Incidental finding of oral white lesions due to tobacco chew
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A 13-year-old male patient presented for an orthodontic consultation. He was previously treated successfully and uneventfully with braces for 15 months and moved into retention. The patient was educated about wearing his retainer and re-called annually for follow-up appointments.

During that 2-year follow-up visit, the patient revealed he did not use his retainer. The intraoral examination showed some Orthodontic relapse to the lower anterior teeth, and the localized gingival recession was evident on his right lower free gingival margin extending from the distal surface of the right mandibular canine to the mandibular right central incisor. There seemed to be some slightly demarcated white lesions present as compared with normal tissues. In addition, his left vestibule appeared normal. From an Orthodontic perspective, there was concern that the previous treatment rendered had resulted in buccal alveolar bone loss and gingival recession due to the non-extraction treatment plan. Impressions and clinical pictures were taken for a new retainer and careful consultation made with an oral surgeon. On the patient's return, a careful social history was obtained, and it was revealed that the patient was chewing Smokeless tobacco just like his parent was. This occurred during his baseball games and some of the games lasted over 4 hours.

Prompt oral diagnosis of white lesions can lead to early intervention leading to successful remission and recovery. oral health providers should make a proactive effort to think beyond their specialty to identify white oral lesions and subsequently conduct counseling on the harmful chemicals of this habit ultimately preventing oral cancers.

Source:https://www.amsjournal.com/article.asp?issn=2231-0746;year=2020;volume=10;issue=2;spage=488;epage=490;aulast=Buendia
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