Escolar Documentos
Profissional Documentos
Cultura Documentos
226]
Case Report
In the literature, different terms are used to refer to these CASE REPORT
lesions. OLRs have sometimes been considered as the
part of OLP[2,3] and have also been described as contact A 56yearold female patient, wife of a retired personnel,
allergies,[4] OLL,[5,6] or contact lesions.[7] The term OLR was reported to the Department of Periodontology, with the
proposed by Finne etal. in 1982[2] to designate clinically chief complaint of swelling in the upper front gums for
indistinguishable lesions of OLP. OLRs may also result the past 3months and difficulty in wearing dentures due
from systemic drug exposure, termed as oral lichenoid drug to the same reason. The history of present illness revealed
that the patient was asymptomatic 3months back and the
Address for correspondence: Dr.Mukherji Arnav, present complaint started with mild pain in the upper front
15/202, Heritage Apartments, On DBP Road, Yelahanka, gums, following which the patient noticed redness in the
Bengaluru560064, Karnataka, India.
Email:arnavmukherjifriend@gmail.com
This is an open access article distributed under the terms of the Creative
Access this article online Commons AttributionNonCommercialShareAlike 3.0 License, which allows
Quick Response Code: others to remix, tweak, and build upon the work noncommercially, as long as the
Website: author is credited and the new creations are licensed under the identical terms.
www.ijhas.in
For reprints contact: reprints@medknow.com
DOI: How to cite this article: Rath SK, Arnav M. Oral lichenoid contact
10.4103/2278-344X.194133 reaction to a complete denture: A rare case report. Int J Health Allied
Sci 2016;5:274-7.
274 2016 International Journal of Health & Allied Sciences | Published by Wolters Kluwer - Medknow
[Downloaded free from http://www.ijhas.in on Monday, September 18, 2017, IP: 114.125.86.226]
region. Apainless growth appeared in the region which and 0.5cm in breadth. The lesion was pedunculated,
grew to the present size over the past 3months. nontender, nonpulsatile, and firm in consistency on
palpation. The mucosal attachment was free from the
On eliciting the medical history, the patient reported no underlying bone and freely movable with the mucosal
underlying disease or conditions for which she is seeking, retraction. Radiographic analysis was performed using
or has undergone any medical consultation. She was orthopantomogram and intraoral periapical radiograph
not on any medications, no admissions to hospital or of the involved site. No osseous lesions or pathology was
a day care facility in the last 6months, and reported to noted[Figure2].
be otherwise systemically healthy. She gave a history of
uneventful childbearing and delivery twice, and attainment Based on the patients history, clinical and radiographical
of menopause at the age of 45years. examination, a provisional diagnosis of a soft tissue
fibroma due to chronic denture irritation was arrived at.
Dental history revealed multiple tooth extractions over Aunilateral excisional biopsy of the lesion of the right
the past 20years. The prime reason for the extractions side, followed by histological examination was planned
was dental caries and tooth mobility. She had been using to arrive at a correct diagnosis. Initially, only one lesion
dentures for the past 2years. was undertaken for biopsy to diagnose the lesion and to
avoid additional postoperative morbidity and discomfort
Family history was noncontributory. On general physical
to the patient.
examination, she was moderately built, adequately
nourished, and with erect posture. There were no clinical A complete hematological analysis including complete
signs of anemia, cyanosis, or icterus. Extraoral examination blood count, international normalized ratio, activated
revealed a bilaterally symmetrical face with no sinus, partial thromboplastin time, and fasting/postprandial
swelling, or scar. Aconvex lateral facial profile, 5cm of blood glucose estimation was carried out, and results were
mouth opening and competent lips at rest were noted. normal.
Temporomandibular joint was normal on palpation and
visual examination. The surgical site was prepared with extraoral disinfection by
5% Povidineiodine scrub and intraoral 0.2% chlorhexidine
Dental examination revealed completely edentulous
rinse. Local anesthesia in the form of ring infiltration
maxillary arch and partially edentulous mandibular arch
with 2% lignocain HCL with 1:80000 adrenaline was
with the presence of anteriors and first premolars bilaterally.
administered by a 30gauge needle, circumferentially
The patient wore upper a complete denture and a partial
around the lesion in the healthy mucosa.
lower denture for the past 2years. On examining the
dentures, it was noticed that the maxillary dentures were A 15c blade was used to give a full thickness incision
slightly overextended at the labial vestibular area. surrounding the lesion on all sides. The incision included
2mm of healthy, uninvolved mucosa on the lesion
The buccal and labial mucosa was normal in color,
periphery[Figure3a]. The full thickness incision and the
contour, and consistency. Amucosal overgrowth was
involvement of the healthy tissue in the incision design,
observed in the upper anterior vestibular area on either
assured the removal of the lesion in total[Figure3b],
side of the labial frenum[Figure1a and b]. The lesion was
failure of which could lead to relapse. The surgical site was
pink and in confluence with the adjoining mucosa, the size
sutured with interrupted 30 silk, and healing by primary
measured at approximately 2cm in length, 1cm in width,
a b
Figure1:(a) Mucosal overgrowth in the upper anterior
vestibular area,(b) mucosal overgrowth in either side of Figure2: Orthopantomogram showing absence of osseous
frenum lesion
International Journal of Health & Allied Sciences Vol.5 Issue 4 OctDec 2016 275
[Downloaded free from http://www.ijhas.in on Monday, September 18, 2017, IP: 114.125.86.226]
intention was aimed[Figure3c]. The patient was advised were seenone dense and focal and the other scant to
to discontinue wearing dentures and not to brush on the moderate diffuse. Dermal edema with no evidence of
operated site till the removal of the sutures. Analgesics in malignancy was noted. The lesion was identified as a
the form of ibuprofen 400mg twice daily for 2days and lichenoid reaction[Figure5]. Based on patient medical
mouth rinse with 0.2% chlorhexidine gluconate twice daily and dental history, a diagnosis of OLCR to dental
for 1week were prescribed. The patient was recalled after material, that is, acrylic based denture material was
24h to check for any uneventful morbidity, which was ruled arrived at.
out and suture removal was planned 10days postoperatively.
The patient was informed and advised to discontinue wearing
The excised tissue measuring 1.5cm by 1cm[Figure4a and b] dentures till the complete healing of the surgical site. Ten
was immediately fixed and transported in 10% formalin days postoperatively, suture removal was done[Figure6a].
solution, to the Department of Pathology, Army Hospital One month postoperative evaluation revealed satisfactory
Research and Referral Delhi Cantt, for histological healing without keloid formation[Figure6b].
examination.
DISCUSSION
The histological analysis of HandE stained section
of the lesion revealed squamous cell epithelial lining The etiology of lumbar puncture is still under discussion,
showing acanthosis and focal elongation of rete pegs in with a tendency to selfimmunity, whereas the etiology of
saw tooth shaped pattern. Two distinct patterns of OLRs is related to the contact with specific agents, such as
plasma cell infiltration in the dermoepidermoid junction metallic restorative materials, resins, and drugs, allowing
the establishment of a causeeffect relationship.
a
Figure4:(a) The excised tissue measuring 1.5cm by 1 cm, (b) the excised tissue measuring 1.5cm by 1 cm
276 International Journal of Health & Allied Sciences Vol.5 Issue 4 OctDec 2016
[Downloaded free from http://www.ijhas.in on Monday, September 18, 2017, IP: 114.125.86.226]
a b
Figure6:(a) Postoperative view after 10days, (b) postoperative
view after 1month without any keloid formation
Acknowledgment
Figure5: HandE section showing patterns of plasma cell
infiltration in the dermoepidermoid junction. No evidence The authors would like to acknowledge Col(Retd.)
of malignancy were noted MK Mukherji, Mrs. SMukherji, and Dr.Siddharth
Mukherji for their valuable help.
buccal/labial mucosa and the buccal/labial vestibular areas.
Van der Meij and van der Waal[12] proposed modified WHO Financial support and sponsorship
criteria according to which OLP could be diagnosed only Nil.
in cases when both clinical and histopathological criteria
are fulfilled, whereas in other cases, the disorder should be Conflicts of interest
considered as OLL. There are no conflicts of interest.
International Journal of Health & Allied Sciences Vol.5 Issue 4 OctDec 2016 277