Current state of research, diagnosis, staging and outcome of oral submucosal fibrosis

Oral submucosal fibrosis (OSMF) is an Areca nut induced, proliferating oral disease found in Southeast Asian regions including India, affecting millions. The limited collective wisdom prevailing in the understanding of OSMF is ineffective in the management of the disease. A tentative disease grading strategy, the iterations of which are periodically published, is used by dentists, oral surgeons, and clinicians, in general, to determine the severity of OSMF. The lack of recognition of a single authoritative staging system compounded by the unavailability of an unbiased measurement tool presents a diagnostic problem. The review presents a case for implementing higher standards of clinical research and the need to correlate various disease parameters with the appropriate disease stage for effective therapeutic approach. Given the irreversible nature of the fibrotic process in advanced stages, the complications of OSMF are discussed in addition to patient compliance issues. A perspective on the potential of future OSMF initiatives is also presented.