CASE STUDY 11

This is a 29 year-old male who presented to his dentist concerned with this white patch
on the lateral border of his tongue. This patient has been immunocompromised for the
past year because of his low T-cell count.

1. Description of lesion:
White, adherent, corrugated irregular slightly raised plaque on the lateral border of the
right side of the tongue. The plaque is large and affects the entire lateral border. The
plaque couldn’t be rubbed off during examination. The patient reported asymptomatic.
Patient is an immunocompromised 29-year-old male and is positive for HIV infection.
The plaque showed up three months ago per patient. Referred patient to an infectious
diseases specialist at UW medical center for HIV infection management. Medical
consultation established between the dental team and the medical team for oral lesion
management and further dental treatments.

2. Location of lesion:
lateral border of the right side of the tongue.

3. Differential diagnosis:
a. hairy leukoplakia

b. chronic hyperplastic candidiasis

c. smoking-related leukoplakia

d. frictional keratosis

e. plaque-type lichen planus

4. Treatment:
Systemic anti-vital medication, such as Acyclovir

5. Final diagnosis: hairy leukoplakia

 CASE STUDY 12
In photo (A) this is a six-year male with many vesicles and ulcers present in the mouth
and lips. I photo (B) this clinically represents recurrence of the same lesion as in (A) but
in an adult.
(A) (B)

1. Description of lesions:
A.
Multiple bright red round ulcerated well-circumscribed vesicles varying in size present
on the labial mucosa. Gingival tissues are erythematous and edematous. Patient reported
painful and burning sensation from the affected area and flulike systemic symptoms.
Patient is a six-year male with no significant medical condition. Referred patient to his
pediatrician for further management. No elected dental treatment performed. Advised
patient to come back three weeks later for follow up and dental treatment.

B.
A cluster of small (1mmX2mm) pink round well-circumscribed fluid-filled vesicles
present below the lower left vermillion border. Patient reported a history of having
similar lesion on her lips. Patient reported the blisters were itching and irritating. Advised
patient to apply OTC anti-viral ointment on the affected area for 10 days until skin healed
and avoid skin-to-skin contact with the blisters. Advised patient to see her primary
physician if lesions do not heal within 2 weeks. No elected dental treatment performed.
Advised patient to come back for dental treatment after skin completely healed.

2. Location of lesions:
A: Labial mucosa and gingiva
B: below the lower left vermillion border

3. Differential diagnosis:
a. recurrent herpetic labialis

b. primary herpetic gingivostomatitis

c. herpangina
 d. NUG

e. erythema multiforme

4. Treatment:
A: Systemic antiviral medication, such as acyclovir in combination with topical acyclovir
ointment.
B:
topical acyclovir ointment.

5. Final diagnosis: for (A) primary herpetic gingivostomatitis

Final Diagnosis For (B) recurrent herpes labialis