance deteriorated in 1 1 subjects (10%) at exit; it was stable in 56 subjects (49%) and impro ved in 48 (41%). The mean interincisor distance was 19.1 +/- 10.8 (SD) mm at exit compared with 16.2 +/- 7.5 mm at baseline, A significant p roportion of concomitant lesions like leukoplakia also regressed at ex it. The major outcome from this study was a beneficial clinical respon se in subjects with OSF to multiple micronutrient intervention, which justifies its further evaluation in well-designed randomized controlle d trials in other settings in South Asia.