Monday, December 13, 2010

The Relationship Between Tobacco and Oral cavity.Case Study -

Smoker’s palate or Nicotina Stomatitis

---Today a patient of age 51years had visited the hospital with his chief complain of Pain in one of his posterior teeth. This patient had a history of excessive tobacco exposure; He smoked 10 to 15 cigarettes per day for 18 years.He had chronic generalized periodontitis too . Clinically dark brownish pigmentation was seen with a white leathery lesion was observed. In Smoker’s Palate or Nicotina stomatitis an erythematous irritation is seen and the lesion is followed by a whitish palatal mucosa, which shows hyperkeratosis. In most cases there are red dots appears representing the opening of the accessory salivary glands which can often undergo metaplasia. (There is hyperkeratsis, acanthosis and mild sub-epithelial inflammation. )


The Smoker’s melanosis is diffuse commonly seen in Cigarette smokers .The color of the pigmented area are brown, flat and irregular and can have geographic in appearance. The etiology for it is considered as heat and smoke. (Histological – basillar melanosis ) but it is not a precancerous lesion. Chronic alcoholism is also the cause of hyper activity of melanocytes in the posterior region of mouth along with the soft palate. Even in OSMF melanosis can be observed but is differentiated by the fibrotic bands present in it.



---Another patient of 47 years used smokeless tobacco, which he used to keep below the labial mucosa in the maxillary 11 and 12 region. – He has been using it for 25 years approximately which resulted in hyperkeratosis in the region of tobacco application.Surprisingly there was no severe breakdown of periodontium .


The use of smokeless tobacco in its mild form the lesion shows wrinkles at the site of application and higher consumption causes white leathery lesion which might have ulceration, Hyperkeratinization, acanthosis and vacuolitions is seen histopathologically with sub-epithelial inflammation. Epithelial dysplasia is not significant here like that in oral leukoplakia.