Nicotine stomatitis

Overview
Nicotine stomatitis is an oral pathologic condition that appears in the hard palate of the mouth as a white lesion. It is not considered to be premalignant and results from tobacco smoking (especially pipes or cigars) or long-term drinking of very hot beverages. Nicotine stomatitis should not be confused with reverse smoker's palate, which is a severe form of palatal keratosis and caused from smoking a cigarette with the lit end inside the mouth.

The cause of nicotine stomatitis is from the palate being exposed to very hot conditions. Pipe smoking produces more heat on the palate than any other form of smoking. The frequency of this condition depends on a society's use of consuming hot beverages and of smoking in its various forms. More commonly found in men over 45 years of age, it is characterized as a "fissured" or "dried mud" appearance from excess keratin production by cells. The palate may appear gray or white and contain many papules that are slightly elevated with red in their center. Furthermore, the teeth may be stained brown or black from tobacco smoke.

Microscopically, epithelial cells of the palate exhibit signs of hyperkeratosis and acanthosis. There may be metaplasia of excretory ducts, which results in the visible papules if the ducts become hyperplastic.

There is usually no treatment since there is no increased risk of cancer. Immediate cessation of smoking may be advised in order to monitor lesion. Nicotine stomatitis should completely resolve on its own after 1 -2 weeks upon termination of smoking. If the lesion persists, a biopsy may be done to confirm diagnosis.