Case Study 2 by Alex, Dipu, Tever A 55yr old male visited a dental office for a routine check-up and prophylaxis. Oral examination revealed a brown hairy plaque on the dorsal tongue. The patient first noticed the hairy area on the tongue three months earlier The patient was not aware of any changes in size, shape, color. The patient stated there is no pain associated with hairy lesion on his tongue.

History The patient admitted smoking one pack of cigarettes for the past 10 years. The patient seems to be in a good states of health. The patient health history was reviewed and shows no positive findings. Examination The patient has regular dental exams and routine treatment. Vital were with in normal limits, with no enlarge lymph nodes. The oral exam revealed a large brown matte plaque on the posterior dorsal tongue. The plaque looked hair like and could not be rubbed off by scrapping.

Benign Migratory Glossitis Hairy leukoplakia Occurs on the lateral border surface of the tongue Corrugates in an irregular white lesion Occurs in HIV and organ transplant plant patients Benign Migratory Glossitis Genetic factors play a role. Its exaggerated by stress Found on the dorsal and lateral borders of the tongue Diffused area devoid of filiform papillae Looks like erythema patches, that are surrounded by a white or yellow perimeter Burning discomfort is common No treatment indicated

Hairy Tongue White Hairy Tongue Black Hairy Tongue White hairy tongue Is an increase accumulation of keratin on the filiform papillae, result in white hairy appearance Black Hairy Tongue Black hairy tongue has the same texture as the white hairy tongue, except the papillae are brown to black color. The cause of the black is due to chromogenic bacteria Tobacco and certain foods may also discolor the papillae.

Median Rhomboid Glossitis Hyperplastic Candidiasis The cause is unclear, may be associated with chronic fungal infection,; candida albicans Appears flat or slightly raised oval / rectangle erythematous area in midline of the dorsal surface of the tongue Devoid of filiform papilla; texture is smooth Hyperplastic Candidiasis White lesion that doesn’t wipe off the mucosa It is in response to antifungal medication When leukoplakia is caused by candidiasis it disappears when treated with antifungal medication Biopsy is considered if the lesion doesn’t respond to antifungal therapy.

‘ Which is it? 1. Hairy leukoplakia 2. Benign Migratory Glossitis 3. Hairy Tongue 4. Median Rhomboid Glossitis 5. Median Rhomboid Glossitis