4 Figure 4: Heavy tobacco dental staining from pipe smoking with Liquorice as an additive. Gingival recession, alveolar bone loss, and periodontal pockets result from the deleterious eﬀect of the tobacco smoke. Figure 5: Ground Tobacco Wedge, ﬂavored with Liquorice, is habitually placed into the labial Fornix adjacent to the lower incisors. This imparts a sense of euphoria deriving from the nicotine content of the tobacco, (not the liquorice), to its users. Figure 6: After removal of the Tobacco Wedge seen in Figure 5. There is cervical recession and staining, and keratotic changes to the adjacent mucosa. This is the result of prolonged contact of the Tobacco Wedge against the teeth and mucosa. Case Reports in Medicine Hypertension (as high blood pressure) is presumed to obtain when a measure of 130/90 mm mercury (Sys- tolic/Diastolic pressure) or more is measured, normal being 120/70 mm mercury. Hypertension is among the major causes of morbidity and mortality in the world today, and because it is mainly symptomless and painless, hyperten- sion has been labelled “the silent killer.” Atherosclerosis, myocardial infarction and stroke can all result from chronic undetected hypertension [15, 26–29]. A linear dose-related rise in blood pressure has been reported with liquorice consumption in various doses of (20–200 g a day for 4–2 weeks), corresponding to a daily intake of 75–540 mg glycerrhetinic acid [14]. This is an inordinate amount of daily liquorice consumption and would be regarded as a “Fad-diet” and not to be sustained for health. An acceptable daily intake of 0.015–0.229 mg gly- cyrrhizin/kg body weight/day has been proposed [30]. Most problems derive from people on diuretic med- ications in combination with other sources of Liquorice. Hypokalemia partially paralyses smooth muscle contrac- tion, and excess imbibing of liquorice-ﬂavoured alcohols contributes to gastric paralysis, prevents emesis, and indi- rectly contributes to the development of alcoholism. Excess consumption aﬀects blood pressure, kidney function, and gastrointestinal tract [30, 31]. Other than the proven aldosterone eﬀect of liquorice, other medical ailments like headache, myalgia, and muscle fatigue also present [32, 33]. Liquorice contributes in part positively to all these, but elim- inating liquorice may only improve, but not cure or totally prevent severe conditions presenting with these symptoms. Some herbal remedies and other common consumables like chewing gum containing liqourice may precipitate hyperten- sion and associated hypokalemic symptoms [34, 35]. Liqourice-induced hypertension with hypokalemia must be diﬀerentiated from other genetic deﬁciencies which may present with similar ﬁndings: three monogenetic types of mineralo-corticoid hypertension have been identiﬁed, Liddle’s syndrome, glucocorticoid-remediable hypertension, and apparent mineralo-corticoid excess, an autosomal reces- sive disorder with mutations in the 11β-HSD2 gene [36– 39]. Use of chewing and sucking tobacco snuﬀs and other products containing liquorice-like herbal medications, teas, breath fresheners, chewing gums, alcoholic drinks, and food products, all contribute to chronic habitual frequent swallowing of large quantities of liquorice [34, 35]. Excess liquorice consumption contributes not only to deteriorating general health through potassium loss and sodium retention [40] but also to oro-dental compromise. Some people stop smoking and then help control tobacco cravings by consuming large quantities of liquorice as a chronic organoleptic stimulus to help quit. Tooth staining from black liquorice is known, but the tooth staining derives mainly from added dyes to liquorice confections and from liquorice-ﬂavoured tobacco. Accumulation of extracellu- lar polysaccharides from microbial activity contributes to bioﬁlm formation and bacterial plaques. This allows for a tacky gummy surface of muco-polysaccharides to stick to stagnant areas on teeth, and with adherent chromogenic