Letter to the Editor Comment on (Facial Atrophy in Oral Submucous Fibrosis: An Association or a Coincidence) Sonal Grover and George Koshy Department of Oral & Maxillofacial Pathology & Microbiology, Christian Dental College, CMC, Ludhiana, Punjab, India Correspondence should be addressed to Sonal Grover; sonalgrvr@yahoo.com Received 18 July 2016; Accepted 8 September 2016 Academic Editor: Giuseppe Colella Copyright © 2016 S. Grover and G. Koshy. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. With reference to a case report titled “Facial Atrophy in Oral Submucous Fibrosis: An Association or a Coincidence” [1] published in your esteemed journal, we would like to emphasize the importance of considering systemic sclerosis (SS) as an important diferential diagnosis in oral submucous fbrosis (OSMF). Systemic sclerosis is a clinically heterogeneous gener- alized disorder which afects the connective tissue of the skin and internal organs such as gastrointestinal tract, lungs, heart, and kidneys. It is characterized by enormous depo- sition of collagen, alterations of the microvasculature, and disturbances of the immune system [2]. Oral manifestations in SS are very common and these include limited ability to open the mouth, facial and tongue rigidity, thinning of lips, xerostomia, periodontal disease, increased periodontal ligament width, and osseous resorption of the mandible [2, 3]. A few decades back, plenty of cases have been reported with neurological manifestations as well [4, 5]. Oral submucous fbrosis (OSMF) is a chronic insidious collagen related disorder associated with betel quid chewing and characterized by progressive hyalinization of the sub- mucosa. Te hallmark of the disease is submucosal fbrosis that afects most parts of the oral cavity, causing progressive trismus with rigid lips, cheeks, pharynx, and upper third of the esophagus leading to dysphagia [6]. Since extensive fbrosis plays a key role in the pathogenesis of OSMF also, it is not possible to distinguish OSMF from SS histologically. In the OSMF case reported [1], the patient had extensive atrophy of facial muscle along with restricted mouth opening. Te striking fnding in this case was cerebral and cerebellum atrophy. Tis fnding should have prompted the authors to rule out the possibility of SS, as extensive facial atrophy with neurological manifestations is more likely to be seen in SS than in OSMF. Except for the epithelial dysplasia observed, all the remaining fndings are common to SS as well. Te epithelial dysplasia can easily be correlated with the long term consumption of areca nut by the patient. Te diagnostic criteria for SS are as given below: Major Criterion (i) Proximal difuse (truncal) sclerosis (skin tightness, thickening, and nonpitting induration) Minor Criteria (i) Sclerodactyly (only fngers and/or toes) (ii) Digital pitting scars or loss of substance of the digital fnger pads (pulp loss) (iii) Bibasilar pulmonary fbrosis Te patient should fulfll the major criterion or two of the three minor criteria. Tus, through this letter, the authors intend to highlight the diferential diagnosis of SS in OSMF cases involving parts of the body other than the oral cavity and pharynx. Competing Interests Tere were no competing interests related to this paper. Hindawi Publishing Corporation Case Reports in Dentistry Volume 2016, Article ID 5747458, 2 pages http://dx.doi.org/10.1155/2016/5747458