|LETTER TO EDITOR
|Year : 2017 | Volume
| Issue : 2 | Page : 125-126
Diagnosis of smokers' palate in a denture wearer patient
Shail Kumari1, Sunil Kumar Mishra2
1 Department of Orthodontics and Dentofacial Orthopaedics, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
2 Department of Maxillofacial Prosthodontics and Implantology, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
|Date of Web Publication||15-Dec-2017|
Dr. Sunil Kumar Mishra
Department of Maxillofacial Prosthodontics and Implantology, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumari S, Mishra SK. Diagnosis of smokers' palate in a denture wearer patient. BLDE Univ J Health Sci 2017;2:125-6
A 48-year-old male patient reported with a chief complaint of ill-fitting maxillary denture and wants it to be replaced. On clinical examination, there was no relevant medical history given by the patient. The patient gives a dental history of extraction and partial dentures with maxillary and mandibular arches. Three months back, the remaining anterior teeth got extracted; so the patient wants a maxillary complete denture. He gives a history of bidi smoking for the last 20 years, he smokes 10–12 bidis per day. On intraoral examination, asymptomatic lesion seen on the hard palate, usually grayish combined with multiple red dots located centrally in small elevated papule or a nodule [Figure 1]. He presented with a partial maxillary denture with suction disc attached and with very poor denture hygiene [Figure 2]. He was under medication for fungal infection and advised to discontinue the use of denture but still the lesion on palate persists. The patient was diagnosed to have smoker's palate (nicotinic stomatitis).
One of the most common causes of mortality and morbidity in developed and developing countries is tobacco smoking. Smoking causes leukoplakia of the oral cavity, smoker's melanosis, black hairy tongue, smoker's palate, and squamous cell carcinoma. Smoker's palate is a lesion involving the palatal mucosa and described since 1926 in the literature. Thoma in 1941 named the lesion as stomatitis nicotine because it is commonly seen in individuals with tobacco smoking. The cause for this lesion is due to concentrated stream of heat released from the tobacco products and the chemicals in tobacco may act as irritants. The palate of the individuals with smokers palate is painless and appears as gray or white with elevated red dots in the center of the papules or nodules. Due to heat, the ducts of minor salivary glands gets inflamed.
Greenburg et al. classified the smoker's palate into three grades.
- Grade I: Mild - consisting of red, dot-like opening on blanched area
- Grade II: Moderate - characterized by well-defined elevation with central umbilication
- Grade III: Severe - Marked by papules of 5 mm or more with umbilication of 2–3 mm.
The differential diagnosis may be leukoplakia, Darier's disease, discoid lupus erythematosus, oral candidiasis, oral lichen planus, and denture-induced hyperplasia. Leukoplakia presents with firmly attached white patch on a mucous membrane. Darier's disease is characterized by dark crusty patches on the skin, sometimes containing pus. Oral discoid lupus erythematosus present as white spots, ulcers, and central erythema lesions. Acute pseudomembranous candidiasis is characterized by a coating or individual patches of pseudomembranous white slough that can be easily wiped away to reveal erythematous. Oral lichen planus does not cause any pain and present with Wickham striae. Denture-induced fibrous hyperplasia or epulis fissuratum and inflammatory papillary hyperplasia are more prevalent in older subjects.
Low-intensity chronic trauma usually from ill-fitting dentures causes fibrous hyperplasia. Lesions typically appear as a single or multiple hyperplastic tissue folds covered with stratified squamous epithelium in the vestibule. Inflammatory papillary hyperplasia is asymptomatic tissue growth due to ill-fitting dentures, poor oral hygiene, candida infections, prolonged use of dentures, and denture sensitivity. In this condition, the mucosa is erythematous and has a pebbly or papillary surface.
The treatment of smoker's palate is advicing the patient to completely stop the smoking and avoid hot beverages and food. If the lesion is caused by heat, it will completely reverse within a few weeks. If the lesion persists even after smoking is stopped, biopsy is to be done to rule out true leukoplakia. Regular observation of the lesion is suggested to avoid any cancers associated with smoking.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dubal M, Nayak A, Suragimath A, Sande A, Kandagal S. Analysis of smoking habits in patients with varying grades of smoker's palate in South Western region of Maharashtra. J Oral Res Rev 2015;7:12-5. [Full text]
Thomas KH. Stomatitis nicotine and its effect on the palate. Am J Orthod 1941;27:38-47.
dos Santos RB, Katz J. Nicotinic stomatitis: Positive correlation with heat in maté tea drinks and smoking. Quintessence Int 2009;40:537-40.
Nayak V, Girish YR, Kini R, Rao PK, Bhandarkar GP, Kashyap RR. Smokers hyperplasia of hard palate. J Dent Oral Disord 2017;3:1055.
Jontell M, Holmstrup P. Red and white lesions of the oral mucosa. In: Greenberg MS, Glick M, Ship JA, editors. Burket's oral medicine. 11th ed. Hamilton: BC Decker; 2008. p. 77-106.
[Figure 1], [Figure 2]