Microscopic Variations In Tobacco Pouch Keratosis: A Retrospective Study

Objectives: The prevalence of smokeless tobacco use has increased with a decrease of smoking in the USA. The oral manifestations of smokeless tobacco use include tobacco pouch keratosis at the sites of pouch placement, gingival recession and staining. The published histological features for diagnosis of tobacco keratosis vary considerably from study to study. This retrospective study evaluated the most frequent histological features associated with tobacco pouch keratosis. Specific aim 1: Attempt to better define the microscopic criteria for tobacco-pouch keratosis. Specific aim 2: To identify the frequency of chewing tobacco use in our sample with respect to age and sex.

Methods: This retrospective study included all cases with a history of smokeless tobacco use and lesions in the mucobuccal fold. The age, sex, location and the clinical diagnosis of the lesion were recorded. The microscopic features including the epithelial and connective tissue features were reviewed.

Results: Among 366 cases reviewed, 95.6% of cases were seen in males. The mean age of chewing tobacco habit was 43.3 years in males and 70% of the cases occurred between 30-59 years of age. The mandibular vestibule was the most common location. Though hyperkeratosis was the main histological feature, only 37.5% cases exhibited characteristic chevrons while 6.3% of cases showed submucosal amorphous material. There was an increase in the amount of inflammation with increasing age.

Conclusion: The habit of chewing smokeless tobacco is most common in males between 30-59 years of age. The chevron pattern of keratinization was noted only in 37.5% while most of the cases showed hyperkeratinization. It can be concluded that the microscopic features in the diagnosis of tobacco keratosis is not definite.