Stomatitis nicotina

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Stomatitis nicotina
Other namesNicotine 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]
Specialty Oral medicine   OOjs UI icon edit-ltr-progressive.svg

Stomatitis nicotina is a diffuse white patch on the hard palate, usually caused by tobacco smoking, usually pipe or cigar smoking. [2] 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. [6]

Contents

Signs and symptoms

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. [6] [7] The condition is painless. [4] If a denture is normally worn while smoking, then the mucosa underneath the denture appears unaffected by the condition. [8] In severe cases, the mucosa may show fissuring and develop a "dried lake bed" appearance. [9] 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

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. [6] 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. [6] This form of the condition is sometimes termed "reverse smoker's keratosis", [9] and is a premalignant lesion. [4] [6] 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. [8] 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. [7]

Diagnosis

The diagnosis is normally made based upon the clinical appearance and history. [8] Tissue biopsy is not usually indicated unless there are areas of ulceration or localized erythroplakia (red patches). [8] 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, [10] oral candidiasis, [10] and oral lichen planus. [10]

If a biopsy is taken, the histopathologic appearance is one of hyperkeratosis and acanthosis. [9] There may be squamous metaplasia of excretory ducts, which results in the visible papules if the ducts become hyperplastic. Neutrophils may fill some ducts. [9] It is characterized as a "fissured" or "dried mud" appearance from excess keratin production by cells. Dysplasia is rarely seen. [9]

Treatment

When the appearance is caused by heat, the lesion is usually completely reversible within a few weeks [7] if the smoking habit is stopped. [4] [6] This is the case even if the condition has been present for decades. [9] 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, [9] and may trigger the decision to carry out a biopsy to confirm the diagnosis. [8] Since this condition almost always develops in the setting of long term heavy smoking, it usually indicates the need for regular observation [8] for cancers associated with smoking, e.g. lung cancer.

Epidemiology

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. [7] The condition was once common, but has become more rare as habits such as pipe and cigar smoking have decreased in popularity. [9]

See also

Related Research Articles

Mouth ulcer Medical condition

A mouth ulcer (aphtha) is an ulcer that occurs on the mucous membrane of the oral cavity. Mouth ulcers are very common, occurring in association with many diseases and by many different mechanisms, but usually there is no serious underlying cause. Rarely, a mouth ulcer that does not heal may be a sign of oral cancer. These ulcers may form individually or multiple ulcers may appear at once. Once formed, an ulcer may be maintained by inflammation and/or secondary infection.

Oral candidiasis Fungal infection

Oral candidiasis, also known as oral thrush among other names, is candidiasis that occurs in the mouth. That is, oral candidiasis is a mycosis of Candida species on the mucous membranes of the mouth.

Leukoplakia Medical condition

Oral leukoplakia is a potentially malignant disorder affecting the oral mucosa. It is defined as “essentially an oral mucosal white lesion that cannot be considered as any other definable lesion.” Oral leukoplakia is a white patch or plaque that develops in the oral cavity and is strongly associated with smoking.Leukoplakia is a firmly attached white patch on a mucous membrane which is associated with increased risk of cancer. The edges of the lesion are typically abrupt and the lesion changes with time. Advanced forms may develop red patches. There are generally no other symptoms. It usually occurs within the mouth, although sometimes mucosa in other parts of the gastrointestinal tract, urinary tract, or genitals may be affected.

Lichen planus Human chronic inflammatory disease

Lichen planus (LP) is a chronic inflammatory and immune-mediated disease that affects the skin, nails, hair, and mucous membranes. It is not an actual lichen, and is only named that because it looks like one. It is characterized by polygonal, flat-topped, violaceous papules and plaques with overlying, reticulated, fine white scale, commonly affecting dorsal hands, flexural wrists and forearms, trunk, anterior lower legs and oral mucosa. Although there is a broad clinical range of LP manifestations, the skin and oral cavity remain as the major sites of involvement. The cause is unknown, but it is thought to be the result of an autoimmune process with an unknown initial trigger. There is no cure, but many different medications and procedures have been used in efforts to control the symptoms.

Erythroplakia Medical condition

Erythroplakia is a clinical term to describe any erythematous (red) area on a mucous membrane, that cannot be attributed to any other pathology.

Aphthous stomatitis Common condition involving ulceration of the oral mucosa.

Aphthous stomatitis, or recurrent aphthous stomatitis (RAS), is a common condition characterized by the repeated formation of benign and non-contagious mouth ulcers (aphthae) in otherwise healthy individuals. The informal term canker sore is also used, mainly in North America, although it may also refer to other types of mouth ulcers. The cause is not completely understood but involves a T cell-mediated immune response triggered by a variety of factors which may include nutritional deficiencies, local trauma, stress, hormonal influences, allergies, genetic predisposition, certain foods, dehydration, or some food additives.

Precancerous condition Medical condition

A precancerous condition is a condition, tumor or lesion involving abnormal cells which are associated with an increased risk of developing into cancer. Clinically, precancerous conditions encompass a variety of abnormal tissues with an increased risk of developing into cancer. Some of the most common precancerous conditions include certain colon polyps, which can progress into colon cancer, monoclonal gammopathy of undetermined significance, which can progress into multiple myeloma or myelodysplastic syndrome. and cervical dysplasia, which can progress into cervical cancer. Bronchial premalignant lesions can progress to squamous cell carcinoma of the lung.

Stomatitis Medical condition

Stomatitis is inflammation of the mouth and lips. It refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration.

The oral mucosa is the mucous membrane lining the inside of the mouth. It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed lamina propria. The oral cavity has sometimes been described as a mirror that reflects the health of the individual. Changes indicative of disease are seen as alterations in the oral mucosa lining the mouth, which can reveal systemic conditions, such as diabetes or vitamin deficiency, or the local effects of chronic tobacco or alcohol use. The oral mucosa tends to heal faster and with less scar formation compared to the skin. The underlying mechanism remains unknown, but research suggests that extracellular vesicles might be involved.

Geographic tongue Tongue disorder

Geographic tongue, also known by several other terms, is a condition of the mucous membrane of the tongue, usually on the dorsal surface. It is a common condition, affecting approximately 2–3% of the general population. It is characterized by areas of smooth, red depapillation which migrate over time. The name comes from the map-like appearance of the tongue, with the patches resembling the islands of an archipelago. The cause is unknown, but the condition is entirely benign, and there is no curative treatment. Uncommonly, geographic tongue may cause a burning sensation on the tongue, for which various treatments have been described with little formal evidence of efficacy.

Inflammatory papillary hyperplasia (IPH) is a benign lesion of the oral mucosa which is characterized by the growth of one or more nodular lesions, measuring about 2mm or less. The lesion almost exclusively involves the hard palate, and in rare instances, it also has been seen on the mandible. The lesion is mostly asymptomatic and color of the mucosa may vary from pink to red.

An oral medicine or stomatology doctor has received additional specialized training and experience in the diagnosis and management of oral mucosal abnormalities including oral cancer, salivary gland disorders, temporomandibular disorders and facial pain, taste and smell disorders; and recognition of the oral manifestations of systemic and infectious diseases. It lies at the interface between medicine and dentistry. An oral medicine doctor is trained to diagnose and manage patients with disorders of the orofacial region, essentially as a "physician of the mouth."

Necrotizing sialometaplasia Medical condition

Necrotizing sialometaplasia (NS) is a benign, ulcerative lesion, usually located towards the back of the hard palate. It is thought to be caused by ischemic necrosis of minor salivary glands in response to trauma. Often painless, the condition is self-limiting and should heal in 6–10 weeks.

Leukoedema is a blue, grey or white appearance of mucosae, particularly the buccal mucosa ; it may also occur on the mucosa of the larynx or vagina. It is a harmless and very common condition. Because it is so common, it has been argued that it may in fact represent a variation of the normal appearance rather than a disease, but empirical evidence suggests that leukoedema is an acquired condition caused by local irritation. It is found more commonly in black skinned people and tobacco users. The term is derived from the Greek words λευκός leukós, "white" and οἴδημα oídēma, "swelling".

Smokers melanosis Medical condition

Smoker's melanosis is seen with the naked eye as a brown to black pigmentation of the oral tissue i.e. the gums, cheeks or palate as well as in larynx. It is most often seen in the lower labial gingiva of tobacco users. Most easily it is found in Caucasians, due to their lack of a genetically caused melanin pigmentation.

Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.

Median rhomboid glossitis Medical condition

Median rhomboid glossitis is a condition characterized by an area of redness and loss of lingual papillae on the central dorsum of the tongue, sometimes including lesions of the tongue and palate. It is seen in patients using inhaled steroids and smokers, and is usually a kind of chronic atrophic oral candidiasis, but hematinic deficiency and diabetes should be excluded.

Morsicatio buccarum is a condition characterized by chronic irritation or injury to the buccal mucosa, caused by repetitive chewing, biting or nibbling.

Denture-related stomatitis is a common condition where mild inflammation and redness of the oral mucous membrane occurs beneath a denture. In about 90% of cases, Candida species are involved, which are normally a harmless component of the oral microbiota in many people. Denture-related stomatitis is the most common form of oral candidiasis. It is more common in elderly people, and in those who wear a complete upper denture. Denture-related stomatitis is more likely to develop when the denture is left constantly in the mouth, rather than removing it during sleep, and when the denture is not cleaned regularly.

Smokeless tobacco keratosis (STK) is a condition which develops on the oral mucosa in response to smokeless tobacco use. Generally it appears as a white patch, located at the point where the tobacco is held in the mouth. The condition usually disappears once the tobacco habit is stopped. It is associated with slightly increased risk of mouth cancer.

References

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  6. 1 2 3 4 5 6 Werning, John W. (2007). Oral cancer : diagnosis, management, and rehabilitation. New York: Thieme. p. 12. ISBN   9781588903099.
  7. 1 2 3 4 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 . Retrieved 31 August 2013.
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  9. 1 2 3 4 5 6 7 8 "Frictional, Chemical, & Thermal Keratosis, from Bond's Book of Oral Diseases, 4th Edition". The Maxillofacial Center for Diagnostics & Research. Retrieved 1 September 2013.
  10. 1 2 3 Laskaris, George (2006). Pocket atlas of oral diseases (2nd ed.). Stuttgart: Thieme. ISBN   9781588902498.
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