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Smoker's melanosis is seen with the naked eye as a brown to black pigmentation of the oral tissue i.e. the gums, [1] cheeks or palate [2] as well as in larynx. [3] [4] It is most often seen in the lower labial gingiva of tobacco users. Most easily it is found in Caucasians, due to their lack of a genetically caused melanin pigmentation. [5] [6]
Most common oral sites include: buccal mucosa, lips, gums, hard palate or tongue. Intraoral sites are usually seen as the first sign and they usually develop prior to the skin lesions. [11] In developing countries, this disease is often associated with tuberculosis, where the infection can lead to destruction of the adrenal gland. [12]
Stomatitis nicotina is a diffuse white patch on the hard palate, usually caused by tobacco smoking, usually pipe or cigar smoking. [2] It is painless, [ 4 ] and it is caused by a response of the palatal oral mucosa to chronic heat.
Nicotinic stomatitis is whitening of the hard palate by hyperkeratosis caused by the heat from smoking or from drinking hot liquids. This irritation also causes inflammation of the duct openings of the minor salivary glands of the palate, and they become dilated. This manifests as red patches or spots on a white background. [12]
To check the uvula, a tongue blade is pressed down on the patient's tongue and the patient is asked to say "ah"; the uvula should look like a pendant in the midline and rise along the soft palate. Abnormal findings include deviation of the uvula from the midline, an asymmetrical rise of the soft palate or uvula and redness of either.
Most appear on the non-keratinizing epithelial surfaces in the mouth – i.e. anywhere except the attached gingiva, the hard palate and the dorsum of the tongue – although the more severe forms, which are less common, may also involve keratinizing epithelial surfaces. Symptoms range from a minor nuisance to interfering with eating and drinking.
Amalgam tattoo is a grey, blue or black area of discoloration on the mucous membranes of the mouth, typically on the gums of the lower jaw. It is a healthcare caused lesion, due to entry of dental amalgam into the soft tissues. It is common, painless, and benign, but it can be mistaken for melanoma
Black hairy tongue syndrome (BHT [4]) is a condition of the tongue in which the small bumps on the tongue elongate with black or brown discoloration, giving a black and hairy appearance. The appearance may be alarming, but it is a harmless condition.
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