Tobacco is a delivery system for the addictive agent nicotine. The dental profession is encouraged to perform oral examinations that focus on oral cancer detection, but other oral changes occur with tobacco use. The oral mucosa is composed of stratified squamous epithelium and masticatory/keratinized (hard palate, dorsum of the tongue, and keratinized gingival) and lining mucosa (floor of the mouth, ventrolateral surface of the tongue, soft palate complex, labial vestibule, and buccal mucosa). Tobacco use affects the surface epithelium, resulting in changes in the appearance of the tissues. The changes may range from an increase in pigmentation to thickening of the epithelium (white lesion). Tobacco use can also irritate the minor salivary glands on the hard palate and directly increase a person's risk for periodontal disease and oral cancer. This article will review some of the more common oral lesions that are associated with tobacco use-smoker's melanosis, nicotinic stomatitis, periodontal disease, smokeless tobacco keratosis, gingival recession/tooth abrasion, black hairy tongue, and oral cancer.
Tobacco is a delivery system for the addictive agent nicotine. Tobacco use in any form is harmful and often results in serious adverse health problems. The dental profession is encouraged to perform oral examinations that focus on oral cancer detection. The relationship between oral cancer and tobacco use is well documented, but other oral changes occur with tobacco use. This article will review some of the more common oral lesions that are associated with tobacco use.
The oral mucosa is composed of stratified squamous epithelium. The epithelial mucosa is separated into two types: masticatory (keratinized) and lining (nonkeratinized). The masticatory mucosa is thick, with a denser, less vascular connective tissue component. Keratin is a protective barrier against stimuli, such as traumatic forces of the everyday activities of eating foods, drinking liquids, speaking, and swallowing, or noxious stimuli from ill-fitting dentures or tobacco use. Stimulation of the masticatory tissues may result in increased keratin formation and the appearance of a white lesion. Masticatory mucosa is found on the hard palate, dorsum of the tongue, and keratinized gingiva. The lining mucosa will form very little keratin and has a less fibrous, more vascular connective tissue. Lining mucosa is found on the floor of the mouth, ventrolateral surface of the tongue, soft palate complex, labial vestibule, and buccal mucosa. In addition to the stratified squamous epithelium of the surface mucosa, the oral cavity will have minor and major salivary glands, sensory and motor nerves, adipose tissue, blood vessels, sebaceous glands, musculature, bone, and teeth.
Tobacco use mainly affects the surface epithelium, resulting in changes in the appearance of the tissues. The changes may range from an increase in pigmentation to a significant thickening of the epithelium (hyperkeratosis), resulting in a distinct white lesion. Tobacco use also can irritate the minor salivary glands on the hard palate and directly increase the risk for periodontal disease.