Oral mucosa pigment changes in heavy drinkers and smokers.

The preliminary observation that heavy drinking and smoking produced oral mucosal changes consisting of splotchy areas of depigmentation surrounded by hyperpigmentation was tested. The study population was comprised of 52 patients from an alcohol detoxification ward, who were compared with 54 patients from psychiatric inpatient and day hospital services. Structured interviewing was developed for both samples of patients who met either diagnostic criteria for alcohol abuse or dependence, or criteria for alcoholism on the Short Form of the Michigan Alcohol Screening Test, and were identified as nonsmokers or as those who smoked one to three or more packs of cigarettes a day. Photographs of the inner surface of the lips, oral mucosa, and gingivae independently were rated for severity of oral pigment change by two raters blind to a patient's alcohol or smoking history. This study demonstrates that reported observable oral pigment changes identify patients who are heavy smokers and drinkers, and may be a useful diagnostic sign.