oral lichen planus (erosive plaquelike) - case presentation
DESCRIPTION
TRANSCRIPT
Case Presenta*on
Erosive/plaque-‐like OLP
HIPAA Declara*on
• The informa,ons presented are within the limits of HIPAA declara,on
Personal Data • Name: C.M. • Age: 51 years old • Gender: female • Race: caucasian • Marital status: single • Occupa,on: furniture refinisher
Medical History • Major illness: Mild mental retarda*on, hypertension, phenylketonuria, anemia, obstruc*ve sleep apnea, obesity, diabetes type II
• ASA: II • Hospitaliza,on & Surgical History: none • Allergies: none
Medica*ons Drug Name Class of drug
Amlodipine/Benazepril Ca channel blocker/ACE inhibitor
Aspirin NSAID
Ferrous sulfate FeSO4
Hydrochlorothiazide thiazidic diure*c
MeKormin biguanide
Metoprolol β1 receptor blocker
Onglyza (Saxaglip*n) DPP-‐4 inhibitor
Vit. B complex supplement
Habits
• Smoking: no • Alcohol consump,on: no • Parafunc,onal habits: none reported
Dental History • Amalgam fillings: #30 • Composite fillings: #21 • Endodon,c treatments: no • Crowns: no • Missing teeth: #s 1, 16, 17, 32 • Oral hygiene: Poor. Pt brushes 2/day, does not floss. Heavy deposits of plaque and calculus
Phisical Examina*on No physical disabili,es were no,ced Mental disability does not prevent the pa,ent to have a the minimal coopera,on needed for a dental visit Records at ini,al visit: • Blood pressure: 126/64 mmHg • Pulse: 98 bpm • Glycemia: 174 mg/dL
Clinical Examina*on • Extra-‐oral examina,on: No facial asymmetry No palpable lymph nodes
• TMJ: – No devia*on detected upon opening – Asymptoma*c TMJ and mas*catory muscles – Mouth opening within normal range
• Head and neck: no abnormali*es or pathology observed
Clinical Examina*on The pa*ent’s tongue, mucosa, floor of the mouth, hard and so_ palate and oropharyngeal region were examined and white lesions were detected on the kera*nized gingiva a 1.5x1cm white plaque was no*ced above tooth #3, a 1x1cm and a 1.5x1cm white plaque were no*ced respec*vely on the le_ and on the right buccal mucosa, plaques appear ulcerated and erythematous. Bilateral white striae on the buccal mucosa. Papillae and gingival margin are swelling, erythematous and bleed spontaneously. Pa*ent reports not being in pain.
History of white lesions • 10/11 -‐ Detec*on of white lesions is first reported in chart (PG Perio clinic)
• 12/11 – Biopsy taken and OLP diagnosed (no OLP diagnosis from lab results)
• No treatment for OLP reported • 9/12 -‐ 6 biopsies taken chart reports that biopsies analysis resulted in diagnosis of ulcera*ve LP (no lab report has been found in the chart)
Periodontal Status • Gingiva erythematous with so[ consistency and loss of s,ppling
• Gingival architecture: scalloped • Many recessions • Lack of kera,nized gingiva • Localized horizontal bone loss #10, 11, 12 • Good ves,bular depth
Periodontal Diagnosis
Chronic Generalized Moderate Periodon**s
Treatment Plan
• OHI, educa*on, mo*va*on • Scaling and root planing • Topical applica*on (sponges) of chlorhexidine .12%
• Re-‐evalua*on in 6 weeks
Re-‐evalua*on a_er 6 weeks
Treatment Progress
• Lidex cream 0.05% (fluocinonide) applica*on on the affected areas 3 *mes per day for 2 weeks
• Re-‐evalua*on • 1 week more full dosage, two weeks maintenance once per day
2-‐weeks Re-‐evalua,on
2-‐weeks Re-‐evalua,on
3-‐months
Re-‐evalua*on
Chronic Generalized Moderate Periodon**s
Localized Slight to Moderate
3-‐months Re-‐evalua,on
3-‐months Re-‐evalua,on
One more cycle with Lidex cream 0.05% (3 weeks full dosage + 1 week maintenance)
Thank You