eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa
Nicotine Stomatitis
Updated: Jun 26, 2009
Introduction
Background
Nicotinic stomatitis (smoker's palate), a lesion of the palatal mucosa, has been described in the literature since 1926. In 1941, Thoma named the lesion stomatitis nicotine because it is almost exclusively observed in individuals who smoke tobacco.1 The concentrated heat stream of smoke from tobacco products causes nicotine stomatitis.2 These mucosal changes are most often observed in pipe and reverse cigarette smokers and less often in cigarette and cigar smokers. Generally, it is asymptomatic or mildly irritating. Patients typically report that they are either unaware of the lesion or have had it for many years without changes.
Classic nicotine stomatitis. Note the speckled white and red appearance from the hyperkeratosis and minor salivary gland openings.
Pathophysiology
Nicotine stomatitis affects the oral mucosa of the hard palate posterior to the rugae and the adjacent soft palate.3
Frequency
United States
The incidence in the United States is unknown.
International
A large study in Saudi Arabia showed that 29.6% of all smokers had nicotine stomatitis and that 60% of pipe smokers had this lesion. See also studies of smokers in India4 and Turin.5
Mortality/Morbidity
Although nicotine stomatitis is caused by smoking tobacco products, it is generally not associated with dysplastic or malignant changes.6 The exception to this is in individuals who reverse smoke. Reverse smoking is common in some parts of the Caribbean and Southeast Asia. The concentrated heat and chemicals increase the potential for malignant change.7
Race
The appearance of nicotine stomatitis is related directly to the population that smokes tobacco products.
Sex
Men and women who smoke tobacco products are affected equally. Women smoke pipes less often than men; therefore, the lesion is less prevalent in women.
Clinical
History
Nicotine stomatitis first becomes visible as a reddened area and slowly progresses to a white, thickened, and fissured appearance. The palate has numerous minor salivary glands. They become swollen and the orifices become prominent, giving the tissue a speckled white and red appearance. Patients are usually asymptomatic.
Physical
Lesions are exclusively found on the palatal mucosa. They have a white cobblestone appearance, often with a red dot in the center of the cobblestone. The lesion cannot be wiped off and can have some fissuring. It is limited to the posterior hard palate and less often to the adjacent soft palate.
Fissured appearance of nicotine stomatitis. Notice the gingival-palatal areas where a partial denture protects the mucosa from the heat and smoke.
Nicotine stomatitis in a reverse smoker. Notice the increased hyperkeratosis, hyperplasia, and swelling of minor salivary glands.
Causes
Nicotine stomatitis has been associated with pipe, cigarette, and cigar smoking, and, rarely, with chronic ingestion of high-temperature liquids. The mechanism of action is heat irritation from a tobacco product that acts as a local irritant, stimulating a reactive process. Dentures often protect the palate from these irritants in patients who wear them.
More on Nicotine Stomatitis |
 Overview: Nicotine Stomatitis |
| Differential Diagnoses & Workup: Nicotine Stomatitis |
| Treatment & Medication: Nicotine Stomatitis |
| Follow-up: Nicotine Stomatitis |
| Multimedia: Nicotine Stomatitis |
| References |
| Further Reading |
| Next Page » |
References
Thoma KH. Stomatitis nicotine and its effect on the palate. Am J Orthod. 1941;27:38-47.
Rossie KM, Guggenheimer J. Thermally induced 'nicotine' stomatitis. A case report. Oral Surg Oral Med Oral Pathol. Nov 1990;70(5):597-9. [Medline].
Vellappally S, Fiala Z, Smejkalova J, Jacob V, Somanathan R. Smoking related systemic and oral diseases. Acta Medica (Hradec Kralove). 2007;50(3):161-6. [Medline].
Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India. Indian J Dent Res. Apr-Jun 2008;19(2):99-103. [Medline].
Pentenero M, Broccoletti R, Carbone M, Conrotto D, Gandolfo S. The prevalence of oral mucosal lesions in adults from the Turin area. Oral Dis. May 2008;14(4):356-66. [Medline].
Lynch MA, Brightman VJ, Greenberg MS, eds. Keratotic white lesions with no increased potential for development of oral cancer. In: Burket's Oral Medicine. 9th ed. Toronto, Canada: Decker; 1994:73-82.
Silverman S Jr, ed. Oral Cancer. 5th ed. Hamilton, Canada: BC Decker; 2003:1-16.
[Best Evidence] Myung SK, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials. Arch Intern Med. May 25 2009;169(10):929-37. [Medline].
[Guideline] United States Preventive Services Task Force. Screening for oral cancer: recommendation statement. National Guideline Clearinghouse. Feb 2004.
[Guideline] HealthPartners Dental Group. Clinics guidelines for the diagnosis and treatment of periodontal diseases. National Guideline Clearinghouse. Mar 2006.
Koski OR, Rhyne RR, Correll RW, Craig RM. Irregular papular lesions of the hard palate. J Am Dent Assoc. Aug 1980;101(2):293-4. [Medline].
Mani NJ. Tobacco smoking and associated oral lesions. Ann Dent. Summer 1984;43(1):6-14. [Medline].
Mirbod SM, Ahing SI. Tobacco-associated lesions of the oral cavity: Part I. Nonmalignant lesions. J Can Dent Assoc. May 2000;66(5):252-6. [Medline].
Further Reading
Clinical guidelines
Screening for oral cancer: recommendation statement. 9
United States Preventive Services Task Force - Independent Expert Panel. 1996 (revised 2004 Feb 24). 4 pages. NGC:003454
HealthPartners Dental Group and Clinics guidelines for the diagnosis and treatment of periodontal diseases. 10
HealthPartners Dental Group - Professional Association. 2006 Mar. 85 pages. NGC:005629
Clinical trials
Spectroscopy for Diagnostic Assessment of Oral Mucosal Lesions
Study of Epidermal Growth Factor on Oral Mucositis Induced by Intensive Chemotherapy for Hematologic Malignancies (EGFOM)
Related eMedicine topics
Candidiasis, Mucosal
Premalignant Conditions of the Oral Cavity
Keywords
nicotinic stomatitis, smoker's palate, smoker's keratosis, smoker's patch
