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This disorder is specific to populations who smoke with the lighted end of the cigars or cigarettes inside the mouth, producing changes in the palatal mucosa. The largest number of reverse smokers are found in certain areas of India, but this habit is also practiced in some Latin American countries, in Sardinia and in the Philippines. The palatal changes consist of several components such as elevated white patches, red areas, ulcerations and hyper- or non-pigmented areas. These components occur independently, but more often, they coexist. Palatal cancers arise in this region with pre-existing palatal changes; hence they are considered as precancerous Pindborg JJ, Reichart PA, Smith CJ, van der Waal I, (1997). World Health Organisation International Histological Classification of Tumours.Histological Typing of Cancer and Precancer of the Oral Mucosa. 2 ed. Berlin: Springer..


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Figure 1: Reverse smoking. The burning end of the chutta (type of cigar) is being introduced into the oral cavity.
Figure 2: Palatal lesion associated with reverse smoking. Note the diffuse whitening of the entire palatal mucosa (palatal keratosis).
Figure 3: Palatal lesion associated with reverse smoking. Note the well-defined elevated white plaques.
Figure 4: Palatal lesion associated with reverse smoking. Note the well-defined reddening of the palatal mucosa.
Figure 5: Palatal lesion associated with reverse smoking. Note the crate-like ulcerated areas covered with fibrin.
Figure 6: An extensive thick leukoplakia on the dorsal surface of tongue in a women who practices reverse chutta (type of cigar) smoking.
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