Forum for Clinical and Surgical Oral Pathology

Case BBOPF 10-3

Dr. Denis Lynch (Marquette University School of Dentistry, Milwaukee, USA) is requesting your opinion. Please send your comments in the window located below the images. This case will be posted from June 4-11, 2010. A summary of the responses will be posted in BBOP.

Clinical History

This is the soft palate of an otherwise healthy 17 year-old boy. These lesions began approximately three months ago, have recurred several times and are limited to the soft palate. They last for several days and then completely resolve, only to recur unexpectedly at a later date. No specific triggers could be elicited by history. The patient denied skin or other mucosal disease. The only significant fact in his history is an allergy to penicillin. The initial lesions were asymptomatic but now are mildly "tender". Both the mother and the patient also described white "lines" adjacent to the lesions; however they were not appreciated by me. The patient described the white lines as "curvy, like a snake" and the mother described them as "lace-like". The extraoral exam was unremarkable. There was no cervical lymphadenopathy. Intraorally, the only other finding was a cupping of the cusp tips of the posterior mandibular teeth, suggestive of acid erosion; however, other tooth surfaces normally affected were unremarkable. He mentioned tooth sensitivity to sweets but not hot, cold or air. He denied GERD symptoms.

The descriptions of the white lines given by the mother and the patient were done without any prodding by me, but I think they are "red herrings". The fact that the lesions come and go (and other factors) seem to rule out oral Crohn's disease or lichen planus. Has anyone seen similar lesions with GERD? I also thought about a fixed drug reaction, but that was a bit of a stretch.

Any and all thoughts would be appreciated.

Thanks,

Denis

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