Clinical Findings

In December 2004, the patient presented with a white and folded right buccal mucosa and vestibule (Figure 2A).  It was rough on palpation and had a leathery consistency.  The area was biopsied and the patient ceased all use of smokeless tobacco for two weeks, which resulted in regression of the disease and regaining of the normal mucosal structure and texture (Figure 2B).  One year later and upon the reuse of smokeless tobacco, the white lesion returned (Figure 1A).  A second incisional biopsy was performed in December 2005 in the same area. The patient then decreased his tobacco use to 4 days per week at an average rate of 2-3 times every other day, a decrease of approximately 25%.  This lead to regression of the white lesions again, except in the retromolar pad area (Figure 2B), where the mucosa remained white and wrinkled in appearance and rough in consistency. He also developed a similar lesion on the left buccal mucosa as a result of switching tobacco use from right to left (Figure 1C).

Figure 1 A, B, & C This photograph was taken on December 2005 after one year of smokeless tobacco use. 

    A. Note the white and wrinkled appearance of the right buccal mucosa

    B. Two weeks after tobacco cessation, note the normal looking buccal mucosa but the white retromolar pad area

    C. Note the white and wrinkled appearance of the left buccal mucosa after three months of use

Figure 2 A & B This photograph was taken on December 2004, after several years of smokeless tobacco use. 

A. Note the white and wrinkled appearance of the right buccal mucosa

B. Two weeks after tobacco cessation, note the normal looking buccal mucosa