Oral changes associated with tobacco use

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.