These mucosal changes are observed most often in pipe and reverse cigarette smokers and less often in cigarette and cigar smokers. Generally, it is asymptomatic or mildly irritating. Patients typically report that they are either unaware of the lesion or have had it for many years without changes. Nicotine stomatitis affects the oral mucosa of the hard palate posterior to the rugae and the adjacent soft palate. The exception to this is in individuals who reverse smoke.
Reverse smoking is common in some parts of the Caribbean and Southeast Asia.
The concentrated heat and chemicals increase the potential for malignant change. The appearance of nicotine stomatitis is related directly to the population that smokes tobacco products. Nicotine stomatitis first becomes visible as a reddened area and slowly progresses to a white, thickened, and fissured appearance. The palate has numerous minor salivary glands. They become swollen, and the orifices become prominent, giving the tissue a speckled white and red appearance.