It presents as a generalized loss of elasticity of the mucosa, with the formation of fibrotic bands due to a fibroelastic change in the lamina propria, which limits the ability to open the mouth. The tongue loses mobility and firmness.  This condition is common in people from India, who chew the areca nut or tobacco.  It has one of the highest rates of malignant transformation among the pre-cancerous lesions.  None have been observed in the Dominican Republic.