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]

Stomatitis nicotina is a diffuse white patch on the hard palate, usually caused by tobacco smoking, usually pipe or cigar smoking.[6] 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.[7]

## Contents

* 1 Signs and symptoms
* 2 Causes
* 3 Diagnosis
* 4 Treatment
* 5 Epidemiology
* 6 See also
* 7 References
* 8 External links

## Signs and symptoms[edit | edit source]

The palate may appear gray or white and contain many papules or nodules that are slightly elevated with red dots in their center.[4] These red dots represent the ducts of minor salivary glands which have become inflamed by heat.[7][8] The condition is painless.[4] If a denture is normally worn while smoking, then the mucosa underneath the denture appears unaffected by the condition.[9] In severe cases, the mucosa may show fissuring and develop a "dried lake bed" appearance.[10] Other changes associated with tobacco use may be evident such as brown or black extrinsic staining of teeth from tar and other components of tobacco smoke.[2]

## Causes[edit | edit source]

The cause of nicotine stomatitis is thought to be chemical or thermally induced keratosis.[3] The chemicals in tobacco may act as irritants in this condition.[2] Chronic heat exposure is also responsible. Pipe smoking produces more heat on the palate than any other forms of smoking. Long-term drinking of very hot beverages can also cause a similar condition. The severity of the changes correlates with the frequency of the habit.[7] The prevalence depends on a society's use of consuming hot beverages and of smoking in its various forms.

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.[7] This form of the condition is sometimes termed "reverse smoker's keratosis",[10] and is a premalignant lesion.[4][7] That is, the condition is associated with an increased risk of malignant transformation to oral squamous cell carcinoma (a type of oral cancer). Some sources do not distinguish between reverse smoker's keratosis and smoker's palate that is caused by heat.[2] As such, these sources tend to state that stomatitis nicotina is a premalignant condition.[9] Some reports show that there is an increased risk of tonsillar cancer, lung cancer and tumors of the posterior oral cavity in people who develop stomatitis nicotina.[8]

## Diagnosis[edit | edit source]

The diagnosis is normally made based upon the clinical appearance and history.[9] Tissue biopsy is not usually indicated unless there are areas of ulceration or localized erythroplakia (red patches).[9] The differential diagnosis is with other causes of white lesions (see leukoplakia for a more complete discussion). Specific conditions which can produce a similar appearance include Darier's disease,[2] discoid lupus erythematosus,[11] oral candidiasis,[11] and oral lichen planus.[11]

If a biopsy is taken, the histopathologic appearance is one of hyperkeratosis and acanthosis.[10] There may be squamous metaplasia of excretory ducts, which results in the visible papules if the ducts become hyperplastic. Neutrophils may fill some ducts.[10] It is characterized as a "fissured" or "dried mud" appearance from excess keratin production by cells. Dysplasia is rarely seen.[10]

## Treatment[edit | edit source]

When the appearance is caused by heat, the lesion is usually completely reversible within a few weeks[8] if the smoking habit is stopped.[4][7] This is the case even if the condition has been present for decades.[10] 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,[10] and may trigger the decision to carry out a biopsy to confirm the diagnosis.[9] Since this condition almost always develops in the setting of long term heavy smoking, it usually indicates the need for regular observation[9] for cancers associated with smoking, e.g. lung cancer.

## Epidemiology[edit | edit source]

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.[8] The condition was once common, but has become more rare as habits such as pipe and cigar smoking have decreased in popularity.[10]

## See also[edit | edit source]

* Smoker's melanosis
* Smokeless tobacco keratosis

## References[edit | edit source]

1. ↑ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Scully C (2013). Oral and maxillofacial medicine : the basis of diagnosis and treatment (3rd ed.). Edinburgh: Churchill Livingstone. p. 287\. ISBN 9780702049484.
3. ↑ 3.0 3.1 Gnepp, Douglas R. (2009). Diagnostic surgical pathology of the head and neck (2nd ed.). Philadelphia, PA: Saunders/Elsevier. ISBN 9781437719512. Archived from the original on 2022-05-27. Retrieved 2022-04-22.
4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Vellappally, S; Fiala, Z; Smejkalová, J; Jacob, V; Somanathan, R (2007). "Smoking related systemic and oral diseases". Acta Medica. 50 (3): 161–6. doi:10.14712/18059694.2017.76. PMID 18254267.
5. ↑ 5.0 5.1 James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. p. 800\. ISBN 978-0-7216-2921-6.
6. ↑ Fehrenbach, Margaret J.; Minihan-Anderson, Kristin; Ibsen, Olga A. C.; Peters, Scott M. (2023). "2. Inflammation and repair: injuries to oral soft tissue". In Ibsen, Olga A. C.; Peters, Scott (eds.). Oral Pathology for the Dental Hygienist (8th ed.). St Louis, Missourie: Elsevier. pp. 52–53. ISBN 978-0-323-76403-2. Archived from the original on 2022-05-27. Retrieved 2022-05-26.
7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Werning, John W. (2007). Oral cancer : diagnosis, management, and rehabilitation. New York: Thieme. p. 12\. ISBN 9781588903099. Archived from the original on 2022-05-27. Retrieved 2022-04-22.
8. ↑ 8.0 8.1 8.2 8.3 G Taybos; K Crews (28 July 2008). "Oral Changes Associated with Tobacco Use" (PDF). The American Journal of the Medical Sciences. The American Academy of Oral Medicine. 326 (4): 179–82. doi:10.1097/00000441-200310000-00005. PMID 14557730. S2CID 40189451. Archived (PDF) from the original on 28 January 2013. Retrieved 31 August 2013.
9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 Treister NS, Bruch JM (2010). Clinical oral medicine and pathology. New York: Humana Press. p. 46\. ISBN 978-1-60327-519-4.
10. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 "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.
11. ↑ 11.0 11.1 11.2 Laskaris, George (2006). Pocket atlas of oral diseases (2nd ed.). Stuttgart: Thieme. ISBN 9781588902498. Archived from the original on 2022-05-27. Retrieved 2022-04-22.

## External links[edit | edit source]

Classification|

* ICD-10: K13.2

|

* v
* t
* e

Oral and maxillofacial pathology

Lips

* Cheilitis
* Actinic
* Angular
* Plasma cell
* Cleft lip
* Congenital lip pit
* Eclabium
* Herpes labialis
* Macrocheilia
* Microcheilia
* Nasolabial cyst
* Sun poisoning
* Trumpeter's wart

Tongue

* Ankyloglossia
* Black hairy tongue
* Caviar tongue
* Crenated tongue
* Cunnilingus tongue
* Fissured tongue
* Foliate papillitis
* Glossitis
* Geographic tongue
* Median rhomboid glossitis
* Transient lingual papillitis
* Glossoptosis
* Hypoglossia
* Lingual thyroid
* Macroglossia
* Microglossia
* Rhabdomyoma

Palate

* Bednar's aphthae
* Cleft palate
* High-arched palate
* Palatal cysts of the newborn
* Inflammatory papillary hyperplasia
* Stomatitis nicotina
* Torus palatinus

Oral mucosa – Lining of mouth

* Amalgam tattoo
* Angina bullosa haemorrhagica
* Behçet's disease
* Bohn's nodules
* Burning mouth syndrome
* Candidiasis
* Condyloma acuminatum
* Darier's disease
* Epulis fissuratum
* Erythema multiforme
* Erythroplakia
* Fibroma
* Giant-cell
* Focal epithelial hyperplasia
* Fordyce spots
* Hairy leukoplakia
* Hand, foot and mouth disease
* Hereditary benign intraepithelial dyskeratosis
* Herpangina
* Herpes zoster
* Intraoral dental sinus
* Leukoedema
* Leukoplakia
* Lichen planus
* Linea alba
* Lupus erythematosus
* Melanocytic nevus
* Melanocytic oral lesion
* Molluscum contagiosum
* Morsicatio buccarum
* Oral cancer
* Benign: Squamous cell papilloma
* Keratoacanthoma
* Malignant: Adenosquamous carcinoma
* Basaloid squamous carcinoma
* Mucosal melanoma
* Spindle cell carcinoma
* Squamous cell carcinoma
* Verrucous carcinoma
* Oral florid papillomatosis
* Oral melanosis
* Smoker's melanosis
* Pemphigoid
* Benign mucous membrane
* Pemphigus
* Plasmoacanthoma
* Stomatitis
* Aphthous
* Denture-related
* Herpetic
* Smokeless tobacco keratosis
* Submucous fibrosis
* Ulceration
* Riga–Fede disease
* Verruca vulgaris
* Verruciform xanthoma
* White sponge nevus

Teeth (pulp, dentin, enamel)

* Amelogenesis imperfecta
* Ankylosis
* Anodontia
* Caries
* Early childhood caries
* Concrescence
* Failure of eruption of teeth
* Dens evaginatus
* Talon cusp
* Dentin dysplasia
* Dentin hypersensitivity
* Dentinogenesis imperfecta
* Dilaceration
* Discoloration
* Ectopic enamel
* Enamel hypocalcification
* Enamel hypoplasia
* Turner's hypoplasia
* Enamel pearl
* Fluorosis
* Fusion
* Gemination
* Hyperdontia
* Hypodontia
* Maxillary lateral incisor agenesis
* Impaction
* Wisdom tooth impaction
* Macrodontia
* Meth mouth
* Microdontia
* Odontogenic tumors
* Keratocystic odontogenic tumour
* Odontoma
* Dens in dente
* Open contact
* Premature eruption
* Neonatal teeth
* Pulp calcification
* Pulp stone
* Pulp canal obliteration
* Pulp necrosis
* Pulp polyp
* Pulpitis
* Regional odontodysplasia
* Resorption
* Shovel-shaped incisors
* Supernumerary root
* Taurodontism
* Trauma
* Avulsion
* Cracked tooth syndrome
* Vertical root fracture
* Occlusal
* Tooth loss
* Edentulism
* Tooth wear
* Abrasion
* Abfraction
* Acid erosion
* Attrition

Periodontium (gingiva, periodontal ligament, cementum, alveolus) – Gums and tooth-supporting structures

* Cementicle
* Cementoblastoma
* Gigantiform
* Cementoma
* Eruption cyst
* Epulis
* Pyogenic granuloma
* Congenital epulis
* Gingival enlargement
* Gingival cyst of the adult
* Gingival cyst of the newborn
* Gingivitis
* Desquamative
* Granulomatous
* Plasma cell
* Hereditary gingival fibromatosis
* Hypercementosis
* Hypocementosis
* Linear gingival erythema
* Necrotizing periodontal diseases
* Acute necrotizing ulcerative gingivitis
* Pericoronitis
* Peri-implantitis
* Periodontal abscess
* Periodontal trauma
* Periodontitis
* Aggressive
* As a manifestation of systemic disease
* Chronic
* Perio-endo lesion
* Teething

Periapical, mandibular and maxillary hard tissues – Bones of jaws

* Agnathia
* Alveolar osteitis
* Buccal exostosis
* Cherubism
* Idiopathic osteosclerosis
* Mandibular fracture
* Microgenia
* Micrognathia
* Intraosseous cysts
* Odontogenic: periapical
* Dentigerous
* Buccal bifurcation
* Lateral periodontal
* Globulomaxillary
* Calcifying odontogenic
* Glandular odontogenic
* Non-odontogenic: Nasopalatine duct
* Median mandibular
* Median palatal
* Traumatic bone
* Osteoma
* Osteomyelitis
* Osteonecrosis
* Bisphosphonate-associated
* Neuralgia-inducing cavitational osteonecrosis
* Osteoradionecrosis
* Osteoporotic bone marrow defect
* Paget's disease of bone
* Periapical abscess
* Phoenix abscess
* Periapical periodontitis
* Stafne defect
* Torus mandibularis

Temporomandibular joints, muscles of mastication and malocclusions – Jaw joints, chewing muscles and bite abnormalities

* Bruxism
* Condylar resorption
* Mandibular dislocation
* Malocclusion
* Crossbite
* Open bite
* Overbite
* Overeruption
* Overjet
* Prognathia
* Retrognathia
* Scissor bite
* Maxillary hypoplasia
* Temporomandibular joint dysfunction

Salivary glands

* Benign lymphoepithelial lesion
* Ectopic salivary gland tissue
* Frey's syndrome
* HIV salivary gland disease
* Necrotizing sialometaplasia
* Mucocele
* Ranula
* Pneumoparotitis
* Salivary duct stricture
* Salivary gland aplasia
* Salivary gland atresia
* Salivary gland diverticulum
* Salivary gland fistula
* Salivary gland hyperplasia
* Salivary gland hypoplasia
* Salivary gland neoplasms
* Benign: Basal cell adenoma
* Canalicular adenoma
* Ductal papilloma
* Monomorphic adenoma
* Myoepithelioma
* Oncocytoma
* Papillary cystadenoma lymphomatosum
* Pleomorphic adenoma
* Sebaceous adenoma
* Malignant: Acinic cell carcinoma
* Adenocarcinoma
* Adenoid cystic carcinoma
* Carcinoma ex pleomorphic adenoma
* Lymphoma
* Mucoepidermoid carcinoma
* Sclerosing polycystic adenosis
* Sialadenitis
* Parotitis
* Chronic sclerosing sialadenitis
* Sialectasis
* Sialocele
* Sialodochitis
* Sialosis
* Sialolithiasis
* Sjögren's syndrome

Orofacial soft tissues – Soft tissues around the mouth

* Actinomycosis
* Angioedema
* Basal cell carcinoma
* Cutaneous sinus of dental origin
* Cystic hygroma
* Gnathophyma
* Ludwig's angina
* Macrostomia
* Melkersson–Rosenthal syndrome
* Microstomia
* Noma
* Oral Crohn's disease
* Orofacial granulomatosis
* Perioral dermatitis
* Pyostomatitis vegetans

Other

* Eagle syndrome
* Hemifacial hypertrophy
* Facial hemiatrophy
* Oral manifestations of systemic disease

* v
* t
* e

Tobacco smoking

Country
and region|

| Africa|

* Egypt
* Nigeria
* South Africa

|

Asia|

* Afghanistan
* China
* Macau
* Hong Kong
* East Timor
* India
* Indonesia
* Iran
* Iraq
* Japan
* North Korea
* Malaysia
* Pakistan
* Philippines
* Saudi Arabia
* Singapore
* South Korea
* Syria
* Taiwan
* Turkey
* Vietnam

Oceania|

* Australia
* New Zealand
* Tokelau

Europe|

* Albania
* Armenia
* Croatia
* Finland
* France
* Germany
* Greece
* Hungary
* Iceland
* Ireland
* Italy
* Latvia
* Norway
* Russia
* Sweden
* Turkey
* United Kingdom

South America|

* Argentina
* Brazil
* Colombia
* Ecuador
* Uruguay

North America|

* Canada
* United States

Religion|

* Smoking in Jewish law
* Islamic views on tobacco
* Tobacco fatwa
* Ceremonial pipe
* Chanunpa
* Kinnikinnick
* Pipe bag

Health|

* Health effects of tobacco (Nicotine poisoning
* Nicotine withdrawal)
* Passive smoking
* Third-hand smoke
* Prevalence of tobacco use
* Schizophrenia and smoking
* Sidestream smoke
* Smokeless tobacco keratosis
* Smoker's face
* Smoker's melanosis
* Stomatitis nicotina
* Smoking age
* Smoking and male infertility
* Smoking cessation
* Tobacco-free pharmacies
* Tobacco packaging warning messages
* WHO Framework Convention on Tobacco Control
* MPOWER
* Protocol to Eliminate Illicit Trade in Tobacco Products
* World No Tobacco Day
* Youth smoking

Women and smoking|

* Breastfeeding difficulties
* Breast cancer
* Cervical cancer
* Menopause
* Ptosis of the breast
* Smoking and female infertility
* Smoking and pregnancy

Smoking ban|

* Inflight smoking
* List of smoking bans
* Smoking bans in private vehicles
* Tobacco-free college campuses

Country and region|

* Australia
* England
* France
* United States

Other|

* Chain smoking
* Tobacco consumption by country
* History of smoking
* Smokeasy
* Smoking fetishism
* Smoking in association football
* Smoking jacket
* Tobacco pipe
* Smoking room
* Nicotine marketing
* Tobacco bowdlerization
* Tobacco industry

* Category
* Cigarettes
* Electronic cigarettes

*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template