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Stomatitis Severe Nicotinic Stomatitis Nicotine stomatitis typically affects males over the age of 45. This lesion is found on the palatal mucosa and has a very characteristic clinical appearance Nicotinic Stomatitis first becomes visible as a reddened area and slowly progresses to a white, thickened, and fissured appearance. The roof of the mouth has numerous minor salivary glands. They become swollen, and the orifices become prominent, giving the tissue a speckled white and red appearance. It cannot be wiped off and can have some fissuring. Patients usually are asymptomatic its often found on routine examination of the mouth as it usually does not cause any symptoms. Sometimes it may be mildly irritating.
Initially there is redness of the hard palate and sometimes the adjacent soft palate. With time, the palate becomes white with a cracked appearance likened to dried mud. The numerous scattered red dots. they are inflammed ducts openings of minor salivary glands.
Dentures protect the palate from the heat stream. The changes are then seen only towards the back of the roof of the mouth beyond the area covered by the denture.
Nicotine stomatitis itself is not regarded as premalignant except with reverse smoking. However, smoking is associated with the development of oral squamous cell carcinoma so the conditions can co-exist. Examination Examination of the head and neck region revealed no palpable lymph nodes. All vital signs were found to be within normal limits. Oral examination revealed multiple, tiny, and flat-topped white papules on the posterior hard palate
Each papule exhibited a central, tiny red dot surrounded by a white keratotic ring. The papules could not be removed by wiping or scraping. The adjacent mucosal surface of the soft palate appeared wrinkled and fissured. Further examination of the oral cavity revealed no other lesions present.
Usually the diagnosis is done by knowledge of the patient's history
and the clinical appearance
(speckled White and red hard palate). Investigations In some cases confirming the diagnosis is not possible especially when the lesion shows no resolution after cessation of smoking .
Performing a 5 mm excision Biopsy is
indicated. Differential diagnosis 1- Cancers of the oral mucosa
2- Candidasis DIFFERENTIAL DX INCLUDES SQUAMOUS CELL CARCINOMA
The differential diagnosis in a case of nicotine stomatitis includes:irritation from dental appliancestrauma from hot liquidssquamous cell carcinomaatrophic candidiasis.
Nicotine stomatitis, it is generally not associated with dysplastic or malignant changes but on the other hand concentrated heat and chemicals should be taken into consideration because they increase the potential for malignant changes. Mortality/Morbidity One hundred and thirteen biopsies of the palate in people accustomed to smoking cigars, most of them with the burning end of the cigar inside the mouth, have been studied.
Thirty-eight of these showed mild to severe atypical changes in the epithelium.
There were 19 lesions showing orthokeratosis and 53 showing hyperorthokeratosis. The earliest atypical change is seen in the mouths of the ducts of the glands.
The papules with umbilication could be due to hyperplasia of the mucous glands
It is suggested that stomatitis nicotina occurring in men and women with the habit of reverse smoking is probably precancerous because of the presence of atypical changes in the epithelium and also the finding of 3 microinvasive carcinomas without any macroscopic evidence. It could include benign hyperkeratosis and acanthosis to hyperkeratosis accompanied with graded epithelial dysplasia or invasive squamous cell carcinoma. The salivary gland ducts would show evidence of ductal ectasia, epithelial metaplasia, hyperplasia and may be even dysplasia depending on the overlying epithelial changes. Nicotinic stomatitis generally does not transform into malignancy and is a response to the heat of tobacco smoke rather than the chemicals in the smoke.
Studies have shown that nicotinic stomatitis in reverse smokers is a specific etiologic factor for squamous cell carcinoma of the hard palate. In reverse smoking, the lit end of the cigarette is placed in the mouth so that an intense heat is generated during smoking.
The salivary gland ducts would show evidence of ductal ectasia, epithelial metaplasia, hyperplasia and may be even dysplasia depending on the overlying epithelial changes.
Treatment depends on the histology and may range from tobacco cessation and close observation to surgical removal with clean margins to a more radical treatment. Squamous Cell Carcinoma of the hard palate Treatment and Prognosis The only treatment is to stop smoking. The changes then improve within 1-2 weeks. Any persistent areas should be biopsied. Regular examination of the mouth is required. Nicotinic stomatitis is not considered a pre-malignant lesion, however there are exceptions to every rule The prognosis of nicotinic stomatitis is excellent. Before 6 weeks after quiting smoking Resources http://doctorspiller.com/nicotinic_stomatitis.htm
Regezi JA, Sciubba J, Jordan RCK. Oral Pathology: Clinical Pathologic Conditions. 4rd ed. Philadelphia, Pa: WB saunders Co; 2003
http://dermnetnz.org/reactions/nicotine-stomatitis.html Thank you Done by: Bayan Jamal 43120126
Lamya Albatli 43120270
Maram Alhumaien 43120271
Nada Softah 43120265
Razan Iskandarani 43120033
Sara Altuwaijri 43020178 Supervised by: Dr. Nishath Sayed Abdul Nicotine stomatitis is a lesion that develops on the hard palate of some smokers. It appears as white with raised red dots; the red area represent inflamed ducts of the minor salivary glands. The surface usually has rough texture, which makes the palate appear cooked. The appearance of the lesion may become more prominent as the condition persist. The cause of nicotine stomatitis seems from the palate being exposed to very hot conditions. Pipe smoking produces more heat on the palate than any other form of smoking. The frequency of this condition depends on a society's use of consuming hot beverages and of smoking in its various forms. More commonly found in men over 45 years of age, it is characterized as a "fissured" or "dried mud" appearance from excess keratin production by cells. Causes of Nicotinic Stomatitis