A 32-year-old woman was referred by her dentist to an oral surgeon for evaluation of persistent bilateral cheek swelling and mouth pain. Two months prior to presentation, the patient had awoken with bilateral linear “gashes” in her mandibular vestibule that were accompanied by bilateral buccal facial swellings. Since that day, the facial swelling remained unchanged, and although the mucosal lesions healed, the oral pain persisted. The patient’s medical history was noteworthy for depression, for which she was taking bupropion and fluoxetine, and prior alcohol use disorder, for which she was 3 years sober. She denied any smokeless tobacco use but endorsed daily electronic cigarette use.