Forum for Clinical and Surgical Oral Pathology

Case BBOPF 03-11

Dr. Mark Littner (Dept. of Oral Pathology and Oral Medicine School of Dental Medicine, Tel Aviv University, Israel) is requesting your comments on the following case. Please send your comments in the window located below the clinical images. This case will be posted from December 29, 2003 to January 12, 2004. A summary of the responses will be posted in BBOP.

Clinical History

A 67 years-old Caucasian female was referred to my clinic due to a burning sensation of the tongue. The burning sensation lasted for a long period of time with gradually increase during the recent months. She was treated with antifungal drugs with no improvement. Her medical history was non-contributing and included only osteoporosis treated with calcium supplements. Oral examination revealed a relatively large tongue with diffused bilateral white patches on the latero-ventral aspect (Fig. 1-2). The lesions could not be rubbed off and did not disappear with stretching of the tongue. The other oral mucous membranes were within normal limits. On following examinations of the patient, it was noticed that the lesion appears at the morning hours and disappears during the afternoon (Fig. 3). Incisional biopsy was preformed and the histopathological examination demonstrated acanthosis with acute and chronic inflammation. It was postulated that the habit of tongue thrust during the sleeping hours is the etiologic factor of these lesions. A mandibular night-guard was fabricated and resulted in complete resolving of the white lesion and the burning sensation (Fig. 4).

Has anybody ever seen such a prominent white lesion disappearing in a matter of hours? Are there any references that describe this condition?

I will appreciate your input concerning the diagnosis of this lesion.

Images

1  [Click for a larger image]	2  [Click for a larger image]
3  [Click for a larger image]	4  [Click for a larger image]

THIS IS AN ACADEMIC EXERCISE ONLY. THE REPLIES ARE NOT TO BE CONSTRUED AS THOSE OF A CONSULTANT FOR LEGAL PURPOSES.

Case prepared by Dr. Alfredo Aguirre (BBOP Manager) and Daniel Emmer (Web Administrator, University at Buffalo School of Dental Medicine).