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.
A 12-year-old boy presented with difficulty in mouth opening () and burning sensation on consumption of spicy food since last 8 months. Maximum interincisal distance was 11 mm, which has increased significantly after conservative management (). The patient gave a history of chewing tobacco and betel nut pouches 20–30 per day since 6 years. On intraoral examination, vertical and circular fibrous bands were palpable over lower lip, upper lip, labial and buccal mucosa.\nHistopathologically, H&E-stained section showed collagen fibres were arranged in separate bundles with dense inflammatory infiltrate, also showed juxtaepithelial hyalinisation.