This is the dental photograph of a 23 year young man who had come to me with swelling of face on his right side (involving lower jaw).
It was noticed that he is not able to open his mouth properly. There was restricted mouth opening as you can see in this picture. The swelling was primarily due to an erupting third molar tooth – this swelling will go away in 3-4 days with a course of antibiotics and analgesic-anti inflammatory medicines. But the trismus (decreased mouth opening) would stay on!
This man had used some products – Pan Masala (mainly comprises of areca nuts or commonly called betel nuts) and Gutkha (made of powdered tobacco). This is a deadly combination. The use of these two products is quite rampant in India.
Because of this habit, people in younger age group are suffering from Oral submucous fibrosis – a precancerous oral condition in which oral opening starts getting lesser and lesser and the oral tissues become very hard -just like dry leather. The patients also develop all type of ulcers in the mouth for which they keep on trying all sorts of gels and drops without any results.
With times, the oral opening becomes so less… that it becomes difficult to even take meals. Some of the youngsters have to switch over to semi-solid or liquid foods. The other day I saw a young man who was pushing food into the mouth with the help of his fingers.
This young man also started using these products when he was around 15 years, used it for around 7-8 years, about 10 packets per day. He says he has left this habit about a month ago when he noticed that he is not open his mouth fully.
Inside his mouth, you can notice the oral mucosa has turned pale and has blanched appearance. It becomes so tight and hard that even oral examination becomes quite difficult.
The persons suffering from oral sub mucous fibrosis have difficulty in having any spicy food. It is definitely a precancerous condition and if this harmful habit of areca nut chewing and smokeless tobacco is not kicked off, it can develop into oral cancer.
People hardly listen. They only listen when they are unable to take food or develop oral cancer- generally it is too late by then.
We refer many such cases to the oral and maxillofacial surgeon who is the best person to treat such condition. Regarding treatment, first of all i counsel them to stop this habit. It definitely helps but i don’t remember when i saw any person totally cured of this condition.
What to do? The treatment is quite expensive. Even though we reimburse the full cost of treatment to our patients, with time they are almost always lost to follow-up. Perhaps they get fed up with lengthy treatment which requires lot of perseverance.
I always tell youngsters to stay away from such habits…prevention, prevention, prevention and very early diagnosis when the inside of mouth starts feeling hard is the best policy. Once the problem sets-in, it is just ‘sugar-coated’ talking, nothing beyond that perhaps.
Seeing such patients is definitely a very depressing experience for doctors howsoever we may act ‘detached’! All the possible warnings- pictorial and graphic- are printed on pouches of these products declaring clearly that its use can cause oral cancer and this habit is lethal.