# CASE DISCUSSION **Case description:** 63 Year old male presenting with a 12-month history of oral mucosal discomfort and irritation of oral mucosal associated with the consumption of food and with toothpaste use. His medical history is significant for hypertension managed with ramipril. He is a past smoker, having quit smoking 8 years ago (20 cigarettes per day for 35 years). He reported consuming 2-4 alcoholic drinks per week on average. He has a heavily restored dentition and his last dental visit was 2 years ago.     #### Patient Profile and Chief Complaint 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. #### Dental History - Heavily restored dentition. - Last dental visit was 2 years ago. A clinical photograph of the inside of a patient's mouth, showing the upper gum line with several dental restorations. The surrounding oral mucosa is pink and appears to be the location associated with the '12-month history of oral mucosal discomfort' mentioned in the text. Another clinical photograph of the oral cavity focusing on the gummy area of the teeth. The image corresponds to the case discussion area for the 63-year-old male patient. A close-up clinical photograph of the tongue, highlighting the texture and coating of the tongue mucosa. A clinical photograph showing the tongue tissue from a different angle, adjacent to the teeth and gums. This visual supports the medical history of 'oral mucosal discomfort'. # CASE DISCUSSION **Activity:** 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? #### Clinical Evaluation Tasks 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]: Original PDF page 1: [[15. Allergies and Immune mediated disease case 1.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.pdf#page=2|15. Allergies and Immune mediated disease case 1, p.2]]