Localized peripheral autonomous neuropathy and dysfunctional myoepithelial cells: A novel hypothesis for xerostomia in oral submucous fibrosis

Oral submucous fibrosis (OSMF) is a potentially malignant disorder of the oral cavity characterized by submucosal deposition of dense collagen bundles leading to limited mouth opening. Besides, patients also complain about the burning sensation in the oral cavity and xerostomia. These symptoms have a major impact on the functional and psychological domains of oral health-related quality of life. However, the pathogenesis of xerostomia in OSMF is not yet well established. In our routine histopathology practice, we observed fibrosis surrounding minor salivary glands, distended acini, obliteration of acinar lumen and loss of interstitial spaces. Based on these features, we hypothesized that fibrosis in OSMF drives localized peripheral autonomous neuropathy in minor salivary glands, which leads to dysfunctional myoepithelial cells. These dysfunctional myoepithelial cells will unable to contract and expel saliva out of the salivary secretary unit, thus leading to xerostomia. In the present paper, experiments are recommended to prove this hypothesis, which can be exploited in the future for the development of appropriate drugs.