Palatal Leukokeratosis Secondary to Candela pa Den

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Abstract
Common among older women in the Leeward islands of the Netherlands Antilles is the habit of smoking with the lit end of the cigarette held inside the mouth. In Papiamento, the local dialect, this is known as candela pa den, or "the fire within." As one might imagine, this deplorable practice has a deleterious effect on the mucosa of the hard palate, where it produces a florid and unusual leukokeratosis. Leukoplakia and leukokeratosis in smokers is well documented.1-5 We have searched the literature, however, and failed to find mention of candela pa den. We now report 21 such cases, including seven which we presented previously.6 Except for some dryness of the mouth, the lesions seem to cause no subjective distress. We have never noticed glossal involvement, no matter what the condition of the palatal mucosa. It is interesting that habitueés of candela pa den who use upper

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