History of the present illness

This is a 58-year-old white male who presented to his dentist with a 9-year history of widespread white lesions involving the left buccal mucosa, left mandibular gingiva and left lateral border of tongue (Figures 1-3). The lesions were white, rough, corrugated, diffuse and leathery in consistency. The lesions were otherwise not painful and not ulcerated. The patient's past medical history is significant for smoking which he quit smoking ten years ago and replaced the habit with Nicorette gum (ten pieces a day for ten years). The left side of his mouth is where the Nicorette gum was held. The dentist instructed the patient to stop holding the Nicorette gum on the left side, which he did for six months, but the white lesions did not show any evidence of regression (Figures 1-3). However he reduced the number of Nicorette use from ten to eight pieces and that small reduction demonstrates improvement (Figure 4).

Figure 1 This clinical photograph was taken at presentation. Note the diffuse white corrugated white lesions of the left buccal mucosa.

Figure 2 This clinical photograph was taken at presentation. Note the diffuse white corrugated white lesions of the left lateral border of tongue.

Figure 3 This clinical photograph was taken at presentation. Note the diffuse white corrugated white lesions of the left mandibular gingiva.

Figure 4 This clinical photograph was taken at eight weeks after decreasing the number of Nicorette gum from ten a day to eight a day. Compare this photograph to Figure 1 and note the difference in the texture of the buccal mucosa; it is smoother in this figure compared to when he was chewing ten pieces of Nicorette gum per day.