Quartz 4

15. Allergies and Immune Mediated Disease

2 min read

Case Discussion Of Oral Mucosal Discomfort

Patient Profile and Chief Complaint1

A 63-year-old male presents with a 12-month history of oral mucosal discomfort and irritation. The symptoms are specifically associated with:

  • Consumption of food
  • Use of toothpaste

Medical and Social History

  • Medical History: Hypertension, currently managed with ramipril.
  • Smoking History: Past smoker; quit 8 years ago. Previously smoked 20 cigarettes per day for 35 years.
  • Alcohol Consumption: Reports an average of 2-4 alcoholic drinks per week.

Clinical Case Description

Dental History

  • Heavily restored dentition.
  • Last dental visit was 2 years ago.

Clinical Assessment Activity

Clinical Evaluation Tasks2

  1. Identify the pathosis and describe the clinical features.
  2. What is the differential diagnosis?
  3. What are the relevant clinical investigations?
  4. What is the diagnosis?
  5. How would you manage this patient?

1. Identify the pathosis and describe the clinical features

2. What is the differential diagnosis

  • Oral lichenoid lesions
    • could be the amalgam or medications
    • check for this iwth patch testing first (i.e. suspect amalgam first )

3. Clinical investigations

  • Biopsy
    • needed to satisfy histopathological criteria
    • need at least tow for the H&E and one for DIF
  • Patch testing for diffrential
    • could send to a dermatologist, some immunologists do it too
    • “Please do patch testing to the Dental Series”

4. What is the diagnosis

5. How would you manage this patient

  • Corticosteroids
    • be careful as thee can speed up dysplasia in dysplastic sessation
    • Kenalog is the only oral preparation in australia but its mild and hard to use
    • Therapeutic guidelines recommeneds beclamethasone ointment
      • ointments are hard to apply to wet oral mucosa
      • need to tell patient to dry the area
      • can use corticosteroid mouthwash/mouthspray but its expensive and costs $80 a bottle
        • beclamethasone mouthspray dosage
          • 2 sprays 3 times a day
          • use everyday until discomfort goes away , then add 3 extra days
    • Follow up in a month
  • Clue for failure of symptom management - super imposed candida
    • “the topical steroids were working then all of a sudden it started to get worse ”
    • In this case, give amphoteracin B for the fungal infect
  • Mildly symptomatic:
    • can use Difflam

Footnotes

  1. Original PDF page 1: 15. Allergies and Immune mediated disease case 1, p.1 ↩

  2. Original PDF page 2: 15. Allergies and Immune mediated disease case 1, p.2 ↩

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