Oral epithelial dysplasia: Classifications and clinical relevance in risk assessment of oral potentially malignant disorders

TLDR

The WHO 2017 three‑tier grading system for oral epithelial dysplasia, though the gold standard, has limitations that have prompted proposals for clinical determinants, molecular markers, and a more reproducible two‑tier system, especially relevant in high‑risk regions such as India. This review aims to trace the evolution of dysplasia grading, assess its relevance, and evaluate its clinical utility. The authors conduct a narrative review of the literature on dysplasia grading systems, focusing on historical changes, clinical relevance, and potential improvements.

Abstract

After more than a decade, the World Health Organization (WHO) published the revised grading system for oral epithelial dysplasia in 2017. The revised classification has changes reflecting our evolution of understanding of the dysplastic process. Although the WHO 2017 three-tier grading system is the gold standard for histological diagnosis of oral potentially malignant disorders, it has certain limitations. Suggestions to overcome these limitations include the use of clinical determinants and molecular markers to supplement the grading system. It has also been suggested that a two-tier system may be more reproducible and clinically translatable for better management. These advances in the understanding of epithelial dysplasia are very important globally and for us in the Indian subcontinent, given the prevalence of habits (tobacco/areca nut) and burden of oral cancer in this part of the world. The following review traces the evolution of the grading system of dysplasia, its relevance and clinical utility.