Nicotine Stomatitis

Nicotine stomatitis is a thickened, hyperkeratotic alteration of the palatal mucosa that is most frequently related to pipe smoking.
The palatal mucosa becomes thickened and hyperkeratotic, sometimes developing a fissured surface.

The surface often develops popular elevations with red centers, which represent the inflamed openings of the minor salivary gland ducts.
The term nicotine stomatitis is actually a misnomer because it isn’t the nicotine that causes the changes; the changes are caused by the intense heat generated from the smoking.
Nicotine stomatitis is seen more often in pipe smokers because of the great amount of heat that is generated from the pipestem.

Although nicotine stomatitis is a tobacco related it is not considered to be premalignant and it is readily reversible with discontinuation of the tobacco habit.
The mechanism of action of nicotine stomatitis (smoker's palate) is heat and chemical irritation from a tobacco product that acts as a local irritant, stimulating a reactive process, including inflammation, hyperplasia, and epithelial keratinization. Dentures often protect the palate from these irritants in patients who wear them.

SYMTOMS - Nicotine stomatitis first becomes visible as a reddened area and slowly progresses to a white, thickened, and fissured appearance. The palate has numerous minor salivary glands. They become swollen and the orifices become prominent, giving the tissue a speckled white and red appearance.
HISTOLOGICALLY, nicotine stomatitis lesions appear acanthotic and hyperkeratotic, with some mild-to-moderate chronic inflammation. The epithelium of the minor salivary ducts often shows squamous metaplasia.
TREATMENT- The only definitive treatment for nicotine stomatitis is smoking cessation.
The sores usually go away after about 2 weeks of no smoking.