Pathology · patient case question
On the same examination, a diffuse greyish-white opacity of the buccal mucosa DISAPPEARS when the cheek is stretched. What is it?
Patient case: Rampant interproximal caries in a smoker who chews mints
Patient: Male, 34 years old
Chief Complaint: “I keep getting cavities between my teeth even though I brush.”
Background: Smokes half a pack a day. Reports brushing twice daily with a fluoride toothpaste. Uses sugar-containing breath mints continuously through the working day to mask the smell of smoke.
Current Findings: Carious lesions on virtually every interproximal surface. Diffuse brown-black pigmentation distributed symmetrically along the attached gingiva of both arches, unchanged for as long as he can remember.
Show answer and explanation
Correct answer: B. Leukoedema
- A. Leukoplakia is a white patch that CANNOT be rubbed off or made to disappear by stretching, and is a diagnosis of exclusion with malignant potential requiring biopsy.
- B. CORRECT. Leukoedema is intracellular oedema of the spinous layer producing a diffuse, filmy, greyish-white appearance of the buccal mucosa. The defining diagnostic manoeuvre is that STRETCHING the mucosa makes it disappear. It is a benign variation of normal, more common in darker-skinned individuals and in smokers, and needs no treatment.
- C. White sponge nevus is an autosomal dominant condition producing thick, folded, spongy white plaques from childhood; it persists on stretching.
- D. Lichen planus presents with reticular Wickham's striae, bilateral and persistent, and does not vanish on stretching.