1. Oral MedicineCompetency Student: Kevin Duniven Team 2 Patient: Shirley Gorrell (352-8-25)

2. Patient: Shirley Gorrell (352-8-25) • Diagnosis and Photos Taken • June 17th, 2010 • Pathology Consult: • Dr. Joseph Craig Whitt • Lesion: • Multiple Traumatic Ulcers on Large Palatal Torus

3. Patient: Shirley Gorrell (352-8-25) Patient Information: • 82 year old, White Female • Chief Complaint: • “The roof of my mouth often gets sore and sometimes burns. There is something hard up there.” • The palatal torus has been present for as long as the patient can remember. She had been given Ulcer Ease (0.6% Phenol) as an oral anesthetic.

4. Patient: Shirley Gorrell (352-8-25)

5. Patient: Shirley Gorrell (352-8-25) Lesion Description: • Midline of Palate • Lobulated • Sessile base • Ulcerated • Likely caused by trauma; interference with eating • Keratinized • white patterns of the healing ulcerations • Burns occasionally

6. Patient: Shirley Gorrell (352-8-25)

7. Patient: Shirley Gorrell (352-8-25) Dialogue with Patient: • How long has the sore spot been present on the roof of your mouth? • For as long as I can remember. • Has the sore spot changed in size? • Not that I can recall? • Has or does the sore spot always caused pain? • No. Only when I bump it with food or eat hot or spicy food. • Have you ever been diagnosed with Hyperparathyroidism or taken Parathyroid Hormone? • No. • Have you ever been given anything to relieve the discomfort? • Yes. It was called Ulcer Ease. It worked a little bit. • Are you interesting in us making a stent to protect that area? • No, not really.

8. Patient: Shirley Gorrell (352-8-25)Traumatic Ulcerations on Large Palatal Torus

9. Patient: Shirley Gorrell (352-8-25)Traumatic Ulcerations on Large Palatal Torus Lesion Diagnosed Provisional Diagnosis: Traumatic Ulcerations on Large Palatal Torus • Traumatic Ulcer • “Palatal tori are vulnerable to trauma and traumatic ulcers are slow to heal.” (Guide to Common Oral Diseases, page 7)

10. Patient: Shirley Gorrell (352-8-25)Traumatic Ulcerations on Large Palatal Torus Lesion Diagnosed Differential Diagnoses: • Erythroleukoplakia • Squamous Cell Carcinoma • Erosive Lichen Planus • rare on palate, but still possible

11. Patient: Shirley Gorrell (352-8-25)Traumatic Ulcerations on Large Palatal Torus

12. Patient: Shirley Gorrell (352-8-25)Traumatic Ulcerations on Large Palatal Torus Prognosis Stable and good, provided that the patient avoid physical and chemical irritants. Treatment Plan • Frequent burning of palate – avoid hot and spicy • Consider stent to protect palate – patient refused • Yeast culture – negative • Lidocaine viscous – prescribed by Dr. Whitt to reduce pain resulting from ulcerations • Warm salt water – patient told to rinse daily

13. The End