Description: The lesion develops on the mucosa adjacent to where smokeless tobacco is held. The usual appearance is a white, wrinkled or corrugated thickened mucosa with intervening areas of erythema. The clinical picture may change and is related to the duration of exposure.
Periodontal degeneration or gingival recession is also a common manifestation with cervical erosion of teeth a less frequent finding. Symptoms are uncommon.
Etiology: Prolonged use of smokeless tobacco products such as chewing tobacco or snuff.
Treatment: Biopsy should be done to rule out dysplasia, otherwise no treatment is necessary.
Prognosis: Verrucous and squamous carcinomas arise in smokeless tobacco lesions more than chance alone can explain. Both the irritation as well as organic carcinogens in the tobacco have been implicated. One article noted almost a 50-fold increased risk of cancers of the gingiva and buccal mucosa in females who were chronic users. The duration necessary to induce dysplastic or malignant change is unknown but appears to be at least 20 years. This potential malignant change is of great concern with the marked increased use by our teenage population. Persistent lesions should be biopsied to rule out dysplastic or carcinomatous change.
Differential diagnosis: The clinical appearance of the lesion plus a history of using smokeless tobacco establishes the diagnosis