HD CASE REPORT
A 39 years old male adult attended for a regular 6 monthly dental check up and routine scaling. The patient reports to suffer from anxiety, he is a teacher, a non-smoker, non-drinker and a regular dental attender.
On his initial examination dated 23/06/13 the patient was seen for a routine full mouth scale and polish with reinforced oral hygiene instruction including flossing technique. He presented with excellent oral hygiene at this appointment which was a reflection of his commitment to good oral hygiene; tooth-brushing twice daily and dental flossing once daily. This was further supported by the patients plaque scores at 5% and bleeding scores at 4% with only minimal supra gingival calculus on lower anterior teeth. There was no erythema or oedema present on the gingival tissues.
Furthermore an extra oral examination revealed no abnormalities. His BPE was 111/121 and he had no restorations and was given a ‘Low Caries Risk’ status.
However, on the a recent visit dated 23/12/13 the patient’s gingival condition had deteriorated, presenting with an increased plaque scores of 34% and bleeding scores to 63%. Intra oral examination also showed generalised oedema and erythema throughout in the mouth in response to this increase in plaque bacteria. The presence of supra-gingival calculus on lower anterior teeth and both sites of upper buccal molars and the patients BPE now reads 212 /121, putting the patients caries risk at a ‘High’ status.
The patient still suffers from anxiety and has been taking the Selective serotonin re-uptake inhibitor - Fluoxetine 20mg (BNF 2014: 251-254) once daily since his last visit and the patient reports very low motivation due to a recent separation affecting his oral hygiene and a general lack of care.
His main complaint was the presence of recurrent mouth ulcers over the last few months that have been causing him a lot of pain. This has also had a negative affect on his daily oral hygiene regime, as he has only been able to carry out minimal tooth brushing and only occasional interproximal cleaning.
Upon examination, an isolated homogenous shallow lesion was noted on the labial mucosa lining of the upper lip. The lesion was approximately 4mm in diameter, round with a white centre and red erythemous demarcated outer halo. It has been painful and recurrent in numbers over last few months.
However the patient did not state since when exactly or whether it has been recurrent in the same location. The lesion was documented that day with the use of a clinical photograph.
Based on the clinical findings in regards to the location, colour, size and history of the lesion, it would indicate that the lesion fits all the diagnostic features of the recurrent aphthous ulcer (Recurrent Apthous Stomatitis or RAS).
Definition of Ulcer:
“‘A lesion through the skin or a mucous membrane resulting from loss of tissue, usually with inflammation “ (Stedman’s Medical...