Breakthrough Clinical oral pathology case: No. 27

Dr. Conway Jensen describes the oral pathology case of a six-year-old male who presents with a 7 mm-plus soft, exophytic, dome-like lesion on the lower lip. The child has a habit of biting his lip. Mom says: "He will bite the bubble and it pops with lots of liquid, but it grows again."

May 30th, 2017
Content Dam Diq Online Articles 2017 06 17jun1bcpathcase27 Thumb

Dr. Conway Jensen describes the pathology case of a six-year-old male who presents with a 7 mm-plus soft, exophytic, dome-like lesion on the lower lip. The child has a habit of biting his lip. Mom says: "He will bite the bubble and it pops with lots of liquid, but it grows again."


Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about it and subscribe here.

A healthy six-year-old male presents for a routine dental visit. He takes no medications and has no known medical allergies.

Dental history: A small amount of caries in the past with an anterior crossbite (end to end), as well as a history and habit of biting his lower lip (i.e., he plays with his lip with his teeth). The parents do not bring the child in for regular checkups; he has been seen three times in the last three years. At a visit six to seven months ago, it was noted that the patient had a sore lower lip from playing with it all day (biting with the teeth). There were no soft-tissue findings.

The patient came for a six-month checkup with a chief complaint of a sore on the lower lip that was large and “comes and goes.” Mom says: "He will bite the bubble and it pops with lots of liquid, but it grows again." They went to see their primary medical doctor, but Mom reports "he did not know what to do and suggested we go see our dentist." Mom said the lesion has been present for the past five months and “it seems to get bigger and bigger.”

At this recare visit, caries was not present, and there was no change in health history. Clinical assessment on the lower lip revealed:

  • 7 mm-plus soft, exophytic, dome-like lesion
  • Normal lip color
  • Fluid filled with a slightly red base
  • No pain, but the patient was having a hard time eating due to position and size of lesion

When I asked Mom why she had not brought her son in sooner, since the lesion has been there for five months, she told me that it was because "it does not hurt him, and it goes away after he bites it for a while. I figured we would see you soon anyway."

We referred the patient to an oral and maxillofacial surgeon (OMS) for evaluation and treatment. I was concerned that Mom would not call the OMS. I attempted multiple times to contact her to follow up and see if an appointment had been made with the OMS, but had no success.

A week later, I called the OMS office directly and confirmed with them that they indeed had an appointment in a couple weeks for evaluation and possible same-day treatment. I will wait for results from their office.

What are your differentials for this lesion? And based upon those, what would your treatment include?

Send your answers to DEbreakthrough@pennwell.com or join our Facebook group to discuss this oral pathology case and more. Next month, we will discuss the final diagnosis and recommended treatment for this case.

Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about it and subscribe here.


For more pathology articles, click 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!


For more articles about clinical dentistry, click here.


Conway Jensen, DDS, grew up in Calgary, Alberta. He obtained his bachelor’s degree in biology from Oregon State University. During dental school at Marquette University School of Dentistry in Milwaukee, Wisconsin, he received a couple of awards in the field of pediatric dentistry. He completed his pediatric dental training at the Children’s Hospital of Wisconsin. Dr. Jensen is a board-certified pediatric dentist in private practice in Washington State and is involved in the American Academy of Pediatric Dentistry. He is a children’s dentist diplomate of the American Board of Pediatric Dentistry. Outside the office, he spends time with his friends and family, and he enjoys the outdoors and travel.


For the most current dental headlines, click here.


More in Clinical