Nicotine stomatitis (stomatitis nicotina palati, smoker’s palate) refers to a specific white lesion that develops on the hard and soft palate in heavy cigarette, pipe, and cigar smokers. The lesions are restricted to areas that are exposed to a relatively concentrated amount of hot smoke during inhalation. Areas covered by a denture are usually not involved. The lesion has become less common since pipe smoking has lost popularity. Although it is associated closely with tobacco smoking, the lesion is not considered to be premalignant.Interestingly, nicotine
stomatitis also develops in individuals with a long history of drinking extremely hot beverages.This suggests that heat, rather than toxic chemicals in tobacco smoke, is the primary cause. Prevalence rates as high as 1.0 to 2.5% have been reported in populations of different cultures.“Reverse smoking” (ie, placing the burning end of the cigarette in the oral cavity), seen in South American and Asian populations, produces significantly more pronounced palatal alterations that may be erythroleukoplakic and that are definitely considered premalignant.TYPICAL FEATURES
This condition is most often found in older males with a history of heavy long-term cigar, pipe, or cigarette smoking. Due to the chronic insult, the palatal mucosa becomes diffusely gray or white (Figure 5-12, A). Numerous slightly elevated papules with punctate red centers that represent inflamed and metaplastically altered minor salivary gland ducts are noted.
Microscopically, the surface epithelium exhibits hyperkeratosis and acanthosis with squamous metaplasia and hyperplasia of the salivary ducts as they approach the surface (see Figure 5-12, B). The subjacent connective tissue and minor salivary glands exhibit a mild to moderate scattered chronic inflammation. No atypical or dysplastic changes are usually identified.
TREATMENT AND PROGNOSIS
Nicotine stomatitis is completely reversible once the habit is discontinued. The severity of inflammation is proportional to the duration and amount of smoking. The lesions usually resolve within 2 weeks of cessation of smoking. Biopsy of nicotine stomatitis is rarely indicated except to reassure the patient. However, a biopsy should be performed on any white lesion of the palatal mucosa that persists after 1 month of discontinuation of smoking habit.
TREATMENT AND PROGNOSIS
Nicotine stomatitis is completely reversible once the habit is discontinued. The severity of inflammation is proportional to the duration and amount of smoking. The lesions usually resolve within 2 weeks of cessation of smoking. Biopsy of nicotine stomatitis is rarely indicated except to reassure the patient. However, a biopsy should be performed on any white lesion of the palatal mucosa that persists after 1 month of discontinuation of smoking habit.