Oral medicine and

radiology case report

N A M E : D E VA N S H I M A U R YA
(INTERN)
Under the guidance of

• Dr. Sunita Gupta

• Dr. Sujoy Ghosh
• Dr. Meera Chaudhary
• Dr. Rizwan
• Dr. Girish
• Dr. Varsha
• Dr. Kavita
• Dr. Chetna
• Dr. Pavitra
CASE 1

Name – Prem Chandra

Age/sex – 32/ Male
OPD no. – 38788
Address – Sadan mandir marg, New Delhi
Occupation – Office worker
Phone no. – 8540332100
Marital status – Married

Chief complaint- Patient complains of difficulty in opening the mouth

since 4 years.
 Patient was apparently well 4 years back when he
History of
presenting illness – started gradually experiencing difficulty in opening his
mouth. He also complaints of burning sensation which
aggravated on eating spicy food and relieved on its own.

Past medical History of hypothyroidism since 4 years.

history -

No significant history
Past dental history
–
No significant history
Allergies -
Medication – Under medication for hypothyroidism since 4 years

Personal habits – Brushing once daily with fluoridated toothpaste and soft
bristle toothbrush.

Oral habits – History of paan chewing : 2-3 times/day since 6 years.

Quit habit since 2 years.

Family history – No significant family history

General physical
Patient is conscious, well oriented with date, place and
examination –
time. No significant findings present on general physical
examination.
EXTRAORAL:

TMJ – No abnormality detected

Lymph nodes – Non palpable

Salivary glands – Non palpable

Mouth opening – Reduced mouth opening

 Soft tissue examination

ON INSPECTION :
• Evidence of mixed red and white ulceration on right buccal mucosa.
• Blanching of bilateral buccal mucosa is seen, colour of buccal mucosa is pale
(marble like)
• Similar lesion is present on hard and soft palate.

ON PALPATION :
• Vertical fibrotic bands are palpable and non tender on palpation.
• All inspectory findings are confirmed.
 Hard tissue examination

• Occulsal caries wrt 18.

• Generalized attrition

PERIODONTAL EXAMINATION:
• Gingiva : No significant finding
• Periodontal pocket : Absent
• Calculus : Present
• Stains : Present

PROVISIONAL DIAGNOSIS :
Oral submucous fibrosis wrt bilateral buccal mucosa, chronic generalized
gingivitis, caries wrt 18
 Differential diagnosis

• Scleroderma
• Iron deficiency anaemia

INVESTIGATIONS :
• Complete blood count (within normal limits)
• Liver function test
• Kidney function test
• Punch biopsy

FINAL DIAGNOSIS : Early Oral submucous fibrosis wrt bilateral buccal mucosa
 Management

• Soft diet, avoid spicy food

• Mouth opening exercises – Wooden spatula technique

• Antioxidant – Lycopene 8 mg 2 times/day

• Oral prophylaxis

• Restoration wrt 18

• Follow up after 15 days.

Extraoral photographs
Intraoral photographs
CASE 2

Name – Naseeruddin
Age/sex – 27/ Male
OPD no. – 39717
Address – Wazirabad, New Delhi
Occupation – Student
Phone no. – 9711298089
Marital status – Unmarried

Chief complaint- Patient complains of bleeding from gums since 3

months.
History of Patient was apparently well 3 months back when he
presenting illness – started noticing bleeding from gums. Bleeding occurred
while brushing the teeth and stopped on its own.
Patient also complains of bad breath.

Past medical history

No significant history
-

No significant history
Past dental history –

No significant history
Allergies -
Medication – Not under any medication

Personal habits – Brushing once daily with fluoridated toothpaste and soft
bristle toothbrush

Oral habits –
History of cigarette smoking 2-3 times/day since 7 years

Family history – No significant history

General physical Patient is conscious, well oriented with date, place and
examination – time. No significant findings present on general physical
examination.

EXTRAORAL:

No abnormality detected
TMJ –

Non palpable
Lymph nodes –

Non palpable
Salivary glands –

Adequate mouth opening

Mouth opening –
 Soft tissue examination

ON INSPECTION :
• Evidence of localized, round, soft to firm, sessile swelling of size approx 0.5*0.5
cm present wrt left buccal mucosa.
• It was not associated with pus, blood or any other discharge.
• Surrounding and overlying mucosa was normal.

ON PALPATION :
• A firm, non tender, non fluctuant swelling present on left buccal mucosa.
• All inspectory findings are confirmed.
 Hard tissue examination

Occlusal caries wrt 28

PERIODONTAL EXAMINATION:
• Gingiva : No significant finding
• Periodontal pocket : Absent
• Calculus : Present
• Stains : Present

PROVISIONAL DIAGNOSIS :
Traumatic fibroma wrt left buccal mucosa, chronic generalized gingivitis, occlusal
caries wrt 28.
 Differential diagnosis

• Lipoma
• Mucocele
• Papilloma

INVESTIGATION :
• Complete blood count (within normal limits)
• Liver function test
• Kidney function test
• Punch biopsy

FINAL DIAGNOSIS : Fibro epithelial hyperplasia wrt left buccal mucosa

 Management

• Surgical excision

• Oral prophylaxis

• Restoration wrt 28

• Follow up after 15 days.

Extraoral photographs
Intraoral photographs
CASE 3

Name – Ravi Srivastav

Age/sex – 36 years/ Male
OPD no. – 38814
Address – Ghaziabad, Uttar Pradesh
Occupation – Shopkeeper
Phone no. – 7048912538
Marital status – Married

Chief complaint- Patient complains of white patch on right cheek region

since 1 month.
 Patient was apparently well 1 months back when he
started noticing white patch on his right cheek region.
History of
presenting illness – He also complains of burning sensation which was
aggravated while eating hot and spicy food and relieved
on its own after sometime.

Past medical history No significant history

-

History of removal of tooth from upper front tooth region

Past dental history – 4 years back from private clinic.

Allergies - No significant history

Medication – Not under any medication

Personal habits – Brushing once daily with fluoridated toothpaste and soft
bristle toothbrush

Oral habits – History of Khaini and gutkha chewing 2 packets/day

since 20 years.

Family history –
No significant history
General physical Patient is conscious, well oriented with date, place and
examination – time. No significant findings present on general physical
examination.

EXTRAORAL:

No abnormality detected
TMJ –

Non palpable
Lymph nodes –

Non palpable
Salivary glands –

Adequate mouth opening

Mouth opening –
 Soft tissue examination

ON INSPECTION :
• A white, irregular, wrinkled patch was present on right buccal and vestibular
mucosa extending from premolar region to retromolar pad region.
• No bleeding, pus or any other discharge present.
• The surrounding mucosa was normal.

ON PALPATION :
• The lesion is non scrappable, non tender and is slightly elevated and rough.
• All inspectory findings are confirmed.
 Hard tissue examination
RPD wrt 11
Root stump wrt 12

PERIODONTAL EXAMINATION:
• Gingiva : No significant finding
• Periodontal pocket : Absent
• Calculus : Present
• Stains : Present

PROVISIONAL DIAGNOSIS :
Homogeneous leukoplakia on right buccal mucosa, root stump wrt 12, chronic
generalized gingivitis.
 Differential diagnosis
• Candidiasis - White sponge nevus

• Lichen planus - Lupus erythematosus

• Leukoedema

INVESTIGATIONS :
• Complete blood count (within normal limits)
• Liver function test
• Kidney function test
• Punch biopsy

FINAL DIAGNOSIS : Hyperorthokeratotic lesion wrt right buccal mucosa.

 Management

• Cessation of habit

• Soft diet, avoid spicy food

• Antioxidant – Lycopene 8 mg 2 times/day

• Oral prophylaxis

• Extraction wrt 12

• Follow up after 15 days.

Extraoral photographs
Intraoral photographs
CASE 4

Name – Ashu Khanna

Age/sex – 43/ Female
OPD no. – 34687
Address – Kashmere gate
Occupation – Home maker
Phone no. – 9536018344
Marital status – Married

Chief complaint-
Patient complains of swelling of gums since 2-3
months.
 Patient was apparently well 3 months back until she
started noticing swelling of gums. She also complains
History of of bleeding from gums of upper front region which
presenting illness –
aggravated on brushing. Bleeding persists for 1-2
minutes and ceased on its own.

Past medical history No significant history

-

History of removal of tooth from lower right and left

Past dental history – back tooth region 8 years back from private clinic.

Allergies -
No significant history
Medication – Not under any medication

Personal habits – Brushing once daily with fluoridated toothpaste and soft
bristle toothbrush

Oral habits – No significant history

Family history –
No significant history
General physical Patient is conscious, well oriented with date, place and
examination – time. No significant findings present on general physical
examination.

EXTRAORAL:

No abnormality detected
TMJ –

Non palpable
Lymph nodes –

Non palpable
Salivary glands –

Adequate mouth opening

Mouth opening –
 Soft tissue examination
ON INSPECTION :
• Irregular, multiple greyish black patches present on bilateral buccal mucosa,
vestibular mucosa and lower alveolar mucosa extending from corner of the
mouth to retromolar pad region.
• No evidence of pus, blood or any other discharge present.

ON PALPATION :
• The lesion is non tender and is smooth.
• All inspectory findings are confirmed.
 Hard tissue examination
Missing 35, 36, 37, 44, 45, 46, 47
Generalised attrition
Recession wrt 16, 26

PERIODONTAL EXAMINATION:
• Gingiva : Soft and oedematous gingiva
• Periodontal pocket : Absent
• Calculus : Present
• Stains : Present

PROVISIONAL DIAGNOSIS :
Post inflammatory Oral lichen planus, chronic generalized gingivitis with localized
periodontitis wrt 16, 26, Partially edentulous 35, 36, 37, 44, 45, 46, 47
 Differential diagnosis
• Oral leukoplakia
• Frictional keratosis
• Discoid lupus erythematosus

INVESTIGATIONS :
• Complete blood count (within normal limits)
• Liver function test
• Kidney function test
• Punch biopsy

FINAL DIAGNOSIS : Post inflammatory pigmentation in oral lichen planus

 Management

• Avoid hot and spicy food.

• Antioxidant – Lycopene 8 mg twice daily

• Multivitamins tablets once a day.

• Oral prophylaxis

• Prosthesis wrt 35, 36, 37, 44, 45, 46, 47

• Follow up after 15 days.

Extraoral photographs
Intraoral photographs
CASE 5

Name – Rahul
Age/sex – 31/ Male
OPD no. – 50325
Address – Ghaziabad, Uttar Pradesh
Occupation – Office worker
Phone no. – 7037169357
Marital status – Married

Chief complaint- Patient complains of pain in right lower back tooth region
since 5 months.
 Patient was apparently well 5 months back until he
started experiencing pain in right lower back tooth
History of
presenting illness – region. Pain was dull aching in nature and gradual in
onset. Pain aggravated on chewing and relieved on its
own.

Past medical history History of depression since 3 months.

-

No significant history
Past dental history –

Allergies - No significant history

 Patient is under antidepressant medication since 3
Medication – months.

Personal habits – Brushing once daily with fluoridated toothpaste and soft
bristle toothbrush

History of gutkha chewing – 15/day since 15 years

Oral habits – History of cigarette smoking – 10/day since 15 years
History of alcohol consumption – daily since 10 years

Family history –
No significant history
General physical Patient is conscious, well oriented with date, place and
examination – time. No significant findings present on general physical
examination.

EXTRAORAL:

No abnormality detected
TMJ –

Non palpable
Lymph nodes –

Non palpable
Salivary glands –

Adequate mouth opening

Mouth opening –
 Soft tissue examination

ON INSPECTION :
• Evidence of white, ulcerative growth on right buccal mucosa and vestibular
mucosa wrt premolar region.
• Blanching present on left buccal mucosa extending from corner of the mouth to
retromolar pad region.
• Blanching of hard and soft palate is also evident.

ON PALPATION :
• A white non scrappable, tender patch present on right buccal and vestibular
mucosa and the surface of the lesion is slightly rough.
• All inspectory findings are confirmed.
 Hard tissue examination
Generalised attrition

PERIODONTAL EXAMINATION:
• Gingiva : Soft and oedematous gingiva
• Periodontal pocket : Absent
• Calculus : Present
• Stains : Present

PROVISIONAL DIAGNOSIS :
Homogeneous leukoplakia on right buccal and vestibular mucosa wrt 41, 42, 43, 44,
generalized attrition
 Differential Diagnosis
• Oral lichen planus
• Candidiasis
• Frictional keratosis
• Lupus erythematosus
• White sponge nevus

INVESTIGATIONS :
• Complete blood count (within normal limits)
• Liver function test
• Kidney function test
• Punch biopsy

FINAL DIAGNOSIS : Hyperorthokeratotic lesion wrt right buccal and vestibular

mucosa
 Management

• Cessation of habit

• Soft diet, avoid spicy food

• Antioxidant – Lycopene 8 mg 2 times/day

• Oral prophylaxis

• Follow up after 15 days.

Extraoral Photographs
Intraoral photographs
THANK
YOU !