Bulletin Board of Oral Pathology
Bulletin Board of Oral Pathology
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Forum for Clinical and Surgical Oral Pathology Case BBOPF 06-1 The following case was contributed by Dr. John Lovas (Canada). Dr. Lovas invites your comments on the following case. This case will be posted from January 26 to February 3, 2006. A summary of the responses will be posted in BBOP. Clinical History37yo Caucasian male with CC: Extensive asymptomatic dental erosion, first noticed by his former dentist around 10 years ago. HPC: He bruxes - since he started wearing a bite plane his condition has stabilized, at least according to his current dentist. He DENIED: using chewable vitamins, orally disolved drugs, regularly sipping pop (only has 1-2cans per week), rarely eats fruit, quickly drinks down 1glass of orange or apple juice per day, 2yrs ago for a year or so he had 1 sports drink per week with lunch, seldom swims in pools, not a candy eater, used cough drops only when sick, denied cocaine use, ethanol abuse / emesis / bulemia (interestingly he belongs to weight-watchers yet does not appear remotely overweight), does not drink much wine, no history of industrial acid exposure, denied cocaine use. He denies having heartburn - in 2001 he had an upper GI scope but no evidence of gastroesophageal reflux disease (GERD) was found. PMH: His past medical history is noncontributory - never used tobacco; his job entails ordering supplies for an offshore drilling company. PE: Examination revealed no regional lymphadenopathy; all except his mandibular anterior teeth, which appear completely spared, show severe erosion, nor only of the enamel, but also of dentin, primarily of the lingual surfaces, but also involving occlusal surfaces of molars (below the level of his amalgams) and buccal surfaces of premolars & molars. His history does not hold clues (for me at least) to the source of the acid causing this extensive erosion. Until the source is found, definitive treatment (eg extensive crown & bridge) is prone to fail. ADDITIONAL IDEAS RE: ETIOLOGY WOULD BE MUCH APPRECIATED. Images
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