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National Journal of Maxillofacial Surgery
 
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SHORT COMMUNICATION
Year : 2020  |  Volume : 11  |  Issue : 2  |  Page : 307-308  

To ponder beyond hype!!!


Department of Oral Medicine and Radiology, Dr. G D Pol Foundation's, YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India

Date of Submission21-May-2019
Date of Acceptance23-Oct-2019
Date of Web Publication16-Dec-2020

Correspondence Address:
Dr. Bhakti Patil Soman
B 1502, The Orien Sector 20, Opposite Navi Mumbai Police Headquarters, Roadpali, Navi Mumbai - 410 218, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njms.NJMS_33_19

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   Abstract 


To date, no treatment strategies for oral submucous fibrosis (OSMF) have been proved to be completely effective, and one of the most accepted medical lines of therapy advised in every stage of OSMF is antioxidants. One of the antioxidant drugs has increasingly earned popularity, which is due to its less expensive market price than other available antioxidants formulations. The presence of copper in its composition questions its ability to be effective in the management of OSMF. Moreover, we would like to emphasize that the presence of copper adds on to the disease burden and antioxidants with copper in its composition should not be advised as an antioxidant of choice for the management of OSMF.

Keywords: Antioxidants, copper, oral submucous fibrosis


How to cite this article:
Soman BP, Das D. To ponder beyond hype!!!. Natl J Maxillofac Surg 2020;11:307-8

How to cite this URL:
Soman BP, Das D. To ponder beyond hype!!!. Natl J Maxillofac Surg [serial online] 2020 [cited 2021 Jan 16];11:307-8. Available from: https://www.njms.in/text.asp?2020/11/2/307/303503



Oral submucous fibrosis (OSMF) is a chronic, insidious, progressive, debilitating, scarring, irreversible, complex, and crippling disorder of the oral cavity. OSMF affects the upper digestive tract, oral cavity, oropharynx, and upper third of esophagus and is characterized by juxta epithelial inflammatory reaction, followed by fibroelastic changes, which leads to progressive fibrosis of the submucosal tissues (lamina propria and deeper connective tissues) with epithelial atrophy leading to stiffness and rigidity of the oral mucosa and eventual inability to open the mouth. The etiology of OSMF is obscure, although various hypotheses are proposed, suggesting multifactorial origins, such as chewing of the areca nut and its flavored formulations (most common), chronic nutritional deficiencies (especially iron, Vitamin B complex, and protein), and genetic predisposition, autoimmunity. Excessive use of the areca nut and its flavored formulations disrupts the hemostatic equilibrium between the synthesis and degeneration of collagen is well established.[1] To date, no treatment strategies for OSMF have been proved to be completely effective, and one of the most accepted medical lines of therapy advised in every stage of OSMF is antioxidants. One of the antioxidant drugs which has increasingly earned popularity with lycopene is due to its less expensive market price than other available antioxidant formulations. The detailed look into the composition of this antioxidant would reveal that it contains the following lycopene 5 mg, beta-carotene 10 mg, selenium 75 mcg, zinc sulfate monohydrate 27.5 mg, copper 1 mg, alpha-lipoic acid 50 mg, and alpha-tocopherol acetate 10 IU. The presence of copper in the composition questions its ability to be effective in the management of OSMF. Moreover, we would like to emphasize that the presence of copper adds on to the disease burden and it should not be advised as an antioxidant of choice for the management of OSMF.

High content of copper (5 mg daily) is released within 5–15 min of chewing areca nut which induces upregulation of lysyl oxidase which, in turn, increases fibroblasts activity,[2] Opsahl et al. reported that lysyl oxidase activity varies by as much as five- to six-fold in response to dietary copper, ranging from 0 to 25 mg Cu/g diet, the upregulation of lysyl oxidase is proportional to dietary intake of copper. 5–7 mol dietary Cu activates 1 mol of lysyl oxidase activity. Only 1 mol Cu/mol of lysyl oxidase enzyme is requisite for functional activity of lysyl oxidase and excess of copper than that increases activity of lysyl oxidase and crosslinking of collagen fibers which is found to be more resistant to degradation.[3] Copper also generates hydroxyl radicals, which cause damage to DNA, activates tumor necrosis factor-alpha and vascular endothelial growth factor which are responsible for inflammatory fibrosis.[4] It has been observed that ceruloplasmin levels increase in patients whom OSMF turns into malignancy.[5] Yadav et al.[6] reported serum copper level of 155–195 μg/day in OSMF patients, Sachdev et al.[7] in meta-analysis reported significant increase in the level of serum copper in OSMF patients, Trivedy et al.[8] reported tissue copper level of 5.5–8.4 μg/g in OSMF patients. Thus, in OSMF increase in copper is seen in saliva, serum, and tissue level, which is more than required and additional copper through drug adds to more copper and in turn increasing lysyl oxidase activity in the fibroblasts.

As per the above studies, it is suggested that the antioxidant combination with copper should be avoided as a choice of antioxidant in the management of OSMF.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ranganathan K, Devi MU, Joshua E, Kirankumar K, Saraswathi TR. Oral submucous fibrosis: A case-control study in Chennai, South India. J Oral Pathol Med 2004;33:274-7.  Back to cited text no. 1
    
2.
Nasulewicz A, Mazur A, Opolski A. Role of copper in tumour angiogenesis – Clinical implications. J Trace Elem Med Biol 2004;18:1-8.  Back to cited text no. 2
    
3.
Rucker RB, Kosonen T, Clegg MS, Mitchell AE, Rucker BR, Uriu-Hare JY, et al. Copper, lysyl oxidase, and extracellular matrix protein cross-linking. Am J Clin Nutr 1998;67:996S-1002.  Back to cited text no. 3
    
4.
Al-Rawi NH, Talabani N. Quantitative analysis oftrace elements in saliva of oral cancer patients from Iraq. J Coll Dent 2005;17:32-5.  Back to cited text no. 4
    
5.
Trivedy C, Baldwin D, Warnakulasuriya S, Johnson N, Peters T. Copper content in areca catechu (betel nut) products and oral submucous fibrosis. Lancet 1997;349:1447.  Back to cited text no. 5
    
6.
Yadav A, Kumar L, Misra N, Deepak U, Shiv Kumar GC. Estimation of serum zinc, copper, and iron in the patients of oral submucous fibrosis. Natl J Maxillofac Surg 2015;6:190-3.  Back to cited text no. 6
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7.
Sachdev PK, Freeland-Graves J, Beretvas SN, Sanjeevi N. Zinc, copper, and iron in oral submucous fibrosis: A Meta-analysis. Int J Dent 2018;2018:3472087.  Back to cited text no. 7
    
8.
Trivedy CR, Warnakulasuriya KA, Peters TJ, Senkus R, Hazarey VK, Johnson NW. Raised tissue copper levels in oral submucous fibrosis. J Oral Pathol Med 2000;29:241-8.  Back to cited text no. 8
    




 

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