Oral submucosal fibrosis: a comprehensive review on pathogenesis, diagnosis, therapeutics and computational advances

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Oral submucosal fibrosis (OSF) is a chronic and progressive fibrosis disease and causes sclerosis in oral mucosal tissue with a higher potential of malignant transformation. It is characterized by excessive production and deposition of extracellular matrix. The major behavioral cause of OSF is chewing areca nut, and the symptoms include severe burning sensation, ulceration, restricted mouth opening, and more. However, despite significant advancements in biochemical and molecular techniques in recent years, no specific and targeted antifibrotic treatment strategies have been approved, potentially due to the complicated molecular mechanism that initiates and drives the fibrotic events, which remains to be completely understood. In this review, we aimed to discuss the epidemiology, etiology, and risk factors associated with the OSF, with special emphasis on the recent developments such as the use of flavored areca nut, etc. Then we highlight the OSF pathogenesis with special emphasis on the role of TGF-b, epithelial-mesenchymal transition, and other processes such as dysregulation of collagen metabolism and angiogenesis. We also mentioned the role of hypoxia-induced pathogenesis, which recently has been more in focus. Next, apart from traditional diagnosis methods, i.e., clinical evaluation and histopathology, we also discussed newer techniques such as biomarkers present in serum,

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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