Case #21:

Case profile:

Summary of Visuals: Examination of the visuals reveals ulcerations of the buccal mucosa bilaterally, gingival erythema and ulceration, plaque, calculus, and periodontitis. Patient: Adult woman.

Case record:

Chief Complaint: The patient reports a sore mouth of eight to nine months duration. The discomfort consistently involves the gingiva and buccal mucosa. The discomfort has varied in intensity, but has never resolved. Blisters have been observed on the buccal mucosa. The discomfort is worse when the patient drinks fruit juice, rinses with peroxide and Listerine, and when her mouth is dry. The patient's physician prescribed Decadron and Kenalog in Orabase. Both of these medications resulted in some improvement, but not total resolution of the discomfort. The patient reports soreness of the left eye five months ago. This was treated with an unknown ointment, resulting in improvement.   Medical History: The patient reports hypertension treated with Ser-Ap-Es and occasional arthritis in the left shoulder treated with aspirin. The patient previously used Minipress for hypertension, but this medication caused xerostomia and a sore throat. The patient has had a cholecystectomy (gallbladder removed) because of gallstones, and varicose veins stripped.   Dental History: The patient has had numerous teeth extracted due to caries. Her last dental visit was approximately one year ago for adjustment of partial dentures. The patient has used maxillary and mandibular partial dentures for ten years. She does not wear her partial dentures at night. She has difficulty wearing her partial dentures because they irritate her gingiva. She has difficulty brushing her teeth because of her gingival discomfort.   Clinical Findings: Ulcerations are present on the buccal mucosa, attached gingiva and attached alveolar mucosa. The ulcerations are mildly compressible, tender, and fixed to surface mucosa and underlying structures. A Nikolsky's sign is present. Cervical lymphadenopathy and skin lesions are not present.

Images:

Labial Gingiva LG Close-up of Labial Gingiva LG   Maxillary Anterior Lingual Gingiva LG   Close-up of Maxillary Anterior Lingual Gingiva LG Mandibular Lingual Gingiva LG Mandibular Lingual Gingiva LG   Right Buccal Mucosa with Ulceration LG   Left Buccal Mucosa with Ulceration LG