A list of a few of the less common dental soft tissue lesions
Dental soft tissue lesions that I think are interesting.
Epulis granulomatosa is found in poorly healing post extraction sites. The lesion just needs excision.
Epulis fissuratum is excess tissue grow from a poorly fitting denture.
Mucous Membrane Pemphigoid (MMP)
MMP is one of several auto-immune conditions that are both difficult to accurately diagnosis and difficult to effectively treat. Treatments are simply managing the symptoms. Differentials include erythema multiforme, Stevens Johnson syndrome, and other autoimmune blistering diseases such as pemphigus vulgaris, bullous pemphigoid, epidermolysis bullosa acquisita, and linear IgA bullous dermatosis. A few others from Gwen Brown are erosive lichen planus and dermatitis herpetiformis. Dermatitis herpetiformis is associated with true celiacs disease.
A patient with Mucous membrane pemphigoid gets topical steroids as needed. This diagnosis requires an eye exam to rule out symblepheron and the potential for the patient losing sight in the affected eye. A really nice post comparing MMP and pemphigus.
The differential between erythema multiforme with ANUG and herpetic gingivostomatitis with ANUG is tricky. If you see vesicles or honey crusted lips then think herpetic. Punched out papilla is a sign of ANUG. This is a tricky case and diagnosis. There are several other cheilitis lesions that are similar as well.
Is this case erythema multiforme or herpetic gingivostomatitis? If there are no lesions on the gingiva then it is not primary herpetic outbreak and secondary does not look like this. So must rule out erythema multiforme.
Again hard to tell if erythema multiforme or herpetic gingivostomatitis. This one came up after a new medication. Erythema multiforme is a mild version of Stevens-Johnson syndrome. Erythema multiforme is self limiting but painful
Very serious condition that needs medical attention immediately. Has a 5% mortality rate and a 30% Lyell disease rate. Questions for a patient that has a lip lesion that you are unsure of are
- Do you have lesion on your eyes, skin, or genitals?
- Have you had a cold sore recently?
- Are you taking any new medications?
Typically SJS comes from a new medication but a virus like a cold sore can cause as well.
Peripheral ossifying fibroma vs Peripheral Odontogenic Fibroma
Not sure the difference can be made without a biopsy. The case report here is very similar clinically to the lesion below. This could also be a peripheral giant cell granuloma but the color isn’t consistent with that. Ossifying fibroma are usually 1.5cm or less and occur on patients from 25-25 years old.
Oral chronic graft-versus-host disease
There are many soft tissue issues with this disease. The disease happens to bone marrow transplant patients.
Proliferative verrucous leukoplakia
Proliferative verrucous leukoplakia (PVL) is a form of oral leukoplakia with a high rate of transformation into oral squamous cell carcinoma according to Gupta.
Unknown soft tissue lesions
This one is most likely an ischemic event brought on from the injection, trauma from surgery, or the healing process. It is possible that is is a chemical burn but seems unlikely with the clear delineation of the lesion along the mucogingival junction. This cologne burn does look similar and appears to stay on the keratinized tissue.