Breakthrough Clinical oral pathology case: No. 17

A 64-year-old female presents for her scaling and root planing appointment. Prior to commencing with care, she expressed concern over some lesions in her mouth that had developed over the course of the last few weeks after her last appointment—sores that had only progressively gotten bigger. Clinical assessment revealed large, ulcer-like lesions on the right and left lateral borders of the tongue, and the vestibular tissue, upon the slightest touch, sloughed and hemorrhaged easily. Stacey L. Simmons, Breakthrough Clinical’s editorial director, presents one of her cases for you to study and offer your recommended treatment modalities and differentials. Read more about the case and view photos ...

Content Dam Diq Online Articles 2016 07 16jul7bcsimmons Path17caset

This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.

A 64-year-old female presents for her scaling and root planing (SRP) appointment. Prior to commencing with care, she expressed concern over some lesions in her mouth that had developed over the course of the last few weeks after her last SRP appointment—sores that had only progressively gotten bigger. She stated that eating and drinking were difficult.

Clinical assessment revealed overall red, inflamed tissue throughout the oral cavity. Most notably present were large, ulcer-like lesions on the right and left lateral borders of the tongue (figures 1 and 2). The edges were well defined; the red center slightly concave and very tender to palpation. Further, the vestibular tissue, upon the slightest touch, sloughed and hemorrhaged easily. Angular cheilitis was observed, and opening was painful (figure 3).

To better understand, here is the patient’s history: Prior to her recare appointment, which was 1.5 months ago, it had been almost two years since she had been seen. During this hiatus, she had a heart attack and stroke. She has a history of hepatitis C, for which she has been on the liver transplant list. Her list of medications include furosemide (blood pressure/diuretic), escitalopram (depression), ursodiol (gallstones), omeprazole (GERD, heartburn), baclofen (muscle relaxant), spironolactone (blood pressure, diuretic), bupropion (depression), potassium (urinary), trazodone (depression), gabapentin (antseizure), lactulose (laxative), and estradiol (hormone). Just three weeks prior to this scaling and root planing, she began the medication Harvoni, a drug used to treat chronic hepatitis C.

With this presentation and history, what are your recommended treatment modalities and differentials?


Figures 1 and 2


Figure 3

Send your answers to DEbreakthrough@pennwell.com or join our Facebook group to discuss this oral pathology case and more.

MORE PATHOLOGY CASES . . .


This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.

Do you have an interesting oral pathology case you would like to share with Breakthrough’s readers? If so, submit a clinical radiograph or high-resolution photograph, a patient history, diagnosis, and treatment rendered to: DEbreakthrough@pennwell.com. We will let you know if we select your case!

Stacey L. Simmons, DDS, is in private practice in Hamilton, Montana. She is a graduate of Marquette University School of Dentistry. Dr. Simmons is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. She is the editorial director of PennWell’s clinical dental specialties newsletter, DE’s Breakthrough Clinical with Stacey Simmons, DDS, and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. Dr. Simmons can be reached at ssimmonsdds@gmail.com.


For the most current dental headlines, click here.


More in Clinical