Oral submucous fibrosis (OSF) is now accepted globally as an Indian disease, having highest malignant potential than any other oral premalignant lesions. Epidemiological evidence strongly indicate the association of the betel quid (BQ) habit and OSF. Other etiological factors suggested are chillies, lime, tobacco, nutritional deficiencies such as iron and zinc, immunological disorders, and collagen disorders. The male-to-female ratio of OSMF varies by region. Recent data suggests that prevalence of OSMF in India has increased from 0.03% to 6.42%.

The hallmark of the disease is submucosal fibrosis that affects most parts of the oral cavity, pharynx and upper third of the esophagus leading to dysphagia and progressive trismus due to rigid lips and cheeks.

Epidemiological survey conducted in Bhavnagar district, Gujarat state diagnosed as suffering from OSMF with a prevalence of 3.2%.

According to the National Report of Global Adult Tobacco Sur­vey conducted in India , the current prevalence of smokeless tobacco use is 25.9 %. There are 30 different types of smokeless products available in India  including zarda, which contains dried and boiled tobacco leaves, limes, areca nut, additives, spices, and tannins.