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16 Clinical symptoms include, burning sensation in the mouth while consuming spicy food, excessive salivation, restricted tongue movement, depapillation, blanching of oral mucosa, fibrous band in the buccal mucosa, deviation of uvula and soft palate, hearing loss due to stenosis of eustachian tube, gradual reduction in mouth opening 17,19 (Figure 5)

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The combination of these two factors prohibits the composting bacteria from accessing the filter fibres easily and as such, significantly decelerates their rate of decomposition