Nicotine Stomatitis

Author: Sol Silverman, DDS, MA, DipABOM; Chief Editor: William D James, MD more...

Updated: Mar 26, 2012

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Background
Pathophysiology
Epidemiology
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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, 3]}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. See the image below

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.^[4]

Frequency

United States

The incidence of nicotinic stomatitis in the United States is unknown. However, approximately 46 million Americans smoke.^[5]

International

A large study in Saudi Arabia showed that 29.6% of all smokers had nicotine stomatitis and that 60% of pipe smokers had nicotinic stomatitis. See also studies of smokers in India,^[6]Turin,^[7]and China.^[8]

Mortality/Morbidity

Although nicotine stomatitis is caused by smoking tobacco products, it is generally not associated with dysplastic or malignant changes.^[9]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.^[10]

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 by nicotinic stomatitis. Women smoke pipes less often than men; therefore, nicotinic stomatitis is less prevalent in women.

Age

Nicotinic stomatitis is related to duration, intensity, and types of smoking and is not related to the age of the smoker.^[11]

Proceed to Clinical Presentation

Contributor Information and Disclosures

Author

Sol Silverman, DDS, MA, DipABOM Professor Emeritus, Department of Orofacial Sciences, University of California at San Francisco

Sol Silverman, DDS, MA, DipABOM is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association

Disclosure: Nothing to disclose.

Coauthor(s)

Dana Gelman Keiles, DMD Assistant Clinical Professor, Department of Stomatology, University of California at San Francisco

Dana Gelman Keiles, DMD is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Marjan Garmyn, MD, PhD Professor, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium; Chair and Adjunct Head, Department of Dermatology, University of Leuven, Belgium

Disclosure: Nothing to disclose.

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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