1. Laura E. Davies FS 2010 – November 8, 2010 Team 1 Competency Case #508-4-81 Oral Diagnosis and Oral Medicine

2. Patient History • 76 year old female • Maxillary Complete Denture and Mandibular Partial Denture • Medications – Darvocet, Lexapro, Morphine, Soma • Medical Findings – Heart murmur, anemic, multiple bone fracture in right leg - July 2010, Osteoporosis, depression, acid reflux

3. Lesion Description • Red, 5 mm single - bilateral ulcerations located on edentulous epithelium of alveolar ridge of mandible, with a well defined border • Other oral findings – mandibular denture not stable and occluding incorrectly with maxillary denture

6. Patient Dialogue • Have you noticed your denture fitting differently lately? • It has felt looser lately. • Have you changed your diet recently? • I ate more Halloween candy the last week or so, it was a little harder than my normal diet • Did you make any other changes to your diet recently? • No • Are you aware of any allergies you might have? • No • Did you drink/eat anything really hot that might have gotten into that region? • No • Did you use any new denture creams or mouth rinses lately? • No • Do you take your denture out at night when sleeping? • Sometimes, I don’t like people to see me without teeth though, so when we have guests I leave it in.

7. Diagnosis Differential Diagnosis • Ulcer from trauma • Chemical burn • Thermal burn • Toothpaste/mouthwash burn • Aspirin burn • candidiasis • Allergic reaction • Aphthous ulcer • Herpes Provisional Diagnosis = Traumatic Ulcer • Lesion is in region where denture has been rocking • Patient has eaten harder foods lately • Lesion was resolved by placing a tissue conditioner in mandibular denture. • Treatment = reline mandibular denture

8. References • D6424 Oral Diagnosis and Oral Medicine Lecture Outlines • Guide to Common Oral Diseases – Dunlap, Charles; Barker, Bruce; and Whitt, Craig