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Dentistry

Breakthrough Clinical oral pathology case: No. 31

Oct. 4, 2017

Dr. Stacey Simmons describes the oral pathology case of a 60-year-old patient who presents for a limited exam. Chief complaint: She noticed some white tissue under her lower implant prosthesis. The patient is concerned because a similar type of lesion was removed and diagnosed as precancerous five years ago when her implants were placed.

Stacey L. Simmons, DDS, Editorial Director of DE's Breakthrough Clinical e-newsletter

Dr. Stacey Simmons describes the oral pathology case of a 60-year-old patient who presents for a limited exam. Chief complaint: She noticed some white tissue under her lower implant prosthesis. The patient is concerned because a similar lesion was removed and diagnosed as precancerous five years ago when her implants were placed.

Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about the clinical specialties newsletter created just for dentists, and subscribe here.

Figure 1

PRESENTATION: A 60-year-old female with a noncontributory health history presents for a limited exam.

CHIEF COMPLAINT: The patient noticed some white tissue under her lower implant prosthesis (figure 1). The patient reported no pain in the area but was concerned about the white tissue being something pathological. Apparently, when she had her implants placed five years prior, a lesion of similar nature was removed and diagnosed as precancerous.

THREE MONTHS EARLIER: The patient had been seen three months earlier for a recall exam and lower prosthesis removal and cleaning. Findings at the soft-tissue exam were within normal limits.

CLINICAL EXAM: Clinical assessment reveals a white, corrugated lesion lingual to the acrylic of the fixed hybrid prosthesis (figure 2). The lesion measures 5x24 mm and is not able to be scraped off or removed. It is not painful or symptomatic, and there are no swellings noted in the sublingual or submandibular lymph node areas (figures 3 and 4).

Figure 2

Figure 3

Figure 4

What are your differentials and recommended course of treatment modalities?

Send your answers to [email protected] or join our Facebook group to discuss this oral pathology case and more. Next month, we will discuss the final diagnosis and recommended treatment for this case.

Do you have an interesting oral pathology case you would like to share with Breakthrough’s readers? If so, submit a clinical radiograph or high-resolution photograph, a patient history, diagnosis, and treatment rendered to: [email protected]. We will let you know if we select your case.

For more oral pathology articles, click here.

Editor's note: This article first appeared inDE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about the clinical specialties newsletter created just for dentists, andsubscribe here.

Stacey L. Simmons, DDS, is in private practice in Hamilton, Montana. She is a graduate of Marquette University School of Dentistry. Dr. Simmons is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. She is the editorial director of PennWell’s clinical dental specialties newsletter, DE’s Breakthrough Clinical with Stacey Simmons, DDS, and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. Dr. Simmons can be reached at [email protected].

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About the Author

Stacey L. Simmons, DDS | Editorial Director of DE's Breakthrough Clinical e-newsletter

Dr. Stacey Simmons grew up in Hamilton, Montana. She did part of her undergraduate work at Purdue University and then received her bachelor’s degree in exercise physiology from the University of Utah. After applying to both medical and dental school, she decided that dentistry was her career of choice. She received her DDS degree from Marquette University School of Dentistry in Milwaukee, Wisconsin, in 2004. In private practice, she focuses her care on prosthodontics and cosmetic dentistry. She is a guest lecturer in the Anatomy and Physiology Department at the University of Montana. Outside the office, she trains for triathlons and spends time with her family. You may contact Dr. Simmons by email at [email protected].

In 2015, Dr. Simmons became the editorial director of DE's Breakthrough Clinical with Stacey Simmons, DDS, an e-newsletter focused on breaking through plateaus in clinical practice. Subscription information may be found here.

Updated May 4, 2016