title: Proposed new grading of oral submucous fibrosis based on cheek flexibility.
abstract: OBJECTIVE
  Oral submucous fibrosis (OSMF) is a potentially malignant disorder of oral cavity, pharynx and upper digestive tract, characterized by progressive inability to open the mouth. Based on clinical and/or histopathological features, various classifications and grading systems have been put forth till date. The aim of the present study was to study the variance in cheek flexibility in OSMF patients, the observance of which led to the introduction of a new grading for the condition.
  
  
  METHODS
  The study included 412 patients with OSMF attending to the Department of Oral Medicine and Radiology during the period from December 2008 to June 2013. A detailed history and examination of the patients was performed with special emphasis on measuring cheek flexibility. Statistical analysis was done using Chi-square test and p<0.05 was considered to be statistically significant.
  
  
  RESULTS
  The most common etiological factor was tobacco (73.3%). All the patients reported with burning sensation of the mouth and blanching of the mucosa. Malignancy was reported in only 4.6% patients. 60.4% patients showed cheek flexibility of 30mm and above, while 29.6% patients showed cheek flexibility between 20-30mm and 10% patients showed less than 30mm of cheek flexibility.
  
  
  CONCLUSIONS
  The observations of the present study have led to the proposal of a new grading of OSMF based on cheek flexibility which could assist in the categorization of the condition by the clinicians. Key words:Cheek flexibility, oral submucous fibrosis, grading, areca nut.
authors.affiliation: Dept of Oral Medicine and Radiology, Chattisgarh Dental College and Research Institute, Rajnandgaon (Chattisgarh).
authors.forename: Santosh
authors.initials: S
authors.lastname: Patil
authors.affiliation: Dental Practitioner, Jodhpur (Raj), India.
authors.forename: Sneha
authors.initials: S
authors.lastname: Maheshwari