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Oral Pathology:  Soft Tissue Case #9

 

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Patient: Adolescent, either sex

Chief Complaint:
Patient requests a routine examination.

Medical History:
The patient recently completed a regimen of penicillin for strep throat.

Dental History:
The patient's last dental appointment was eight months ago.

Clinical Findings:
A sharply delineated, erythematous area is located at the midline of the posterior dorsum of the tongue. The erythematous area is nonthickened, nontender and does not bleed. Several compressible, tender submandibular lymph nodes are palpable bilaterally. The patient was unaware of the lesion.

Clinical Image
dorsum of tongue, posterior region
Dorsum of Tongue, Posterior Region

 

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 vesicular-ulcerated-erythematous surface lesion of the oral mucosa.
  ~White plaques that rub off.
  ~Mucosa under the plaques is tender and erythematous.

Lesions to Exclude in the Differential Diagnosis:
All Hereditary Lesions
  ~Ulcers, and often vesicles are present
  ~Skin lesions are present
  ~Lesions are present from birth or childhood
All Viral Lesions
  ~Viral lesions have an acute onset
  ~Vesicles may be present although they often rupture before they are noticed.
  ~Ulcers are present
  ~Systemic manifestations and lymphadenopathy, although these are not always present with viral infections.
All Autoimmune Lesions
  ~Blisters and painful ulcers of slow onset
  ~May get better and worse, but are persistent and progressive
All Idiopathic Lesions
  ~Aphthous Ulcers
       *Ulcers are present
       *Acute or abrupt onset
       *Usually resolves in 7-14 days, or the same amount of time for each patient
       *Location – on non-keratinized mucosal surfaces
  ~Erosive Lichen Planus
       *The white patches do not rub off
       *White patches often have a network pattern (Wickham’s striae)
  ~Erythema Multiforme
       *Acute onset of blisters and ulcers
       *May have systemic manifestations
       *Does not usually have white patches that rub off.
  ~Medication-Induced Stomatitis and Contact Stomatitis
       *Associated white lesions do not rub off
  ~Erythroplasia
       *These lesions are asymptomatic – patient is almost never aware of these
       *If white lesions are present they do not rub off

Lesions to Include in the Differential Diagonsis:
Mycotic Lesions – Candidosis
  ~Produces white plaques that appear as cottage cheese or curdled milk and rub off
  ~Leaves a tender, erythematous base
  ~Patient is taking antibiotics, which may be disrupting the normal oral bacterial flora

Management:
Educate the patient and/or parents about the cause and nature of candidosis (candidiasis), stressing that it is best understood as an overgrowth of fungal organisms that many people harbor in their mouths.

Provide treatment options, including topical antifungal medications, and stress the importance of compliance, that is, using the medications properly.

Discuss the prognosis: The lesions may recur whenever the patient takes antibiotics but candidosis can be managed with antifungal medication.

Final Diagnosis:
Candidosis variant termed central papillary atrophy or median rhomboid glossitis