C L I N I C O PAT H O L O G I C R E V I E W :
Synchronous White Lesions
of the Lateral Tongue and Cheek
By Caroline Michaels, DMD and Joanne Prasad, DDS, MPH
University of Pittsburgh School of Dental Medicine
CLINICAL HISTORY
A 30-year old white male presented to the Emergency Clinic at
the University of Pittsburgh School of Dental Medicine with
recent onset of constant, aching pain of the right lower jaw.
An exam and work-up revealed a diagnosis of pulpal necrosis
with symptomatic apical periodontitis of the right mandibular
second premolar (tooth #29). An intraoral soft tissue
examination was performed at that time, which revealed
asymptomatic, diffuse, gray-white lesions of the right and left
buccal mucosa (Figure1). The patient was also noted to have a
white, shaggy, plaque-like lesion spanning the length of the
right lateral border of the tongue along with a similar-
Figure 1: Diffuse white lesion of the left buccal mucosa. A similar lesion was
noted on the contralateral side.
appearing lesion located on the anterior half of the left lateral
tongue (Figure 2). Both tongue lesions were asymptomatic and
the patient was unaware of any mucosal changes. A review of
the patient’s social history revealed a cigarette-smoking habit
of one pack per day for 15 years. Medically, the patient
indicated a history of grand mal seizures for which he takes
phenytoin, as well as a history of mild depression and anxiety,
treated with Buspar® (buspirone) and Remeron® (mirtazapine).
An oral pathology consult was requested to evaluate the
lesions of the buccal mucosa and tongue.
Figure 2: Shaggy, white plaque-like lesion of the left lateral tongue. A similar
appearing leukoplakic lesion was noted on the right lateral border of the tongue
WHAT IS THE DIAGNOSIS?
A. Lichen planus
B. Oral Hairy Leukoplakia
C. Frictional keratosis
D. Contact reaction
E. Leukoplakia (Epithelial Dysplasia)
MARCH/AP RIL 2020 | P EN N SYLVAN IA DEN TAL JOURNAL
29