Soft tissue lesions

A list of a few of the less common dental soft tissue lesions

Dental soft tissue lesions that I think are interesting.

Epulis granulomatosa

Epulis granulomatosa is found in poorly healing post extraction sites. The lesion just needs excision.

Picture of an epulis granulomatosa after a tooth extraction.

Epulis fissuratum

Epulis fissuratum is excess tissue grow from a poorly fitting denture.

Epulis fissuratum

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.

Mucous Membrane Pemphigoid of the upper and lower attached gingivaPhoto of a case of Mucous Membrane Pemphigoid or MMP

Herpetic Gingivostomatitis

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.

Case of herpetic gingivostomatitis with ANUG

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.

Erythema mutliforme or herpetic gingivostomatitis?

Erythema mutliforme or herpetic gingivostomatitis?

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

Erythema multiforme lesions on the lip

Stevens-Johnson syndrome

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.

Stevens-Johnson syndrome on the lips

 

 

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.

Determining if this a peripheral ossifying fibroma or Peripheral Odontogenic Fibroma without a biopsy is impossible.

Peripheral ossifying fibroma vs Peripheral Odontogenic Fibroma?

Peripheral ossifying fibroma on a 25 year 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.

Proliferative verrucous leukoplakia (PVL) is a distinct form of oral leukoplakia.

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.

Photo of an ischemic keratinized gingiva.

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