Oral Submucous Fibrosis-current Concept of Etiology, Pathogenesis, Classification and Management

Abstract

Introduction: Oral submucous fibrosis (OSMF) is a chronic, progressive, oral potentially malignant disorder with malignant transformation rates between 7% and 13%. Etiology & Pathogenesis: The disease is primarily associated with areca nut and betel quid chewing, compounded by nutritional deficiencies, immunological changes, genetic susceptibility, and epigenetic factors. Fibrosis develops due to an imbalance between collagen synthesis and degradation, fibroblast-to-myofibroblast transition, and cytokine dysregulation such as TGFβ overexpression. Clinical Features: OSMF typically manifests with mucosal rigidity, burning sensation, blanching, fibrotic bands, reduced mouth opening, and impaired oral function. Histological changes range from inflammation and fibrosis to epithelial atrophy, with a significant risk of malignant transformation. Management: Current strategies emphasize habit cessation, dietary supplementation, and medical therapy including corticosteroids, antioxidants, enzymes, immunomodulators, vasodilators, and herbal products. Physiotherapy is essential to preserve oral function, while surgical options such as fibrotic band release, flap reconstruction, coronoidectomy, myotomy, and laser therapy are reserved for advanced cases. Novel approaches like stem cell therapy and mucoadhesive drug delivery systems show encouraging results. Conclusion: Although no single therapy provides complete reversal, a multimodal approach combining behavioral, medical, physiotherapeutic, and surgical interventions remains the cornerstone of OSMF management. Continued research on molecular mechanisms and innovative therapies is critical to improve patient outcomes and reduce malignant progression.