MORSICATIO BUCCARUM (CHRONIC CHEEK CHEWING)

Morsicatio buccarum is a classic example of medical terminology gone astray; it is

the scientific term for chronic cheek chewing. Morsicatio comes from the Latin word morsus,
or bite. Chronic nibbling produces lesions that are located most frequently on the buccal
mucosa; however, the labial mucosa (morsicatio labiorum) and the lateral border of the
tongue (morsicatio linguarum) also may be involved. Similar changes have been seen as a
result of suction and in glassblowers whose technique produces chronic irritation of the
buccal mucosa.

A higher prevalence of classic morsicatio buccarum has been found in people who are
under stress or who exhibit psychologic conditions. Most patients are aware of their habit,
although many deny the self-inflicted injury or perform the act subconsciously. The
occurrence is twice as prevalent in women and three times more prevalent after age 35. At
any given time, one in every 800 adults has active lesions.

CLINICAL FEATURES

Most frequently, the lesions in patients with morsicatio are found bilaterally on the
anterior buccal mucosa. They also may be unilateral, combined with lesions of the lips or the
tongue, or isolated to the lips or tongue. Thickened, shredded, white areas may be combined
with intervening zones of erythema, erosion, or focal traumatic ulceration (Figs. 8-2 and 8-3).
The areas of white mucosa demonstrate an irregular ragged surface, and the patient may
describe being able to remove shreds of white material from the involved area.

The altered mucosa typically is located in the midportion of the anterior buccal
mucosa along the occlusal plane. Large lesions may extend some distance above or below the
occlusal plane in patients whose habit involves pushing the cheek between the teeth with a
finger.

HISTOPATHOLOGIC FEATURES

Biopsy reveals extensive hyperparakeratosis that often results in an extremely ragged

surface with numerous projections of keratin. Surface bacterial colonization is typical (Fig. 8-
4). On occasion, clusters of vacuolated cells are present in the superficial portion of the
prickle cell layer. This histopathologic pattern is not pathognomonic of morsicatio and may
bear a striking resemblance to oral hairy leukoplakia (OHL), a lesion that most often occurs
in people who are infected with the human immunodeficiency virus (HIV) (see page 268), or
to uremic stomatitis (see page 851). A similar histopathologic pattern is noted in patients who
chronically chew betel quid and has been termed betel chewer’s mucosa (see page 402).
Similarities with linea alba and leukoedema also may be seen.

DIAGNOSIS

In most cases the clinical presentation of morsicatio buccarum is sufficient for a

strong presumptive diagnosis, and clinicians familiar with these alterations rarely perform
biopsy. Some cases of morsicatio may not be diagnostic from the clinical presentation, and
biopsy may be necessary. In patients at high risk for HIV infection with isolated involvement
of the lateral border of the tongue, further investigation is desirable to rule out HIV-
associated OHL.

TREATMENT AND PROGNOSIS

No treatment of the oral lesions is required, and no long-term difficulties arise from
the presence of the mucosal changes. For patients who desire treatment, an oral acrylic shield
that covers the facial surfaces of the teeth may be constructed to eliminate the lesions by
restricting access to the buccal and labial mucosa. For patients desiring either confirmation of
the cause or preventive therapy, construction and use of two lateral acrylic shields connected
by a labial stainless steel wire can provide quick resolution of the lesions while being
acceptable aesthetically and not interfering with speech. Several authors also have suggested
psychotherapy as the treatment of choice, but no extensive well-controlled studies have
indicated benefits from this approach.