DOI: https://doi.org/10.36347/sjds.2026.v13i1.002

Pages: 10-17

Oral potentially malignant disorders (OPMDs) represent a diverse group of conditions affecting the oral mucosa that carry an increased risk of malignant transformation to oral squamous cell carcinoma (OSCC). Despite significant advances in understanding their etiology and pathogenesis, OPMDs continue to pose substantial challenges for clinicians, with global oral cancer mortality rates remaining largely unchanged over recent decades. This review synthesises current evidence on the epidemiology, risk factors, early detection modalities, and management strategies for OPMDs. Recent meta-analyses confirm that leukoplakia represents the most common OPMD, with an overall malignant transformation rate of approximately 6%, although proliferative verrucous leukoplakia demonstrates considerably higher transformation rates approaching 48%. Independent risk factors for malignant progression include severe epithelial dysplasia (HR 6.24), high-risk anatomical sites such as the ventral tongue and floor of mouth (HR 3.34), and betel quid chewing history (HR 2.62). Histopathological assessment of epithelial dysplasia remains the gold standard for risk stratification, though emerging evidence supports the potential utility of biomarkers such as DNA aneuploidy. Management has evolved towards risk-stratified approaches incorporating multidisciplinary team collaboration, with risk-adapted surveillance protocols ranging from six-monthly reviews for low-risk lesions to three-monthly monitoring for high-risk cases. This review critically examines contemporary classification systems, debates surrounding overdiagnosis, and novel therapeutic approaches including photodynamic therapy and immune checkpoint inhibition. The evidence underscores the need for standardised screening protocols, improved access to specialist care, and continued research into molecular predictors of malignant transformation to optimise patient outcomes and reduce the global burden of oral cancer.