An 11-year-old boy presented with a chief complaint of difficulty in eating and restricted mouth opening () since 1 year. On asking leading questions, the patient gave a history of burning sensation over buccal mucosa while consuming spicy food since 1 year. The patient had a habit of tobacco and betel nut chewing 15–20 times per day since 5 years. He also had a habit of keeping the quid in the buccal vestibule.\nOn clinical examination, maximum interincisal distance was 13 mm. Intraoral examination revealed palpable fibrous bands over labial and buccal mucosa along with blanching of palate, soft palate and floor of mouth (). Tongue movements were restricted and the uvula was shrunken. Histopathological examination showed moderately hyalinised collagen in connective tissue stroma. Few areas show thickened collagen bundles. Inflammatory exudate chiefly consists of lymphocytes and plasma cells.
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.