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 2009, a 11-year-old Indian Muslim girl was referred to the Oral Medicine Clinic, CSM Medical University, Lucknow, India by Public Health Dentist during “School oral health care 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 seven year; the reduced mouth opening was noticed from past one year, with discomfort and a burning sensation particularly when eating hot and spicy foods.\nIntraoral examination revealed that her entire oral mucosa was pale, especially the buccal mucosa, which does not show areas of erosion and the hard palate, which was completely blanched or opaque. Her tongue, uvula and soft palate were normal.\nDental examination reveals carious lesion in posterior tooth and poor oral hygiene.\nPhysical examination reveals a mouth opening of 14 mm and absence of fibrotic bands.