Nicotine palatinus is a disorder associated with cigar and pipe smoking. The condition is characterized by changes in the inner lining of the mouth caused by the chemicals, heat and friction produced by smoking and smoking devices. The condition was fairly common a few decades back when pipe and cigar smokers were significantly higher in numbers. The condition is also known as stomatitis nicotina, smoker’s keratosis and smoker’s palate. It is similar to a mouth lesion seen in reverse smokers.
Nicotine palatinus mainly affects the hard and soft palate. The lesion is a white keratotic patch of tissue in most of the instances. Long term exposure to heat produced by pipe and cigars affect the inner lining of mouth and palate. The palate becomes diffusely gray or white in color.
The lesion also shows small areas of elevation along with the white coloration. The elevated areas are known as papules and have a red-colored center. The papules generally represent the inflamed minor salivary gland located in the palate. The tissue covering the papules appears whiter than the surrounding lesion.
If the habit is not discontinued at this stage the condition progresses further. The white color of palate is caused by excess production of keratin from the epithelial cells lining the inside of the mouth. Eventually the palate keratin may become so thickened that the it appears fissured or has a dried mud-pattern appearance. The whiteness may also involves the gums and inner lining of the cheeks.
The condition most commonly occurs in males who smoke pipes and cigars. The age group affected is usually above 45 years .The condition is associated with pipe smoking as it tends to produce more heat then other forms of smoking. It may also be associated with frequent consumption of very hot beverages but usually there is a history of smoking.
Another similar condition affecting the palate is “reverse smokers palate” which is seen in individuals practicing smoking with the lit end of the cigar held within the mouth (reverse smoking). The practice is popular in few areas of the world such as South America and Southeast Asia. The condition should be promptly treated as it has a potential to turn in to cancer.
Nicotine palatinus, however, is a benign condition which generally does not have the potential to transform into cancer.
Nicotine palatinus is a completely reversible condition even if it has been present for a long duration of time. The palate recovers and returns to a normal form within 1 to 2 weeks after cessation of smoking. Even though the lesion may not develop in to cancer, it is best to motivate patients to quit smoking. Nicotine palatinus is one of the many lesions associated with smoking and the other associated lesions such as leukoplakia may turn in to oral cancer.
In advanced cases where the inner lining of the cheek and gums are involved and exhibit white patches, biopsy is advisable to rule out leukoplakia. The lesions that do not subside within a month after smoking cessation and it should also be considered as leukoplakic lesions. Appropriate treatment is necessary.