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.
Patients usually are asymptomatic.
Lesions are found exclusively on the palatal mucosa. They have a white cobblestone appearance, often with a red dot in the center of the cobblestone. The lesion cannot be wiped off and can have some fissuring. It is limited to the posterior hard palate and less often to the adjacent soft palate. The mechanism of action is heat irritation from a tobacco product that acts as a local irritant, stimulating a reactive process.