TNF and stomatitis: Continuous chronic irritation due to chewing of areca nuts may cause MC activation and degranulation, releasing inflammatory cell mediators such as histamine, tryptase, heparin, histamine, serotonin acid hydrolases, and cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukin 16 (IL-16), causing the initial inflammatory signs of burning sensation, stomatitis, and glossitis in OSMF [15].