Stomatitis nicotina
| Stomatitis nicotina | |
|---|---|
| Other names | Nicotine stomatitis,[1] Nicotinic stomatitis,[2] Nicotine palatinus,[3] Stomatitis palatini,[2] Leukokeratosis nicotina palate,[2] Palatal leukokeratosis,[4] Smoker's keratosis,[5] Smoker's palate,[2] and Smoker's patches[5] |
| Specialty | Oral medicine  |
Stomatitis nicotina is a diffuse white patch on the hard palate, usually caused by tobacco smoking, usually pipe or cigar smoking.[2] It is painless,[4] and it is caused by a response of the palatal oral mucosa to chronic heat. A more pronounced appearance can occur with reverse smoking, sometimes distinguished from stomatitis nicotina by the term reverse smoker's stomatitis. While stomatitis nicotina that is caused by heat is not a premalignant condition (i.e. it does not carry an increased risk of transformation to oral cancer), the condition that is caused by reverse smoking is premalignant.[6]
Signs and symptoms
The palate may appear gray or white and contain many
Causes
The cause of nicotine stomatitis is thought to be chemical or thermally induced
A similar, but more pronounced palatal keratosis occurs with reverse smoking. This is where the lit end of the cigar or cigarette is held in the mouth, another form of smoking associated with high levels of heat in the mouth.
Diagnosis
The diagnosis is normally made based upon the clinical appearance and history.
If a biopsy is taken, the histopathologic appearance is one of hyperkeratosis and acanthosis.[9] There may be squamous metaplasia of excretory ducts, which results in the visible papules if the ducts become hyperplastic. Neutrophils may fill some ducts.[9] It is characterized as a "fissured" or "dried mud" appearance from excess keratin production by cells. Dysplasia is rarely seen.[9]
Treatment
When the appearance is caused by heat, the lesion is usually completely reversible within a few weeks[7] if the smoking habit is stopped.[4][6] This is the case even if the condition has been present for decades.[9] Without stopping smoking, spontaneous remission of the lesion is unlikely.[2] If the lesion persists despite stopping smoking, this is usually then considered to be a true leukoplakia rather than a reactionary keratitis,[9] and may trigger the decision to carry out a biopsy to confirm the diagnosis.[8] Since this condition almost always develops in the setting of long term heavy smoking, it usually indicates the need for regular observation[8] for cancers associated with smoking, e.g. lung cancer.
Epidemiology
The condition is uncommon.[2] It occurs usually in elderly males who have a history of heavy pipe smoking, but it also can occur in cigar or cigarette smokers.[7] The condition was once common, but has become more rare as habits such as pipe and cigar smoking have decreased in popularity.[9]
See also
References
- ISBN 978-1-4160-2999-1.
- ^ ISBN 9780702049484.
- ^ ISBN 9781437719512.
- ^ PMID 18254267.
- ^ ISBN 978-0-7216-2921-6.
- ^ ISBN 9781588903099.
- ^ S2CID 40189451. Retrieved 31 August 2013.
- ^ ISBN 978-1-60327-519-4.
- ^ a b c d e f g h "Frictional, Chemical, & Thermal Keratosis, from Bond's Book of Oral Diseases, 4th Edition". The Maxillofacial Center for Diagnostics & Research. Archived from the original on 24 June 2013. Retrieved 1 September 2013.
- ^ ISBN 9781588902498.
- Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.
External links
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