Prevalence Patterns and Treatment Strategies for OSMF, Peri-Implantitis,  and Dental Caries in a Target Population

Rajesh, M; Jothilakshmi, V

doi:10.65188/nurexus.1036

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ORIGINAL ARTICLE

Journal of MedVerse Research & Practice

ISSN: 3107-4278

Prevalence Patterns and Treatment Strategies for OSMF, Peri-Implantitis,

and Dental Caries in a Target Population

Dr. M Rajesh

1

, Dr. V Jothilakshmi

2

Professor, Associate Professor

Faculty of Dental Sciences, MS Ramaiah University,

Email: rajesh1974@gmail.com

Submission Date: 22.07.2025

Accepted Date: 17.08.2025

Published Date: 31.08.2025

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits

unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Background: Oral submucous fibrosis (OSMF), peri-implantitis, and dental caries are prevalent oral health

conditions with significant clinical and public health implications. While OSMF is primarily linked to areca nut

consumption, dental caries remains the most widespread chronic disease globally, and peri-implantitis poses a

growing challenge in implant dentistry.

Aim: The present study aimed to determine the prevalence of OSMF, peri-implantitis, and dental caries in a defined

population and to evaluate their management strategies

Materials and Methods: A total of 150 participants were clinically examined for the presence of OSMF, peri-

implantitis, and dental caries. Diagnoses were recorded, and individualized treatment plans were provided. Data were

analyzed using SPSS software to assess prevalence patterns and treatment outcomes.

Results: The prevalence of OSMF, peri-implantitis, and dental caries was 30.0%, 44.7%, and 25.3%, respectively.

Gender distribution revealed higher OSMF prevalence in males, whereas peri-implantitis and dental caries were more

common in females. Management strategies included curcumin therapy with topical corticosteroids for OSMF, local

antiseptics and antibiotics for peri-implantitis, and root canal treatment with restorative procedures for dental caries.

Treatment outcomes showed the highest improvement in dental caries cases (92.1%), followed by peri-implantitis

(71.6%) and OSMF (71.1%).

Conclusion: Peri-implantitis emerged as the most common oral health condition in the studied population, followed

by OSMF and dental caries. Condition-specific therapeutic approaches proved effective, with dental caries showing

the most favorable outcomes. Early detection, preventive strategies, and patient education remain critical for reducing

the burden of these diseases and improving long-term oral health.

Keywords: Oral submucous fibrosis, peri-implantitis, dental caries, prevalence, management, oral health

Introduction

Oral submucous fibrosis (OSMF) is a chronic, progressive condition of the oral cavity, most often

presenting with mucosal blanching and reduced flexibility of the oral tissues. Histopathological evaluation

typically reveals hyalinization of connective tissue accompanied by marked epithelial thinning [1]. A

wealth of literature has established areca nut and betel quid chewing as the major causative factors for

OSMF. Findings from epidemiological, case–control, experimental, and interventional studies consistently

demonstrate a strong association between OSMF and the habitual consumption of areca nut [2]. Bioactive

compounds such as arecoline, arecaidine, tannins, and catechins act as chemical and mechanical irritants;

they enhance fibroblast proliferation and stimulate excessive collagen deposition, leading to fibrosis of the

oral mucosa. [1,2,3]

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In parallel, dental caries remains a highly prevalent oral disease worldwide despite advances in preventive

and restorative dentistry. Although the global trend shows a relative decline across age groups, the burden

is still disproportionately high in developing nations, where it continues to pose a significant public health

challenge. In India, caries prevalence has risen steadily over the last five decades, affecting nearly 80% of

children. The aetiology of dental caries is multifactorial, involving biological, environmental, and

behavioural determinants [4]. Risk factors such as age, sex, socioeconomic status, fluoride availability,

dietary composition, carbohydrate form, frequency of sugar intake, and oral hygiene practices all interact in

complex ways to influence disease occurrence [5-7]. Left untreated, dental caries can cause pain, infection,

and tooth loss, in addition to contributing to substantial financial and social burdens. Despite the

availability of effective preventive and therapeutic measures, unmet treatment needs remain particularly

high among children [8,9].

Peri-implantitis, another emerging concern, is characterized by inflammatory destruction of the peri-

implant tissues leading to progressive bone loss around integrated implants. It is widely regarded as a major

complication in implant dentistry, with prevalence varying depending on patient- and implant-related

factors. Its multifactorial pathogenesis involves microbial biofilm accumulation, host immune response,

and considerations related to prosthetic or surgical devices. Early detection and appropriate management

are crucial for preventing implant failure and preserving oral function and aesthetics.

Given these challenges, the present study was designed to determine the prevalence of OSMF, peri-

implantitis, and dental caries within a defined population and to highlight current management strategies

for these conditions.

Materials and Methods

Study Design and Setting

This hospital-based observational study was conducted in the Department of Oral Medicine and Radiology

at a tertiary care dental teaching hospital over a period of 18 months. The study was designed to evaluate

the prevalence, clinical characteristics, and management of Oral Submucous Fibrosis (OSMF), peri-

implantitis, and dental caries among adult patients attending the outpatient department. Prior to

commencement, the study protocol was reviewed and approved by the Institutional Ethics Committee, and

all procedures were performed in accordance with the ethical principles outlined in the Declaration of

Helsinki.

Study Population

A total of 150 participants aged 18 years and above were enrolled using a convenience sampling technique

after satisfying the predefined inclusion and exclusion criteria. Adult patients presenting with clinical

features suggestive of OSMF, peri-implantitis, or dental caries and willing to participate in the study were

included. Individuals with uncontrolled systemic diseases affecting oral health, immunocompromised

conditions, pregnancy, lactation, previous history of oral malignancy, those undergoing radiotherapy or

chemotherapy, and individuals unwilling to provide written informed consent were excluded from the

study.

Sample Size

The study included 150 participants who fulfilled the eligibility criteria during the study period. The sample

size was determined based on the expected patient inflow, feasibility of recruitment, and availability of

eligible participants within the study duration.

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Sampling Technique

Eligible participants attending the outpatient department during the study period were recruited

consecutively using a convenience sampling method until the required sample size was achieved.

Study Procedure

After obtaining written informed consent, each participant underwent a detailed interview using a

structured and prevalidated questionnaire. Information regarding age, gender, educational status,

occupation, socioeconomic status, oral hygiene practices, dietary habits, tobacco smoking, smokeless

tobacco consumption, areca nut or betel quid chewing, alcohol intake, duration of deleterious oral habits,

previous dental treatment, and relevant medical history was documented.

A comprehensive intraoral examination was subsequently performed by calibrated oral medicine specialists

under standardized clinical conditions using mouth mirrors, periodontal probes, explorers, and adequate

illumination. Oral Submucous Fibrosis was diagnosed clinically based on characteristic findings including

blanching of the oral mucosa, palpable fibrous bands, progressive reduction in mouth opening, restricted

tongue movements, and burning sensation during consumption of spicy foods. Clinical staging was

recorded according to established diagnostic criteria.

Patients with dental implants underwent detailed peri-implant examination. Peri-implantitis was diagnosed

based on clinical evidence of bleeding on probing, suppuration, increased probing pocket depth, peri-

implant soft tissue inflammation, and radiographic evidence of progressive crestal bone loss around

functioning implants. Standardized intraoral periapical radiographs or panoramic radiographs were

obtained whenever indicated to confirm the diagnosis.

Dental caries were assessed using visual-tactile examination according to World Health Organization

diagnostic criteria. Suspicious lesions were further evaluated using intraoral radiographs whenever

proximal or occult carious lesions were suspected. The number of decayed, missing, and filled teeth was

also documented for each participant.

Data Collection Tool

Data were collected using a structured case record proforma specifically designed for the study. The

proforma included demographic characteristics, risk factors, clinical history, oral examination findings,

diagnosis of OSMF, peri-implantitis, and dental caries, radiographic findings, treatment rendered, and

follow-up recommendations. Clinical findings were recorded immediately after examination to ensure

completeness and accuracy of documentation.

Management Protocol

Following diagnosis, individualized treatment plans were implemented according to the identified oral

condition. Patients diagnosed with OSMF received comprehensive habit cessation counselling, nutritional

advice, antioxidant supplementation, intralesional corticosteroid therapy where indicated, physiotherapy

exercises for improving mouth opening, and regular follow-up evaluation. Cases of peri-implantitis were

managed through professional mechanical debridement, scaling and root surface decontamination, local or

systemic antimicrobial therapy when indicated, reinforcement of oral hygiene instructions, and surgical

intervention in advanced cases requiring regenerative or resective procedures. Dental caries were managed

by preventive counselling, topical fluoride application, restorative procedures, endodontic treatment, or

extraction depending on the severity of the lesion.

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Statistical Analysis

All collected data were entered into Microsoft Excel and analysed using Statistical Package for Social

Sciences (SPSS) software version 23.0 (IBM Corp., Armonk, NY, USA). Continuous variables were

expressed as mean ± standard deviation, while categorical variables were presented as frequencies and

percentages. Associations between categorical variables were evaluated using the Chi-square test or

Fisher's exact test whenever appropriate. Pearson or Spearman correlation analysis was performed to

determine relationships between clinical findings and associated risk factors. Multivariate logistic

regression analysis was carried out to identify independent predictors associated with OSMF, peri-

implantitis, and dental caries after adjusting for potential confounding variables. A p-value of less than 0.05

was considered statistically significant.

Results

Figure 1: Prevalence of OSMF, Peri-implantitis, and Dental Caries (n=150)

Among 150 participants, OSMF was identified in 30% of cases, peri-implantitis in 44.7%, and dental caries

in 25.3%.

Table 1: Gender-wise Distribution of Oral Conditions

Oral condition

Male (n=80)

Female (n=70)

Total (n=150)

OSMF

28 (35.0%)

17 (24.3%)

45 (30.0%)

Peri-implantitis

33 (41.2%)

34 (48.6%)

67 (44.7%)

Dental caries

19 (23.8%)

19 (27.1%)

38 (25.3%)

OSMF was slightly more common among males, whereas peri-implantitis and dental caries showed a

higher proportion among females.

Table 2: Management Plan for Oral Conditions

Oral condition

Management approach

OSMF

Curcumin therapy and topical corticosteroids

Peri-implantitis

Local antiseptics and systemic antibiotics

Dental caries

Root canal treatment and restorative procedures

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Patients with OSMF were managed using curcumin and topical steroids. Peri-implantitis cases were treated

with antiseptics and antibiotics. Dental caries cases underwent root canal therapy followed by restorative

management.

Table 3: Treatment Outcome Distribution

Oral condition

Improved (%)

Not improved (%)

Total (%)

OSMF (n=45)

32 (71.1%)

13 (28.9%)

100

Peri-implantitis (n=67)

48 (71.6%)

19 (28.4%)

100

Dental caries (n=38)

35 (92.1%)

3 (7.9%)

100

Highest improvement was observed in dental caries patients (92.1%), followed by peri-implantitis (71.6%)

and OSMF (71.1%).

Discussion

Dental implants have revolutionized oral rehabilitation, with reported long-term survival rates exceeding

90–95% in most clinical studies, making them a reliable option for replacing missing teeth (Schwarz et al.,

2023) [10]. However, implant failures, although relatively uncommon, still occur due to biological

complications, particularly peri-implant infections. The inflammatory process around implants resembles

that of periodontal disease in natural teeth but progresses more aggressively due to the absence of the

periodontal ligament and reduced defence mechanisms (Derks & Tomasi, 2022) [11]. Peri-implant diseases

are broadly categorized into peri-implant mucositis, a reversible inflammation confined to soft tissues, and

peri-implantitis, which involves both inflammation and progressive marginal bone loss detectable

radiographically (Berglundh et al., 2018) [12]. Our study aimed to assess the prevalence of oral submucous

fibrosis (OSMF), peri-implantitis, and dental caries in a defined population, while also comparing findings

with previously published literature.

In the present study, the prevalence of dental caries was consistent with the findings of Kumar et al.

(2019)[13], who reported a 54.6% prevalence among schoolchildren aged 5–15 years in Ghaziabad, with

significant associations with age, gender, socioeconomic status, and sugar consumption patterns. Similarly,

Kassebaum et al. (2020) emphasized that dental caries remains the most prevalent global oral condition,

affecting approximately 2.4 billion individuals [14]. These findings underline the continuing burden of

dental caries despite preventive measures. With respect to peri-implantitis, our results align with those of

Astolfi et al. (2021) [15], who conducted a longitudinal analysis of 555 implants and found that peri-

implantitis prevalence was significantly higher among smokers (72.7%) compared to nonsmokers (27.3%).

Their study further demonstrated that patients with a history of periodontitis and irregular maintenance

therapy were at greater risk. Likewise, Monje et al. (2022) reported that periodontitis is a strong predictor

of peri-implant tissue breakdown, supporting the concept that host susceptibility plays a central role in

disease progression [16].

In addition, our findings corroborate the observations of Sanz-Martín et al. (2021) [17], who demonstrated

that peri-implant mucositis occurs in up to 43% of cases, whereas peri-implantitis affects approximately

22%, highlighting the clinical relevance of early diagnosis and maintenance care. The role of maintenance

therapy is further emphasized by Costa et al. (2012) [18], who reported that compliant patients had a

significantly lower risk of peri-implantitis compared to those who missed follow-up visits. Systemic factors

such as diabetes and hypertension have been evaluated in relation to implant complications. Ravidà et al.

(2021) [19] showed that uncontrolled diabetes significantly increases the risk of peri-implantitis, whereas

Astolfi et al. (2021) found no statistically significant association with systemic comorbidities. This

discrepancy could be due to differences in population characteristics and glycemic control levels. Similarly,

Canullo et al. (2020) observed that cardiovascular diseases do not directly predispose to peri-implantitis,

though they may influence healing potential [20].

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Smoking continues to emerge as a consistent risk factor across multiple studies. Chrcanovic et al. (2023)

concluded in a systematic review that smokers have nearly twice the risk of implant failure and peri-

implantitis compared to nonsmokers. This is in line with the outcomes of our study, suggesting that

smoking cessation should be emphasized in implant therapy protocols [21]. Interestingly, our study also

included oral submucous fibrosis (OSMF), which is less frequently studied in the context of implantology.

Tilakaratne et al. (2021) highlighted that OSMF leads to progressive fibrosis of oral mucosa, which could

complicate oral hygiene and indirectly increase susceptibility to caries and peri-implant infections. This is

an area requiring further prospective investigation [22]. Collectively, the present findings indicate that peri-

implantitis is a multifactorial disease influenced by behavioral (smoking, oral hygiene, maintenance

compliance), biological (history of periodontitis, systemic conditions), and environmental (socioeconomic,

dietary habits) risk factors. Preventive strategies, including routine maintenance therapy and patient

education, remain critical in reducing disease prevalence and improving long-term implant success

(Renvert et al., 2022) [23].

Conclusion

Among the 150 individuals examined, the prevalence of oral submucous fibrosis (OSMF) was 28%, peri-

implantitis was the most frequent condition at 46%, and dental caries was identified in 26% of cases.

Management was condition-specific: OSMF patients were treated with curcumin therapy combined with

topical corticosteroids, peri-implantitis was managed using antiseptic mouth rinses and systemic antibiotics,

and dental caries was addressed through restorative procedures including root canal therapy and fillings.

These findings highlight peri-implantitis as the most common oral problem in the study population,

underscoring the importance of timely diagnosis and targeted treatment strategies to reduce disease

progression and improve oral health outcomes.

Conflict of Interest: Nil

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