Serum Homocysteine and Its Diagnostic Significance in Oral Submucous Fibrosis: A Cross-Sectional Study

Oral Submucous Fibrosis (OSMF) is a chronic, progressive, potentially malignant disorder of the oral cavity, predominantly associated with areca nut chewing. Oxidative stress and nutritional deficiencies, particularly of folate and vitamin B12, have been implicated in its pathogenesis. Homocysteine (Hcy), a sulfur-containing amino acid, serves as a sensitive biomarker for folate and B12 metabolism and is known to contribute to oxidative stress when elevated. This study aimed to evaluate the serum homocysteine levels in OSMF patients and assess its potential as a biochemical marker for disease severity and progression.

A comparative study was conducted on 60 participants, including 30 clinically and histopathologically confirmed OSMF patients and 30 healthy age- and gender-matched controls. Serum homocysteine levels were estimated using ELISA. Clinical grading of OSMF was based on interincisal distance. Statistical analysis was performed using t-tests, ANOVA, and Receiver Operating Characteristic (ROC) curve analysis to determine the diagnostic utility of homocysteine levels.

Mean serum homocysteine levels were significantly higher in the OSMF group (24.17 µmol/L) compared to controls (10.80 µmol/L) (p < 0.001). ANOVA revealed a progressive increase in homocysteine levels across OSMF grades: Grade I - 19.05 µmol/L, Grade II - 23.65 µmol/L, Grade III - 28.92 µmol/L, and Grade IV - 36.98 µmol/L. ROC analysis showed an AUC of 1.00, with an optimal cut-off of 15.90 µmol/L yielding 100% sensitivity and specificity for distinguishing OSMF from controls.

Elevated serum homocysteine levels are significantly associated with OSMF and correlate with disease severity. Homocysteine may serve as a promising, non-invasive biochemical marker for early detection and progression monitoring in OSMF patients.