A 9-year-old boy presented with a chief complaint of gradual reduction in mouth opening since the last 6 months (). History of present illness revealed decrease in mouth opening since 1 year with inability to eat and maintain proper oral hygiene. He also complained of burning sensation in the mouth since 1 year while consumption of spicy food and decreased salivation since 7–8 months.\nThe patient gave a history of tobacco and betel nut chewing, 20–25 times per day since 4 years and used to keep it in buccal vestibule on both sides for about 3–4 min before swallowing.\nClinical examination revealed a maximum interincisal distance of 11 mm. On intraoral examination, labial and buccal mucosa were blanched and inelastic, with vertical and circular fibrous bands palpable on both sides, including the lower lip, upper lip, () buccal mucosa and reteromolar region. Vestibular mucosa, palatal mucosa and floor of the mouth also showed blanching. Tongue had restricted movements.\nHistopathologically, H&E-stained section showed juxtaepithelial hyalinisation and collagen fibres were arranged in separate bundles with dense inflammatory infiltrate.
In 2011, another 10-year-old Indian Muslim boy who had not been attending school at all was referred to the Oral Medicine Clinic, CSM Medical University, Lucknow, India by Public Health Dentist during the “Community oral health screening program”, with a complaint of reduced mouth opening, discomfort and a burning sensation particularly when eating spicy foods.\nPatient showed history of areca nut chewing since six year; the reduced mouth opening was noticed from past eight month, with discomfort and a burning sensation particularly when eating hot and spicy foods and loss of gustatory sensation.\nClinical examination of soft tissue of oral cavity reveals blanched or opaque appearance of mucosa, reduced mobility of the soft palate and tongue, loss of tongue papillae and dryness of the mouth.\nDental examination reveals dental fluorosis in the anterior teeth, carious lesion in posterior tooth and a poor oral hygiene.\nPhysical examination reveals mouth opening is 13 mm, with presence of palpable fibrous band especially in the retro molar area but does not involve the uvula and tonsil.