Introduction
Sir, we enjoyed reading the recent paper on the management of patients with reduced oral aperture and mandibular hypomobility (BDJ2008; 204: 125–131). In addition to the causes of mandibular hypomobility discussed in the paper, we feel it is important to remind readers of an important and common cause of mandibular hypomobility not mentioned, namely oral submucous fibrosis. Oral submucous fibrosis is a potentially malignant disorder mainly seen in South-East Asia, Taiwan, Southern China and Polynesia.1 It is also found elsewhere in the world amongst people of Asian descent, including in the UK.1 This condition is predominantly due to the chewing of the areca nut which causes a submucosal fibrosis and consequent limitation of opening of the mouth.2 Worldwide, it is estimated that approximately 600 million people chew areca nut daily.3 In India the number of cases of oral submucous fibrosis has risen rapidly over recent years, which is thought to be due to an upsurge in the popularity of commercially prepared areca nut preparations by young people.3, 4
Cessation of areca nut consumption remains an important public health goal, both in Asia and in communities of Asian descent in the UK and elsewhere in the world. Should consumption continue to increase, then it is likely that many dentists will come into contact with cases of oral submucous fibrosis in the future. Dentists should be aware of this important cause of mandibular hypomobility.