A 44-year-old female presented with a two-month history of burning sensation in the mouth and ulcerated mucosa, previously consulting a gastroenterologist and dental clinics without relief. Examination revealed erosive lichen planus and candidiasis with characteristic white lesions and erythematous borders on the lower labial vestibule and tongue. The treatment plan includes topical corticosteroids and oral medications, with follow-up scheduled.

1. CASE PRESENTATION
Dr. Nitha Willy
First Year PG
Department Of Oral Medicine And Radiology

2. BIOGRAPHIC DATA
Name : Jaseela Shaji
Age :44 years
Sex : F
Occupation : Home maker
Address : Thanickamolath Methala
O P No :2971
Phone no: 9446972349

3. CHIEF COMPLAINT
Patient complaints of burning sensation in mouth since two months.

4. HISTORY OF PRESENTING ILLNESS
Patient complaints of burning sensation in mouth since 2 months while eating spicy food.
Patient complaints that mucosa gets ulcerated which is then painful.
Patient visited a dental clinic for the pain in lower mouth last day and was prescribed a
dologel which was not effective in reducing patient’s complaint.
Patient had consulted a gastroenterologist at Lisie hospital before one month relating
problem of mouth to be associated with gastric problem and she was informed that there was
no problems associated with GIT.

5. Patient has stress related to family issues.
Patient has not taken any special foods, patient has not changed toothpaste.
VAS score : 8/10

6. MEDICAL HISTORY
H/O Hypertension and hyperlipidemia under medication for 4 years
Patient doesn’t remember name of medications.
Patient had no recent hospitalization history or recent episodes of fever.

7. Drug Allergy
No known drug allergy

8. REVIEW OF SYSTEMS
CNS: No abnormalities reported
GIT: No abnormalities reported
Respiratory system: No abnormalities reported
CVS: No abnormalities reported
Endocrine system: No abnormalities reported
Genito urinary system: No abnormalities reported

9. PAST DENTAL VISIT
For similar complaint two day before in a private dental clinic.

10. PERSONAL HISTORY
Marital status: Married
Sleep and appetite: decreased sleep and loss of appetite.
Bowel and bladder movements: regular
Diet: mixed
Oral hygiene: brushes twice daily using tooth paste and toothbrush.
No deleterious and parafunctional habits noticed

11. FAMILY HISTORY
Parents and siblings are diabetic and hypertensive patients

12. GENERAL PHYSICAL EXAMINATION
Patient was conscious, co-operative and well oriented with person, place, time.
1. Gait: steady gait
2. Built: moderately built
3. Nourishment: moderately nourished
4. Temperature: 37 ͦ C
5. Pulse rate:72 beats/minute
6. Respiratory rate: 16 beats/minute
7. Blood pressure: 120/90 mm Hg

13. 8. No signs of pallor, Icterus, Cyanosis/ Clubbing/ edema and no lymphadenopathy
9. Height: 5 ft 5 in
10. Weight: 70 kg

14. LOCAL EXAMINATION OF HEAD AND NECK
Extra oral examination
1) Head : Mesencephalic
2) Hair : No abnormalities detected
3) Face :Apparently symmetrical
4) Skin : no abnormalities detected
5) Eyes : no abnormalities detected
6) Ears : no abnormalities detected
7) Nose: no abnormalities detected
8) Lips :competent
9) TMJ : Mouth Opening Within Normal Limits, No Deviation, No Clicking/ Crepitus
10) Muscles of mastication : non-tender
11) Lymph nodes : not palpable
12) Cranial nerve examination: no abnormalities

15. Intra oral examination
Soft tissue examination
1. Labial mucosa: no abnormalities detected
2. Labial vestibule: white lacy striations with erythematous border in lower labial vestibule
extending distal aspect of 32 to distal aspect of 43.
3. Buccal mucosa: no abnormalities detected
4. Buccal vestibule: no abnormalities detected.
5. Lingual vestibule: A white plaque seen extending from lingual vestibule of 31,41 to
lingual frenum, of size 2*2 cm.
6. Gingiva : coral pink color, scalloped contours with knife edge margins, stippling present,
gingiva is firm and resilient.
7. Bleeding on probing: absent
8. Periodontal pocket: absent

16. 9. Tongue: The dorsal and lateral borders of tongue had presence of white coating.
10. Floor of mouth: no abnormalities detected
11. Frenal attachment : mucosal frenal attachment detected
12. Palate: no abnormalities detected
13. Oropharynx: no abnormalities detected
14. Salivary gland orifices: no abnormalities detected

17. Hard tissue examination
1. Number of teeth : 16-27,36-47
2. Carious teeth :0
3. Missing teeth : 18,17,28,38,37,48
4. Root stump:0
5. Restored tooth: 47,46,35,34,36,14,24
6. Fractured tooth:0
7. Mobility :0
8. Attrition : generalised

18. Examination of lesion
On inspection
On inspection,
White lacy striations with
erythematous border in lower labial
vestibule extending from labial
vestibule distal of 32 to distal of 43
and supero-inferiorly from
mucogingival junction to labial
vestibule was noted.
On palpation,
All inspectory findings were
confirmed.
Non tender, non scrappable, no
bleeding or no pus discharge

19. On Inspection
A white plaque of approximate size 1*3 cm extending
from superoinferiorly 2 cm below the mucogingival
junction of 31,41 to 3 cm into the lingual frenum and
mediolaterally extending 2cm on both sides of lingual
frenum.
On medial aspect of white plaque, on left sublingual fold
overlying the sublingual gland, peripheral radiating
striations are seen and pinpoint erythematous areas seen on
sublingual fold overlying the sublingual gland and
sublingual caruncle
On palpation
All inspectory findings were confirmed.
Non tender, non scrappable, no bleeding or no pus discharge

20. The dorsum and lateral borders of tongue show
white lesion which is scrapable on palpation.
Discrete greyish black pigmentation seen on lateral
borders of tongue.

21. Case Summary/ Analysis
A 44 year old female patient reported to our department with chief complaint of burning sensation in
mouth since 2 months. On examination, White lacy type lesion with erythematous border in lower
labial vestibule extending from labial vestibule distal of 32 to distal of 43 and supero-inferiorly from
mucogingival junction to labial vestibule was noted. A white plaque type lesion with radiating
striations on left on sublingual fold overling the sublingual gland and overlying pinpoint
erythematous areas seen on sublingual fold overlying the sublingual gland and sublingual caruncle
extending from superoinferiorly 2 cm below the mucogingival junction of 31,41 to 3 cm into the
lingual frenum and mediolaterally extending 2cm on both sides of lingual frenum. The dorsal and
lateral borders of tongue show white pigmentation and was scrappable on palpation.

22. PROVISIONAL DIAGNOSIS
EROSIVE LICHEN PLANUS ON LOWER LABIAL VESTIBULE
PLAQUE TYPE LICHEN PLANUS ON LINGUAL FRENUM AND
LINGUAL VESTIBULE
CANDIDIASIS ON DORSUM AND LATERAL BORDERS OF
TONGUE

23. Differential Diagnosis
1. Speckled leukoplakia: middle older age male group, associated with tobacco,
unilaterally present, no striae.
2. Hyperplastic candidiasis: presence of striae, associated with stress, negative fungal
hyphae seen in cytosmear.
3. Homogeneous leukoplakia : non scrappable, whitish patch or plaque, well
demarcated borders.
4. Thermal burn

24. INVESTIGATIONS
CYTOLOGY, HEMATOLOGYAND BIOPSY
Smear from dorsum of tongue showed presence of candida
hyphae.

25. Treatment Plan
1) 0.1 % Triamcinolone Acetonide topical application three times daily for
15 Days
2) Tab oxidil(ginseng extract,lycopene, lutein, zinc oxide) 1-0-0 * 15 Days
3) Betamethasone sodium phosphate 0.5mg( Swish and Spit )1-0-1 for 15
Days

26. FOLLOW UP