White End of Hairy Leukoplakia to the Dark End of Human Immunodeficiency Virus: A Diagnostic Challenge.

As commonly accepted hairy leukoplakia may be highly associated with human immunodeficiency virus (HIV) infection and may be the first sign of the infection. Even though it is highly associated with immunosuppression, the awareness of oral hairy leukoplakia became prevalent with the advent of HIV and AIDS and it became the first suspicious sign of HIV and later the hallmark of disease process. A 36-year-old male taxi driver presented with the complaint of deposits on his teeth. Medical history revealed chronic cough, weight loss, loss of appetite, recurrent episodes of fever since 1-year, which was not investigated. Examination revealed multiple palpable cervical lymph nodes with intraoral findings such as pigmentation on buccal mucosa, erythema of palate, non-scrapable and non-tender white patch on lateral border of tongue, papillary atrophy on the dorsal surface of the tongue, and gingival inflammation (Figures 1-3). Patient was referred to higher medical center for investigation where the patient was diagnosed as HIVpositive.

De Novos Presentation of Cannon’s Disease.

White spongy nevus (WSN) is a rare hereditary disorder belonging to genodermatosis with a suggested etiology as a mutation in a gene.1 Lesions usually appear in younger age which can be seen in any part of the oral mucosa.2 WSN can affect any mucosa in body with or without oral involvement. A 12-year-old female patient came to our department for dental evaluation. A general examination of body showed no abnormalities. The intraoral examination revealed generalized white patches in the oral mucosa with the wrinkled surface (Figures 1-4). The lesion was totally asymptomatic and the patient was aware of roughness in oral mucosa which she noticed from her childhood. There were no mucosal changes anywhere in the body. There was no history of a similar lesion in family members. An incisional biopsy was done from the buccal mucosa. Fromclinical and histopathological features, we arrived at a diagnosis of WSN.

Bisphosphonate-Associated Osteonecrosis of the Jaw Posing as a Diagnostic Tight Spot.

Clinical acumen is an acquired trait, something one gain by experience. Many a time one may not be able to explain how the correct diagnosis was given in some critical situations, and this is not accidental. It is the subconscious that analyses the previous knowledge and correlates with the current situation. Here is a case report, which underlies the need for theoretical knowledge to be support practical success and highlighting the need for updating. Even in the era of apps and androids one’s mind can work faster than all of these. A 60-year-old male patient was referred for dental consultation by a physician following bone necrosis of jaw bones. He had difficulty in having food as the exposed bone was chipping off, but pain was minimal. He had a history of multiple myeloma 10 years back which was treated by both radio and chemotherapy. Three years back another course of radiotherapy was given. The patient was currently on many medications. On examination, the patient was of average built and no specific findings were present on general and extraoral examinations. Intraoral examination revealed denuded necrotic bone bilaterally on the posterior aspect of both the jaws (Figures 1-3). There was practically no tenderness on palpation. The absence of signs of inflammation put us in a dilemma.

Painless Management of Speckled Leukoplakia using Cryosurgery.

Cryosurgery is a well-known and well-documented treatment modality in orofacial lesions since 1960. According to review of literature various studies has already proved the efficacy of cryosurgery in leukoplakia.2,3 Cryosurgery was done for a male patient of age 38 years who was diagnosed with speckled leukoplakia on the left buccal mucosa (Figure 1). Cryosurgery was selected because of patients fear for scalpel surgery. The Patient was treated in outpatient department using liquid nitrogen and cryogun. Liquid nitrogen was sprayed directly into lesion using cryogun till ice ball was formed in the lesion (Figure 2). There was no intra operative or post-operative pain during cryosurgery and no anesthetic agents were used during treatment. The patient was recalled after 7 days and intra oral examination revealed a healing ulcer formation in the area of treatment (Figure 3). There was no pain or any symptoms on the site of treatment. The patient was recalled after 15 days of treatment, which showed healed ulcer and areas of re-epithelization (Figure 4). Patient compliance toward the treatment was good. The patient was advised to do review after 1-month.

Tip of the Iceberg: The Dental Radiograph.

Most of the lesions involving the mandible are inflammatory or infectious or odontogenic or fibro-osseous lesions. Osteosarcoma of the mandible is comparatively rare and hence is not usually included in the primary differential diagnosis. A 66-year-old male patient came to oral medicine and a radiology department with a complaint of pain and swelling in the left lower jaw of 3 weeks duration (Figure 1). Medical history revealed chronic liver and respiratory diseases and personal history disclosed heavy smoking and alcohol consumption since 40 years. On extraoral examination, a diffuse hard swelling was present on left lower posterior region of the mandible with a step deformity in the lower border of the mandible.