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Oral pathology case: Think on the fly—what’s your call, doc?

Sept. 9, 2020
Dr. Stacey Gividen says you have to be quick, efficient, and know your pathology. Cases seldom present themselves at an opportune time. Here’s a short case for you if you haven’t had your daily dose of path yet.
Think on the fly. That’s what we have to do as clinicians, especially when we see multiple patients per day. Take, for instance, this patient who was in for a periodontal maintenance visit without a planned doctor exam.
The patient did, however, have concerns that warranted me popping in to assess and make a call regarding some lesions that had manifested approximately six months ago. The lesions had progressed in size and location, and his comfort level was worsening. He reported that it hurt to eat and speak due to the constant rubbing and movement of the oral tissues.

The patient’s health history included lorazepam (for PTSD), lisinopril, and milk thistle. He had an allergy to codeine and penicillin. He shared that he’d been given a prescription of triamcinolone acetonide 0.1% (Kenalog in Orabase) for the lesion from the VA about four months ago, but it didn’t help after applying it for about four weeks.

Clinically, the lesions were generalized, more prominent in the posterior buccal vestibular areas. White patches and collective striations were seen, measuring from 4 mm to 12 mm in size. They were painful to the touch and did not rub off with gauze. The patient said he noticed the start of the lesions on the tip of his tongue and on his lower lip, which appeared to be cracked and dry. See accompanying images.

OK, doc, you’ve got three patients waiting for you—a crown seat, another hygiene exam, and the start of a crown prep. What’s your call? This patient needs your expertise, care, and guidance for his concerns because the lesions are clearly beginning to affect his quality of life.

Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles at this link and subscribe here.

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Stacey L. Gividen, DDS, a graduate of Marquette University School of Dentistry, is in private practice in Hamilton, Montana. She is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. Dr. Gividen is the editorial co-director of Through the Loupes and a contributing author for DentistryIQPerio-Implant Advisory, and Dental Economics. She serves on the Dental Economics editorial advisory board. You may contact her at [email protected].