Medication Summary

Medical therapy for nicotine stomatitis is directed at smoking cessation.^{[22, 23]} Varenicline decreases the stimulatory effect from consuming nicotine products by blocking nicotine receptors.^{[24, 25]}

Class Summary

Nicotine substitutes are available as a transdermal patch, gum, an inhaler, or nasal spray.

Nicotine transdermal system (Nicotrol, NicoDerm CQ, Habitrol)

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The nicotine transdermal system works best when used in conjunction with a support program (eg, counseling, group therapy, behavioral therapy).

Class Summary

These are used in conjunction with a support group and/or behavioral counseling.

Bupropion (Zyban)

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Bupropion inhibits neuronal dopamine reuptake in addition to being a weak blocker of serotonin and norepinephrine reuptake.

Class Summary

Nicotinic acetylcholine receptor partial agonists bind to nicotine receptors and elicit mild nicotine central effects to ease withdrawal symptoms.

Varenicline (Chantix)

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Varenicline is a partial agonist selective for alpha4, beta2 nicotinic acetylcholine receptors. Its action is thought to result from activity at a nicotinic receptor subtype, where its binding produces agonist activity while simultaneously preventing nicotine binding. Agonistic activity is significantly lower than nicotine. It also elicits moderate affinity for 5-HT3 receptors. Maximum plasma concentrations occur within 3-4 hours after oral administration. Following regular dosing, a steady state reached within 4 days.

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Media Gallery

Classic nicotine stomatitis. Note the speckled white and red appearance from the hyperkeratosis and minor salivary gland openings.
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.
Inflamed salivary gland ducts in nicotine stomatitis.

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Author

James E Cade, DDS, FACD Associate Professor, Chair, Department of Oral Diagnostic Sciences, Meharry Medical College School of Dentistry; Private Practice, Honeycutt Family Dentistry

James E Cade, DDS, FACD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio

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

Disclosure: Nothing to disclose.

Chief Editor

Jeff Burgess, DDS, MSD (Retired) Clinical Assistant Professor, Department of Oral Medicine, University of Washington School of Dental Medicine; (Retired) Attending in Pain Center, University of Washington Medical Center; (Retired) Private Practice in Hawaii and Washington; Director, Oral Care Research Associates

Disclosure: Nothing to disclose.

Additional Contributors

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.

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

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

Disclosure: Nothing to disclose.

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, American Dental Association

Disclosure: Nothing to disclose.