History of the present illness

This is a 65-year-old Filipino female with 40+ year history of "reverse smoking".   Reverse smoking is smoking with the lighted end of the cigarette held inside the mouth.  She denies alcohol use.  She was referred by her general dentist for the evaluation of a diffuse, thick, yellowish-white slightly nodular mucosa of the hard palate, some of which overlying the torus palatinus (Figure 1).  The patient deferred the suggested incisional biopsy for about six months during which time she essentially discontinued her smoking habit.  This resulted in mucosal healing except for two or so small white plaques on her palatal torus (Figure 2).  They were completely excised.

Figure 1.  This photograph was taken in February 2007.  Note the thick and diffuse, white to yellow plaques on the middle and anterior hard palate, some overlying the torus palatinus

Figure 2. This photograph was taken in August 2007 after six months of cessation of reverse smoking.  Note only two small flat white plaques are present overlying the torus palatinus.