A systematic review of staging systems for oral submucous fibrosis: evolution, variations, and clinical implications.

Introduction: Multiple clinical, functional, and histopathological staging frameworks for OSMF have been described in the literature. Staging helps clinicians assess prognosis, tailor interventions, and monitor progression. The aim of the study is to collect and analyze the various staging systems for OSMF reported in the literature to date and to identify how these systems have evolved over time. Materials and methods: A comprehensive search using multiple electronic databases and gray literature was undertaken to synthesize evidence on existing staging systems. Two reviewers independently performed the study search and selection process. Results: Eighteen articles (18 staging systems) were finally included. Most frameworks used criteria such as clinical functional (mouth opening) and histopathological features (collagen deposition, fibroblast response, and inflammation) for staging, either individually or in combination. We observed that articles primarily focused on the clinical and histopathological features (1950-1970), functional limitations such as trismus and cheek flexibility (1980-1990), and integrated systems (after 2000). Discussion: Despite many available staging methods, no single system has yet gained universal acceptance due to heterogeneity in criteria, lack of validation, and variability in clinical-pathological correlations. The review underscores the critical need for standardised, evidence-based staging systems that combine clinical functionality with pathological assessment to improve diagnostic precision, prognostic evaluation, and treatment planning. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251134270, PROSPERO CRD420251134270.