Rare Dental Case Study!

[zoralsurgeon]

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Hey guys and girls! I have a quick question, wanted to see the different opinions each of you had.

You have an 18 year old asian female with non healing ulcers in her mouth. They are non painful, but persistent. She is sexually active and performs oral sex on her boyfriend.

There are 3 pea-sized lesions on her left buccal surface, and one pea-sized lesion on her lower lip. They do not cause pain, at the same time they don't seem to go away. She sometimes has a bad taste in her mouth because she thinks the lesions may drain at times. They have been present for the last 10 months, when her and her boyfriend began having sexual intercourse (primarily oral sex).
What are possible diagnoses?

How would you identify the cause?

How would you treat it?


Just curious .. I am not a DDS, yet. So: Thought I'd ask the big dogs!

Thanks much!

 

[aphistis]

Hey guys and girls! I have a quick question, wanted to see the different opinions each of you had.

You have an 18 year old asian female with non healing ulcers in her mouth. They are non painful, but persistent. She is sexually active and performs oral sex on her boyfriend.

What are possible diagnoses?

How would you identify the cause?

How would you treat it?


Just curious .. I am not a DDS, yet. So: Thought I'd ask the big dogs!

Thanks much!

You're going to have to describe the lesions more thoroughly for anyone to have a shot at identifying their cause. Size? Physical description? Location? Number? Duration?

The two leading candidates for any case study that mentions "she performs oral sex on her boyfriend" are intraoral condylomae (genital warts) and palatal petechiae, but there isn't enough information at present to formulate a diagnosis.

 

[zoralsurgeon]

You're going to have to describe the lesions more thoroughly for anyone to have a shot at identifying their cause. Size? Physical description? Location? Number? Duration?

The two leading candidates for any case study that mentions "she performs oral sex on her boyfriend" are intraoral condylomae (genital warts) and palatal petechiae, but there isn't enough information at present to formulate a diagnosis.

Thanks! I appreciate the intraloral condylomae and palatal petechiae information. I was not given any other information, but let's say:

There are 3 pea-sized lesions on her left buccal surface, and one pea-sized lesion on her lower lip. They do not cause pain, at the same time they don't seem to go away. She sometimes has a bad taste in her mouth because she thinks the lesions may drain at times. They have been present for the last 10 months, when her and her boyfriend began having sexual intercourse (primarily oral sex).

Now, with this information, are the 3 questions able to be answered easier? I do appreciate your help and time regardless!!

Oh, and ps - what exactly is palatal petechiae, if you don't mind me asking?

 

[Theillestill]

If it's painless it could be syphilis.

 

[aphistis]

Thanks! I appreciate the intraloral condylomae and palatal petechiae information. I was not given any other information, but let's say:

There are 3 pea-sized lesions on her left buccal surface, and one pea-sized lesion on her lower lip. They do not cause pain, at the same time they don't seem to go away. She sometimes has a bad taste in her mouth because she thinks the lesions may drain at times. They have been present for the last 10 months, when her and her boyfriend began having sexual intercourse (primarily oral sex).

Now, with this information, are the 3 questions able to be answered easier? I do appreciate your help and time regardless!!

Oh, and ps - what exactly is palatal petechiae, if you don't mind me asking?

They could still be papillomas, with bacterial superinfection accounting for the purulent drainage. Palatal petechiae are pinpoint hemorrhages caused when capillaries burst due to nearby negative pressure. Think of them like an intraoral hickey, and I'll let you do the math from there.

Most importantly, though: pea-sized = big enough to biopsy. These lesions don't sound particularly ominous (i.e. unlikely to represent cancer or other significantly morbid disease), but the best way to diagnose them is to cut a piece out of each and see what they look like under the microscope. Treatment will depend on what comes back on the pathology report.

 

[ClassVII]

papillomas are exophytic growths, not ulcers, correct?

 

[ccoonen]

my vote is for syphilis.

 

[bigstix808]

If it's painless it could be syphilis.

non painful lesions usually leads to syphilis -- there's where my vote stands

 

[UKdent]

well if they are ulcers then they dont drain. so you must make sure they are ulcers.
could be syphilis, a lichenoid reaction to amalgam/composite. traumatic granuloma, intraoral TB, blastomycosis, histomycosis, cryptococcosis. However you need to watch the lesions and try to determine if they are moving around at all. If the move then all of these would be wrong and you would need to formulate a different differential. palatal petechie is out of your differential because the are basically bruises of the palate and bruises dont stick around for 10 months. if it is an ulcer then get a dry gauze and rub on it if you have bleeding points under it then you have an ulcer. you should photograph the ulcers and compare in a few weeks to determine if they are non-migrating.

you should perform vitality testing and probe on all all teeth in the area to make sure you dont have chronic supprative peridontitis, if it is truely draining.