_Background: _Epithelial-mesenchymal transition (EMT) is a biological process where epithelial cells acquire mesenchymal traits. Epithelial cells are characterized by tight cell-cell adhesions and apical-basal polarity, whereas mesenchymal cells are generally elongated in appearance with loose cell-cell interactions, allowing increased cell migration. Many studies have been done on EMT pathways in oral cavity carcinoma, but there are few studies about the possible clinical implications. _Aims_ _&_ _Objectives:_ This systematic review was carried out to find the clinical implications of EMT in HNSCC and bring together the molecular, genetic, and epigenetic pathways found to be acting on the cadherin switch. _Materials & Methods: _An extensive search for relevant papers was made on PubMed, Medline, and Google Search. Only good-quality studies pertaining to epithelial–mesenchymal transition in oral cavity cancers in humans were selected. Furthermore, all selected papers were assessed for their clinical relevance. _Results: EMT has role in prognostication, diagnostic dilemma, margin assessment, mandibular preservation, making OSCC more prone to systemic therapies and planning risk reduction in strategies. _The cadherin switch is regulated by transcription factors like Snail, SLUG, ZEB1, and ZEB2. It is also acted on by epigenetic modifiers. These transcription factors are regulated by multiple pathways like Wnt/β–catenin, PI3K/AKT, MAPK, etc. These pathways are in turn regulated by molecular and external agents like NNK from tobacco smoke, hypoxia, the DDB2 gene, reactive oxygen species (ROS), and melatonin.
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