Oral Pathology: Soft Tissue Case #2
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Patient: Young adult, either sex
Patient requests a routine examination.
Patient takes tetracycline, 250 mg twice a day, for acne.
Good oral hygiene.
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.
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.
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:
~Location – Bilateral buccal mucosa
Epithelial Dysplasia, Carcinoma in Situ, and Squamous Cell Carcinoma
~These lesions are usually not bilateral and symmetrical.
~Location and appearance. Although it can be on the tongue, it typically involves the buccal mucosa.
~Location – Hard palate
Familial Epithelial Hyperplasia (White Sponge Nevus)
~Diffuse and multifocal
~Present from early childhood
~May have a familial history.
~Location – Would include the dorsum of the tongue
~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:
~Probably due to chronic irritation by tooth trauma.
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
Hyperkeratosis, consistent with tongue chewing