{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T04:23:57Z","timestamp":1788236637320,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,3,2]],"date-time":"2018-03-02T00:00:00Z","timestamp":1519948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Oral Pathology Medicine"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>We have evaluated the rationale of existing grading and staging schemes of oral submucous fibrosis (<jats:styled-content style=\"fixed-case\">OSMF<\/jats:styled-content>) based on how they are categorized. A novel classification and staging scheme is proposed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 300 <jats:styled-content style=\"fixed-case\">OSMF<\/jats:styled-content> patients were evaluated for agreement between functional, clinical, and histopathological staging. Bilateral biopsies were assessed in 25 patients to evaluate for any differences in histopathological staging of <jats:styled-content style=\"fixed-case\">OSMF<\/jats:styled-content> in the same mouth. Extent of clinician agreement for categorized staging data was evaluated using Cohen's weighted kappa analysis. Cross\u2010tabulation was performed on categorical grading data to understand the intercorrelation, and the unweighted kappa analysis was used to assess the bilateral grade agreement. Probabilities of less than 0.05 were considered significant. Data were analyzed using <jats:styled-content style=\"fixed-case\">SPSS<\/jats:styled-content> Statistics (version 25.0, <jats:styled-content style=\"fixed-case\">IBM<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> USA<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A low agreement was found between all the stages depicting the independent nature of trismus, clinical features, and histopathological components <jats:italic>(K\u00a0<\/jats:italic>=<jats:italic>\u00a00.312, 0.167, 0.152<\/jats:italic>) in <jats:styled-content style=\"fixed-case\">OSMF<\/jats:styled-content>. Following analysis, a three\u2010component classification scheme (<jats:styled-content style=\"fixed-case\">TFM<\/jats:styled-content> classification) was developed that describes the severity of each independently, grouping them using a novel three\u2010tier staging scheme as a guide to the treatment plan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The proposed classification and staging could be useful for effective communication, categorization, and for recording data and prognosis, and for guiding treatment plans. Furthermore, the classification considers <jats:styled-content style=\"fixed-case\">OSMF<\/jats:styled-content> malignant transformation in detail.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jop.12689","type":"journal-article","created":{"date-parts":[[2018,2,5]],"date-time":"2018-02-05T15:04:43Z","timestamp":1517843083000},"page":"403-409","source":"Crossref","is-referenced-by-count":22,"title":["<scp>TFM<\/scp> classification and staging of oral submucous fibrosis: A new proposal"],"prefix":"10.1111","volume":"47","author":[{"given":"Gururaj","family":"Arakeri","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery King Fahad Medical City Riyadh Saudi Arabia"},{"name":"Department of Oral and Maxillofacial Surgery Radboud University Medical Centre Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Oral &amp; Maxillofacial Surgery Queen Alexandra Hospital Portsmouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulsalam S.","family":"Aljabab","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery King Fahad Medical City Riyadh Saudi Arabia"},{"name":"Faculty of Dentistry Department of Dentistry King Saud University Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santosh","family":"Hunasgi","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Navodaya Dental College and Hospital Raichur Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirthi Kumar","family":"Rai","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Bapuji Dental College and Hospital Davangere Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverley","family":"Hale","sequence":"additional","affiliation":[{"name":"Institute of Sport University of Chichester Chichester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe Paiva","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Department of Oral Surgery and Pathology School of Dentistry Universidade Federal de Minas Gerais Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo Santiago","family":"Gomez","sequence":"additional","affiliation":[{"name":"Department of Oral Surgery and Pathology School of Dentistry Universidade Federal de Minas Gerais Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siavash","family":"Rahimi","sequence":"additional","affiliation":[{"name":"Pathology Centre\u2010Histopathology Queen Alexandra Hospital Portsmouth UK"},{"name":"School of Pharmacy and Biomedical Science University of Portsmouth Portsmouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias A. 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