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ePaper created 2010-05-26, 17:23:02 | version 1.16.4
A 28-year-old healthy male pre- sented with the chief complaints of mobility of tooth #33, sensitivity on the lower left side of his teeth and a non-scrapable, white, fissured patch in the lower labial mucosa. The patient had a habit of chew- ing smokeless tobacco for the past two to three years. 1) The most suitable differential diagnosis (D/D) is: a. Oral submucous fibrosis (OSF) b. White sponge nevus (WSN) c. Tobacco pouch keratosis(TPK) d. Verrucous carcinoma (VC) e. Factitial injury (Go to page 6 for the answer) Let’s proceed step-by-step and assemble all the clues toward a diagnosis. Clue No. 1 Age/sex/general health • 28-year-old healthy male 2) We can’t exclude any differential because of the variations seen with respect to age/sex/general health, but a few things should be remem- bered by solving the matching exer- cise given below. Match the lesion with the correct age of occurance. a. Verrucous carcinoma (VC) occurs during old age / at birth or during early childhood. b. White sponge nevus (WSN) occurs during old age / at birth or during early childhood. Clue No. 2 Affecting the dentition 3) Which of the lesions given below can cause mobility and sensitivity (circle all that apply)? a. Oral submucous fibrosis (OSF) b. White sponge nevus (WSN) c. Tobacco pouch keratosis (TPK) d. Verrucous carcinoma (VC) e. Factitial injury Clue No. 3 4) Mark scrapable (S) or non- scrapable (NS) next to the following lesions: a. Oral submucous fibrosis (OSF) b. White sponge nevus (WSN) c. Tobacco pouch keratosis (TPK) d. Verrucous carcinoma (VC) e. Factitial injury Clue No. 4 Pattern and site • White fissured plaque in the lower labial mucosa. 5) Please write the D/D in front of the pattern and site given: a. White, thin, almost “trans- lucent” plaque with a border that blends gradually into the surround- ing mucosa. Usually in mandibular vestibule. b. White, thickened, shredded areas exhibiting a ragged surface. DENTAL TRIBUNE | May 2010 Oral Pathology 5 AD By Monica Malhotra Diagnose this … white lesions Part II of III g DT page 6 (Photo/Dr. Monica Malhotra)