14/11

AHMED – file number 101846

Chief complaint: This patient had ulcers that are painful and recurrent.

History of chief complaint: It appears every 2-3 weeks and stays there for 1 to 2 weeks, he said he first
got them in his high school period so at around 15-16 years of age.

Upon extraoral examination there were no any abnormalities detected, the patient has no tender lymph
nodes.

The patient said that He does not take any medications or do anything for it to heal. He has implants
with bad occlusion so we considered trauma from teeth. However he is medically healthy and following
a healthy diet. The patient has a recent habit of chewing gum. He has no eye or skin problems so we
excluded Behjet disease, because for it to be behjet disease there have to be oral ulcers plus two of the
following:

Skin lesions (acne), genital lesions, and positive pathergy test and eye problems.

Differential diagnosis: trauma from teeth, behcjet disease, cyclic neutropenia, H-pylori, vitamin
deficiencies.

He said it also appears in periods of exams so we related apthous ulcers to exams because of the
changes in lifestyle that happen within that period and the poor integrity of mucosa as a result of
stressful times. The poor integrity of mucosa could be genetic in addition to having excessive force or
stressors like the type of food we eat during the exams period, we usually do not think about what we
eat and we do not follow proper timings of our meals. We considered cyclic neutropenia since the ulcers
happen every 2-3 weeks so they get the ulcers every month. If we take a blood test at the time of
ulceration, we might see a drop in neutrophils and symptoms like mild fever and lymphadenopathy.

The ulcers are painful and the patient can precisely locate it in the floor of the mouth. Intraoral
examination: First ulcer in is in the lip and it has white floor and not that pronounced red halo. Another
one is in the tongue, it is edematous, more closer to the teeth, third is on keratinized mucosa, and the
fourth seems to be healing on the other side of the tongue.

The patient is advised to do the H-pylori test and check for any vitamin deficiencies as they can facilitate
the presence of oral ulcers. He will be given a capsule which contains radioactive carbon with urea. H-
pylori needs urea for its development so it will break it from the radioactive carbon. If radioactive
carbon is present and it broke away from urea, this means that H-pylori is present. If not, then the
capsule just passes through the GIT.

Treatment: we prescribed to him Dexamethasone, he will not swallow it just gargle with it for two mins
without rinsing. This will shorten the duration for ulcers and reduce the symptoms.

If it is more severe, we can give systemic glucocorticoids. However, Ahmed can speak, eat and a general
practitioner should not prescribe function so we do not need to give systemic glucocorticoids and it
because it has many side effects. Cyclic neutropenia is accompanied by other infections, fever and
lymphadenopathy + absence of red halos because blood supply to the ulcer is compromised + ulcers
happen at young age.
Haidee Rose. File number: 113015 date: 17/10/2017

Haidee came to the clinic with a chief complaint of a swelling on the inner side of her lower lip.

History of chief complaint: happened 3 weeks ago.

Upon extraoral examination haidee had clicking sounds from her TMJ, everything else was normal.

Upon intraoral examination, we noticed a soft exophytic lesion covered by normal and slightly rough
mucosa.

Haidee remembers that she bit her lip the day before she got it and says that it releases a sticky, clear
fluid.

Differential diagnosis: a lower mass could have the same appearance with a sinus tract but this would be
an abscess.

We explained to Haidee that this swelling is called a mucous extravasation cyst or Oral Mucocele, which
happens as a result of trauma and cutting of the minor salivary gland duct and extravasation of the duct.

We also talked to haidee about the complications of surgically removing this mucocele

Which were the risk of injuring an adjacent nerve and resulting in permanent numbness in that area or
loss of sensation. Moreover, another complication is the chance of its recurrence. Alternatively, inducing
another mucocele by damaging another salivary gland ducts

However, the bleeding and infection is controlled. We have explained to her about the complete surgical
procedure and told her that it has minor complications and the surgical procedure is simple. However,
we did not do any surgical treatment on that day to give haidee a chance to think about what she wants
to do about it and perhaps read and educate herself more about her case. We have told haidee that the
lesion would rarely disappear on its own however, it can increase and decrease in size. In addition, the
mucocele is not a dangerous condition as much as it is uncomfortable to the patient.
FAROUQ SHAER 17/10/2017

Chief complaint: This patient came complaining of very big tonsils (tonsilitis), bacterial tonsillitis in
associated with fever, pain joint pain and weakness. Follicular tonsillitis: membrane filled with bacteria
colonies and the patient becomes very weak and with a lot of pain so we prescribe antibiotics.

However, in case of just very large tonsils we usually do not recommend antibiotics if it is not inflamed
because 90% are viral and antibiotics will not work.

Follicular tonsillitis have a higher rate of morbidity especially if its compromising the airways or retarding
the child’s growth because of oxygen deficiency so the child can’t play sports or is not sleeping well and
snoring while sleeping so because of sleep apnea he might not be able to undergo his daily social
activities and is always tired in school.

The patient is also complaining of dental pain and dry socket.

Upon extraoral examination, we examined the lymph nodes one side at a time and there were no
tenderness or palpation or any other abnormalities.

Intraoral examination: patient has linea Alba buccaris and signs of odontomas appeared on the x-ray, he
also has retained deciduous canine with an impacted permanent canine. The deciduous canine has
attrition. He thinks he has dry socket on the extraction site but that is not the case and the yellowish
color is just remnants of fibrin, which will seal the wound to prevent secondary infection and start the
healing.

Diagnosis: bacterial tonsillitis

Differential diagnosis: follicular tonsillitis

Management: antibiotics.
Ibrahim file number: 355747

Ibrahim came with pain on his lateral border of the tongue that appears after stress or after being
physically tired and it lasts for 1 day.

Same spot – trauma

Erosion– biting on tongue.

Osuji 14/11/17 113839

The patient came complaining of skin rash and it is itchy

He said that he worked as a ceramic worker in Nigeria and now he is working as an electrician. He left
the ceramic work a year ago.

Lichenoid skin lesion (it’s elevated and rough) in areas of friction

Differential diagnosis: eczema – dermatitis

All related to the materials he meets during his work

Usually we see signs of lichenoid reaction in the mouth then we see it in skin

However, in his case we see changes in skin but not in the oral cavity

IntraOral cavity examination – white changes that are poorly demarcated

Both cheeks are traumatized, the patient has an extracted tooth, and we noticed blood clots

The patient should not be dismissed before observing the initial signs of healing.
Liaqat file no: 113081

31 years old Male

Liaqat came to the clinic with three problems

We have elevated and ulcerated papules around the vermilion border.

Intraorally: the gingiva on the same side has some changes and multiple ulcerations with ragged
borders, 2 spots on the attached gingiva on canines (herpes- on keratinized tissue and part of the lips)
but not Apthous ulcers because of its location apthous occurs in non-keratinized tissues. In addition to
two, more spots around the premolars.

Liaqat has multiple dental problems, he has pain and perio diseases and he has a polyp in his vestibule.

His main CHIEF COMPLAINT: is a big white patch in the vestibule that is striated, poorly demarcated and
nonhomogeneous because of the debris covering it. After wiping it, some keratinized tissues were
removed. Liaqat also has calculus and gum recession and discoloration and heavy staining adjacent to it
in the roots. This patient is using Niswar for 15 years.

The lesion is reactive and being in the vestibule and homogenous after wiping it this is typical of reactive
lesions.

Niswar- is a substance that keeps patient alert and it has tobacco in it is a psychoactive agent and makes
the patient in an elevated mood.

Liaqat feels pain especially with cold and sweets, which is probably because of multiple carious lesions
that he has. We will see after 2 months if his condition improved after cutting down on niswar.
Mohammed abrar 114193

Patient has a history of using pan or betel quid, which is a psychoactive agent and culturally acceptable
and enjoyed.

Chief complaint: crackings in mucosa or cut or scratched then later he said it feels fluffy and painful
when he eats spicy foods.

Intraoral examination: the patient’s buccal mucosa is a little bit tight while pulling but it’s healthy and
the patient has moderate opening of oral cavity (2 fingers)

Two opening of Wharton’s duct are slightly elevated in floor of the mouth can be observed and there is
fibrosis in the floor of the mouth. The buccal mucosa is undergoing fibrosis and the lower vestibule is
good but the upper has a bulge from trauma but anterior to it, there is erythroleukoplakic lesion. It is
well demarcated and beside it, there are white changes, which is the location of a previous lesion and a
previous biopsy.

The area next to the active lesion has reactive lesions probably because of the teeth and biting.

When the doctor felt the new lesion it was hard and it is the one from which we want to take the biopsy
from. Therefore, we started giving the patient local anesthesia. Dr. Suhail gave the patient three carpels
of Local anaesthesia and wiped the tissues off any debris to have a better view. We could then see
erythema and a depression clearly located. The doctor took an incisional biopsy (2 specimens) he took
another one from the surrounding tissues to make sure it is sufficient also because the lesion was
splitting into fragments.

Differential diagnosis: traumatic eosinophilic ulcer or squamous cell carcinoma, sub mucous fibrosis in
the cheek.

The previously seen white patch in the check is now ulcerated and indurated

History: use of pan

Location: vestibule

Clinical appearance = mixed (erythroplakic) + well demarcated and beyond the area of trauma

Biopsy was taken for the white patch and it turned out to be lichen planus.