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This man in his 20s presented with a three month history of a burning sensation in his mouth, associated with mildly restricted mouth opening. He had no medical history, but reported chewing betel (areca) nuts daily for the past two years. Examination showed reticular marble-like pallor to the soft palate and buccal mucosa bilaterally (fig 1), which was firm to palpation. Histopathology of a biopsy taken from the right buccal mucosa showed epidermal atrophy, vacuolar interface alteration, and excessive collagen deposition with chronic inflammatory infiltration below the mucosa. He was diagnosed as having oral submucous fibrosis (OSF).