What are the other Names for this Condition? (Also known as/Synonyms)

• Nicotine Palatinus
• Palatal Leukokeratosis
• Smoker's Palate

What is Nicotine Stomatitis? (Definition/Background Information)

• Nicotine Stomatitis is a typically benign lesion that develops on the roof of the mouth (palate) due to extreme heat exposure caused by tobacco smoking. Individuals who smoke pipes or perform some antics, such as place the lit end of the cigarette in the mouth (called reverse smoking), have a very high risk for the condition
• The formation of Nicotine Stomatitis is also dependent on the duration of smoking. It is important to note that the chemical substance nicotine, found in tobacco smoke, is not responsible for the formation of the lesion, but it is the long-term exposure to extreme heat that is causative
• Nicotine Stomatitis is also known as Smoker's Palate, and a vast majority of the cases are observed in men. The lesions are generally asymptomatic. There is no specific treatment available for the condition; smokers are strongly advised to stop smoking

Who gets Nicotine Stomatitis? (Age and Sex Distribution)

• Nicotine Stomatitis is commonly seen in adults. It is reported that nearly 1 in 3 cigarette smokers may develop the condition
• Both males and females are affected, but it is more common in men
• The condition is observed worldwide, and no specific racial or ethnic group bias is seen

What are the Risk Factors for Nicotine Stomatitis? (Predisposing Factors)

The risk factors for Nicotine Stomatitis may include:

• Pipe smoking - nearly 3 in 5 individuals who smoke pipes are known to develop Nicotine Stomatitis
• Reverse cigarette smoking (when the lit end of a cigarette is placed in the mouth)
• Cigar, cigarette, and beedi smoking: Beedi (or bidi) is a form of thin cigarette in which tobacco flakes are wrapped in a non-tobacco leaf that is tied or glued at one end
• In rare cases, chronically consuming very hot drinks (such as tea, milk, or coffee)

In some individuals, more than one risk factor may be observed.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Nicotine Stomatitis? (Etiology)

Nicotine Stomatitis develops from chronic exposure of the mouth to concentrated heat stream of tobacco smoke.

• Individuals who smoke pipes have the highest risk for developing the condition
• The response of the mucosal surfaces to long-term high heat exposure results in the formation of white patches (lesion) on the hard palate, termed thermally-induced keratosis
• The greater the period of heat exposure and the longer the duration of smoking, the higher is the risk

What are the Signs and Symptoms of Nicotine Stomatitis?

Apart from the presence of white-grey patches on the roof of the mouth, in a majority of cases, Nicotine Stomatitis is an asymptomatic and painless condition. In many cases, it is an incidental finding in smokers.

In some individuals, the following signs and symptoms may be noted:

• Presence of several small papules and nodules on the hard palate
• The patches may be whitish or greyish in appearance
• Red and inflamed surrounding surfaces (duct openings of minor salivary glands)
• A slight discomfort may be observed in some individuals
• Severe cases may present fissuring (cracking) of the hard palate

Additionally, dark teeth and lips and bad breath may be noticed in chronic smokers.

How is Nicotine Stomatitis Diagnosed?

The following tests and procedures may be performed to diagnose Nicotine Stomatitis:

• Physical examination and a complete medical history (including history of smoking)
• Oral cavity exam
• Tissue biopsy: A tissue biopsy may be undertaken to rule out malignancy, because white patches and growths in the oral cavity can represent carcinoma

A differential diagnosis to eliminate other conditions may be considered, before arriving at a definitive diagnosis, since the list of oral lesions with a similar appearance is extensive.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Nicotine Stomatitis?

• Complications are usually not observed with Nicotine Stomatitis, particularly in those who smoke pipes. However, complications caused by the long-term smoking of tobacco products (nicotine) may be observed if any
• Lesions that develop in individuals who engage in reverse smoking are associated with squamous cell carcinoma of the mouth; these lesions are thus termed pre-malignant

How is Nicotine Stomatitis Treated?

• The single most important treatment measure for Nicotine Stomatitis is smoking cessation
• Individuals who are chronic smokers and want to stop smoking may be recommended nicotine replacement therapy, medications, counselling, and behavioral and cognitive therapy

How can Nicotine Stomatitis be Prevented?

Nicotine Stomatitis can be mostly prevented by abstaining from tobacco and tobacco products. Additionally, individuals who want to give up smoking may:

• Surround oneself with friends and family members who are understanding and supportive
• Always keep follow-up appointments with the healthcare provider

What is the Prognosis of Nicotine Stomatitis? (Outcomes/Resolutions)

• In general, the prognosis of Nicotine Stomatitis is usually good following stoppage of smoking. The condition may heal in about 10-14 days
• It is important to hold regular follow-up visits with the physician to watch out for any suspicious or persistent oral patches

Additional and Relevant Useful Information for Nicotine Stomatitis:

Please visit our Dental Health for more physician-approved health information:

http://www.dovemed.com/healthy-living/dental-health/