Oral epithelial dysplasia: Recognition, grading and clinical significance

Edward Odell, Omar Kujan*, Saman Warnakulasuriya, Philip Sloan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

91 Citations (Scopus)


Histopathological grading of epithelial dysplasia remains the principal laboratory method for assessing the risk of malignant transformation in oral potentially malignant disorders (OPMDs). Current views on the molecular pathogenesis and histological interpretation of the features of epithelial dysplasia are described, and the use of grading systems for epithelial dysplasia is discussed. Changes to the current 2017 WHO criteria for diagnosis are proposed with emphasis on the architectural features of epithelial dysplasia. The predictive values of three-grade and binary systems are summarised, and categories of epithelial dysplasia are reviewed, including lichenoid and verrucous lesions, keratosis of unknown significance, HPV-associated dysplasia, differentiated and basaloid epithelial dysplasia. The implications of finding epithelial dysplasia in an oral biopsy for clinical management are discussed from the pathologists' viewpoint.

Original languageEnglish
Pages (from-to)1947-1976
Number of pages30
JournalOral Diseases
Issue number8
Early online date14 Sept 2021
Publication statusPublished - Nov 2021


  • dysplasia
  • grading systems
  • HPV
  • malignant transformation
  • oral cancer
  • oral potentially malignant disorders
  • pre-cancer


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