1. Continuing education program October, 2011 TAOP

2. Chief complaint CC: Ulcerations on the bilateral buccal mucosae and gingival bleeding after tooth brushing Case 1

3. Present Illness PI: This 65-year-old female patient came to our OPD with the chief complaint of ulcerations on the bilateral buccal mucosae and gingival bleeding after tooth brushing. Oral examination revealed erosive and ulcerative lesions surrounded by white keratotic lines on the bilateral buccal mucosae (Figs. 1A and 1B) and generalized gingival inflammation (Fig. 1C). Case 1

4. Present Illness The patient was treated by levamisole (1# tid for 3 consecutive days per week), predonine (1# tid for 3 consecutive days per week), vitamins B complex and C (1 cap bid), and local application of dexaltin (twice a day) on the lesions for 9 weeks. The clinical oral photographs after 9-week treatment are shown in Figs. 1D-F). Case 1

5. Fig. 1A

6. Fig. 1B

7. Fig. 1C

8. Fig. 1D

9. Fig. 1E

10. Fig. 1F

11. 1.What are the differential diagnoses for this patient’s buccal mucosal and gingival lesions? 2. Explain why the patient got well after treatment. 3. May these oral lesions recur sometime in the future? Why and how to treat the recurrent lesions? Case 1 Discussion

12. Case 2 Present illness Generalized gingival hyperplasia was found in a 45-year-old male patient with DM (Fig. 2A), in a 43-year-old male patient with angina pectoris and hypertension (Fig. 2B), and in a 25- year-old male patient without any systemic disease (Fig. 2C).

13. Fig. 2A Patient 1

14. Fig. 2B Patient 2

15. Fig. 2C Patient 3

16. Case 2 Discussion 1.Explain why these 3 patients had gingival hyperplasia or overgrowth? 2.Is oral hygiene related to gingival hyperplasia or overgrowth in these 3 patients? 3.How to treat these 3 patients? 4.Do you expect recurrence of gingival hyperplasia after a proper treatment?

17. Present illness Case 3 CC: Burning sensation of the oral mucosa PI: This 65-year-old female patient complained of burning sensation of the oral mucosa especially the tongue for 6 months. She was referred to our OPD for treatment. Oral examination revealed a smooth tongue with delicate white coatings on the dorsal surface and angular cheilitis (Fig. 3A).

18. Fig. 3A

19. 1.What are the differential diagnoses for this patient’s smooth tongue and angular cheilitis? 2. Do we have to order some laboratory tests in order to confirm the diagnosis? 3. May the patient have some underlying diseases? 4. How to treat this patient? Case 3 Discussion

20. CC: Multiple oral ulcerations PI: This 63-year-old male patient had mild DM and recurrent oral ulcerations on the oral mucosa. Three days ago, he applied bee propolis on the newly formed oral ulcerations several times trying to hasten the healing of the ulcerations. The oral ulcerations did not heal. In addition, multiple oral ulcerations developed on the labial mucosa, buccal mucosa, and tongue (Figs. 4A-E). Present illness Case 4

21. He came to our OPD for treatment. The patient was treated by predonine (5 mg, 4# tid for 3 days, 2# tid for 2 days, and 1# tid for 2 days). The oral ulcerations disappeared after treatment (Figs. 4F-J). Present illness Case 4

22. Fig. 4A

23. Fig. 4B

24. Fig. 4C

25. Fig. 4D

26. Fig. 4E

27. Fig. 4F

28. Fig. 4G

29. Fig. 4H

30. Fig. 4I

31. Fig. 4J

32. Case 4 Discussion 1. What are the differential diagnoses for this patient’s oral ulcerations? 2. Do we need any laboratory tests to confirm the final diagnosis? 3. What is bee propolis for? 4. What is the final diagnosis for this patient?