Oral Diagnosis and Medicine Competency Case

1. Oral Diagnosis and MedicineCompetency Case Team 3 Jacob Smith #433-5-01

2. Patient Medical History • 78 year old, white, female • Stable Angina-nitro as needed • Emphysema • Glaucoma • Cataracts • Angular Cheilitis, vertical dimension too far closed

3. Patient Information Medications Allergies • Calcium - 1000mg/day • Lovastatin - 20mg/day • Magnesium - as needed • Vitamin B-100 Complex - 1/day • Vitamin c - 500mg/day • Vitamin E - as needed • Zinc - as needed • Codeine • Chronic Seasonal • Adverse Reactions with Lidocaine

4. Patient Presentation / Lesion Description • After adjusting patient’s maxillary denture and using adhesive to help retain it, patient returns to clinic 1 week later with the lesions presented. • Patient reports that lesions appeared 3 days after adjustment and adhesive were placed. • The lesions are painful, small, multiple, red, flat, circular, epithelial involved macules with well-defined borders occurring on the palate.

7. Patient Dialogue • Have you ever had these lesions anywhere on your body before? • After using the adhesive, do you present with any of the following symptoms: itchy, watery eyes, congestion, difficulty breathing, rashes, hives, or nausea? • Have you recently been exposed to high amounts of sunlight or eaten any hot foods? • Have you changed your diet recently? • Does the lesion only hurt on palpation?

8. Diagnosis Differential Diagnoses Provisional Diagnosis • Recurrent Oral Herpes Simplex • Stomatitis • Allergic Reaction • Aphthous Ulcer • Recurrent Oral Herpes Simplex • Lesion has classic appearance of herpes simplex • Lesion is painful • Appeared suddenly, probably due to new denture fitting

9. Treatment • Patient is informed of lesions and told that lesions will disappear on their own after 2 weeks • Patient is advised to use topical anesthetic if needed and not to wear dentures unless necessary (eating, etc)