**CASE DISCUSSION** **Case description:** *66-year-old male presented for a routine dental examination. He was not aware of any oral mucosal problems, having been asymptomatic. His medical history is significant for hypertension, hypercholesterolaemia, sleep apnoea, GORD, NIDDM. He currently takes Diaformin, Norvasc, Mizart, Lorstat and Acimax. He reported smoking 30 cigarettes per day, having stared smoking at the age of 16, and reported consuming one bottle of wine per day.* **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?  #### Patient History and Presentation A 66-year-old male presented for a routine dental examination. The patient was asymptomatic and unaware of any oral mucosal problems. #### Medical History and Medications His medical history is significant for the following conditions: - Hypertension - Hypercholesterolaemia - Sleep apnoea - Gastro-oesophageal reflux disease (GORD) - Non-insulin-dependent diabetes mellitus (NIDDM) He currently takes the following medications: - Diaformin - Norvasc - Mizart - Lorstat - Acimax #### Social History - **Smoking:** 30 cigarettes per day; started smoking at age 16. - **Alcohol:** Consumes one bottle of wine per day. #### Clinical 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? This clinical photograph shows the hard palate of a patient's mouth, revealing multiple small, raised, reddish-yellow nodules scattered across the mucosal surface. [^1]: Original PDF page 1: [[CASE 2.pdf#page=1|CASE 2, p.1]]