A 14-year-old girl reported to the hospital for a routine dental check-up with difficulty opening the mouth and burning feel while eating spicy food. She had the pattern of chewing flavoured areca nut and scented tobacco, two packets/day for one year. While recording the details of her chewing practice, she revealed that she mixes the separately available packets of flavoured areca nut and scented tobacco and keeps the mixture in the left buccal vestibule in the second molar region. On general physical examination, pallor was observed in the lower sclera, tongue, oral mucous membrane and palmar creases depicting anaemia.
On oral examination, generalised dental stains were present. On inspection, blanching was noticed in the right and left buccal mucosa along with the palate, as shown in the figure. The oral mucosa was white and pale. Diffuse white lesions of approximately 3.5–2 cm and multiple diffuse areas of melanotic pigmentation were present on the buccal mucosa advancing from the retromolar site to the premolar area on the left side. All the findings were confirmed on palpation. The buccal mucosa was rubbery and inelastic, though fibrous bands
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