Document Type : Review Article


Ziauddin College of Dentistry, Ziauddin University, Karachi, Pakistan


Oral submucous fibrosis is chronic progressive condition of oral cavity. The condition is well recognized for its malignant potential. Usually the disease initiates with redness, blistering, and ulceration inside the mouth. It is characterized by progressive fibrosis of submucosal tissue. The pathogenesis of oral submucous fibrosis is not well understood. Betelquid chewing is the major etiological factor. In Pakistan, oral cancer is the second most common cancer in women and the third most common cancer in men. The incidence of oral cavity cancer in Karachi South district of Pakistan is the highest in the world. Head and neck cancer are major cancer burden in Pakistan. The incidence of oral submucous fibrosis is common in women as compared to men. While banning tobacco, betel nut, betel, Panmasala and Gutka is the key to prevention of the disease. No specific laboratory tests are available for oral submucous fibrosis. Comprehensive head and neck examinations should be part of all medical and dental examinations. The treatment of patient of oral submucous fibrosis depends on the degree of involvement. Commercially available of economical sachets of gutka, paan have strong association with this.  Government should take some steps for the cessation of these products.


Paul RR, Mukherjee A, Dutta PK, Banerjee S, Pal M, Chatterjee J, et al. A novel wavelet neural network based pathological stage detection technique for an oral precancerous condition. J Clin Pathol 2005;58(9):932-8.

Rajendran R. Oral submucous fibrosis: etiology, pathogenesis, and future research. Bull World Health Organ 1994;72(6):985-96.

Pandya S, Chaudhary AK, Singh M, Singh M, Mehrotra R. Correlation of histopathological diagnosis with habits and clinical findings in oral submucous fibrosis. Head Neck Oncol 2009 2;1:10.:10.

Auluck A, Hislop G, Poh C, Zhang L, Rosin MP. Areca nut and betel quid chewing among South Asian immigrants to Western countries and its implications for oral cancer screening. Rural Remote Health 2009;9(2):1118.

Rajalalitha P, Vali S. Molecular pathogenesis of oral submucous fibrosis--a collagen metabolic disorder. J Oral Pathol Med 2005;34(6):321-8.

Lee CH, Ko YC, Huang HL, Chao YY, Tsai CC, Shieh TY, et al. The precancer risk of betel quid chewing, tobacco use and alcohol consumption in oral leukoplakia and oral submucous fibrosis in southern Taiwan. Br J Cancer 2003 ;88(3):366-72.

Misra V, Singh PA, Lal N, Agarwal P, Singh M. Changing pattern of oral cavity lesions and personal habits over a decade: hospital based record analysis from allahabad. Indian J Community Med 2009;34(4):321-5.

Merchant A, Husain SS, Hosain M, Fikree FF, Pitiphat W, Siddiqui AR, et al. Paan without tobacco: an independent risk factor for oral cancer. Int J Cancer 2000 ;86(1):128-31.

Maher R, Lee AJ, Warnakulasuriya KA, Lewis JA, Johnson NW. Role of areca nut in the causation of oral submucous fibrosis: a case-control study in Pakistan. J Oral Pathol Med 1994;23(2):65-9.

Bile KM, Shaikh JA, Afridi HU, Khan Y. Smokeless tobacco use in Pakistan and its association with oropharyngeal cancer. East Mediterr Health J 2010;16 Suppl:S24-30.:S24-S30.

Merchant AT, Haider SM, Fikree FF. Increased severity of oral submucous fibrosis in young Pakistani men. Br J Oral Maxillofac Surg 1997;35(4):284-7.

Mehrotra R, Gupta A, Singh M, Ibrahim R. Application of cytology and molecular biology in diagnosing premalignant or malignant oral lesions. Mol Cancer 2006 ;5:11.:11.

Rahman MS, Ingole N, Roblyer D, Stepanek V, Richards-Kortum R, Gillenwater A, et al. Evaluation of a low-cost, portable imaging system for early detection of oral cancer. Head Neck Oncol 2010 ;2:10.:10.

Lountzis I N. Oral submucous fibrosis: Differential Diagnoses & Workup. Medscape Education eMedicine. 25 Mar 2009. http://www.

Oakley E, Demaine L, Warnakulasuriya S. Areca (betel) nut chewing habit among high-school children in the Commonwealth of the Northern Mariana Islands (Micronesia). Bull World Health Organ 2005;83(9):656-60.

Tanwir F, Altamash M, Gustafsson A. Influence of betel nut chewing, dental care habits and attitudes on perceived oral health among adult Pakistanis. Oral Health Prev Dent 2008;6(2):89-94.

Parsell D. Palm Nut Problem Asian Chewing Habit Linked to Oral Cancer. Science news online 2005;273(167):3.

Jeng JH, Chang MC, Hahn LJ. Role of areca nut in betel quid-associated chemical carcinogenesis: current awareness and future perspectives. Oral Oncol 2001;37(6):477-92.

Rajendran R. Oral Submucous Fibrosis. J oral Maxillofac Pathol 2003;7(1):1-4.

Sinor PN, Gupta PC, Murti PR, Bhonsle RB, Daftary DK, Mehta FS, et al. A case-control study of oral submucous fibrosis with special reference to the etiologic role of areca nut. J Oral Pathol Med 1990;19(2):94-8.

Bhurgri Y. Cancer of the oral cavity - trends in Karachi South (1995-2002). Asian Pac J Cancer Prev 2005;6(1):22-6.

Chang KW, Lee TC, Yeh WI, Chung MY, Liu CJ, Chi LY, et al. Polymorphism in heme oxygenase-1 (HO-1) promoter is related to the risk of oral squamous cell carcinoma occurring on male areca chewers. Br J Cancer 2004 ;91(8):1551-5.

Mazahir S, Malik R, Maqsood M, Merchant RAK, Malik F. Sociodemographic correlates of  betel, areca and smokeless tobacco use as a high risk behavior for head and neck cancers in a squatter settlement of Karachi, Pakistan. Subst abuse treat prev policy. 2006 ;1:10 10.1186/1747.Available from

Areca nut. Taipei Times of oral pathology and medicine 23 (2): 65–9. Available at

WHO IARC monograph program finds betel quid and areca nut chewing

carcinogenic to human . GENEVA, 2003 August 17. Available at

Chou J. Chewing betel nuts now a serious matter. DOH. Cancer agent betel nut chewing. Dec 06, 2005 Page 2. Available at http://www,

Paramhans D, Mathur RK, Newaskar V, Shukla S. Role of collagen membrane for reconstruction of buccal defects following fibrotic band excision and coronoidectomy in oral submucous fibrosis. World articles in ear nose and throat, 2010; 3-1. Available at

Fedorowicz Z, Dorri M, Naseer M. Interventions for the management of oral submucous fibrosis. Database of Systematic Reviews 2008. Available at