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Oral Pathology:  Soft Tissue Case #2

 

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Patient: Young adult, either sex

Chief Complaint:
Patient requests a routine examination.

Medical History:
Patient takes tetracycline, 250 mg twice a day, for acne.

Dental History:
Good oral hygiene.

Clinical Findings:
Bilateral white plaques are present on the middle and anterior portion of the lateral surfaces of the tongue. The white plaques are firm, rough, nontender, and fixed to surface mucosa but not underlying structures. They will not rub off. An erythematous base is associated with the plaques. The patient was unaware of the lesions.

Tongue with White Plaques
tongue with white plaques

 

There are no radiographs available for this case.

There are no lab reports available for this case.

There are no charts available for this case.

Summary:
This is a white surface lesion.  It is white due to epithelial thickening because it is rough, asymptomatic, and will not rub off.

Lesions to Exclude from Differential Diagnosis:
Leukoedema
  ~Location – Bilateral buccal mucosa

Epithelial Dysplasia, Carcinoma in Situ, and Squamous Cell Carcinoma
  ~These lesions are usually not bilateral and symmetrical.

Lichen Planus
  ~Location and appearance. Although it can be on the tongue, it typically involves the buccal mucosa.

Nicotinic Stomatitis
  ~Location – Hard palate

Familial Epithelial Hyperplasia (White Sponge Nevus)
  ~Diffuse and multifocal
  ~Present from early childhood
  ~May have a familial history.

Hairy Tongue
  ~Location – Would include the dorsum of the tongue

Hairy Leukoplakia
  ~Can be excluded once patient’s immune function is determined.

Geographic Tongue (Erythema Migrans)
  ~Erythematous with irregular, thin, white border.

Lesions to Include in Differential Diagnosis:

Hyperkeratosis
  ~Probably due to chronic irritation by tooth trauma.

Management:
Explain to the patient the cause and diagnosis of the lesion. That way if the lesion is noticed by another health care professional, the patient will not be alarmed.  Recommend that the patient stop chewing the tongue and follow up in 3-4 weeks

Final Diagnosis:
Hyperkeratosis, consistent with tongue chewing