Nicotinic Stomatitis; Smokers Palate

The images on this page are copyright 2006 Martin S. Spiller, D.M.D. courtesy of Dr. Ed Cataldo

Tobacco smoke can be quite irritating to oral tissues.  The image above shows a chronic irritation to the soft palate caused by pipe smoke.  Nicotinic stomatitis occurs almost exclusively in pipe smokers and appears on the hard and soft palate.  It looks grayish-white with a nodular appearance due to keratinization of the areas around the ducts of the minor salivary glands.  Keratinized tissue is like a callus, and it is a natural reaction of the oral tissues to noxious stimuli including chronic heat and tobacco smoke, a combination especially prevalent in pipe smokers.  Nicotinic stomatitis is not considered a pre-malignant lesion, however there are exceptions to every rule (see the last image on this page)

The image above is the same patient after cessation of pipe smoking for six weeks.  All the nicotinic stomatitis has cleared up. 

Nicotinic stomatitis happens only in areas where the pipe smoke can make contact with the palatal tissues.  The above image shows nicotinic stomatitis in a patient who wears a partial denture which covers the anterior half of the hard palate.  Thus the nicotinic stomatitis is seen only in areas distal to (behind) the plastic flange which has protected the tissues under it from the heat and toxicity of the pipe smoke.

Painful palatal erosions due to heavy smoking may occur in addition to nicotinic.  They are probably due to the heat of the smoke.  The above image shows an early stage nicotinic stomatitis with heat related lesions.  Biopsy must be performed to rule out dysplasia.

Nicotinic stomatitis is not considered a pre cancerous condition, however there are exceptions to every rule.  The image above shows nicotinic stomatitis in an elderly man who has been smoking a pipe for many years.  He does not have teeth, nor does he have a denture to protect his palate.  The thick, white keratinization on the edentulous (toothless) ridges are probably at least partly due to years of chewing on bare gums, made worse by the pipe smoke which was probably habitually aimed more at this area of the mouth than others.  The irregular red and white lesion proved to be squamous cell carcinoma. While nicotinic stomatitis is not considered to be pre cancerous, leukoplakia definitely is!  (See the images below.)   Both leukoplakia and nicotinic stomatitis are composed of keratinized tissue, and the difference in carcinogenicity may, in fact, be due mostly to the differences in the resistances of the tissues on which they are found.  Perhaps very long exposure of the palatal tissues to hot, caustic pipe smoke can break down the resistance of the palatal tissues and stimulate dysplasia there.