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The serious disease burden comes largely from the chemical mixture found in tobacco and tobacco smoke (Food and Drug Administration [FDA], 2026)

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Vascular compromise may lead to necrotic ulcers in necrotizing sialometaplasia, an infarction of salivary gland tissue that presents first with a slight swelling followed by break down of the mucosa leading to an ulcer with sharply demarcated margins, and then resolution over a period of weeks.36,37 Infrequently, cases may be bilateral,38 or associated with bulimia.39 The fairly superficial nature of these ulcers, their sharp border, relatively small size, and short duration differentiates this from long-standing ulcers of systemic vasculitides and lesions of midline destructive disease (see below)

1 2 McNeill 2018, p

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