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Readers are encouraged to submit clinical experiences, good and bad, in a culture of open reporting, so that other clinicians will learn from these experiences. Unlike articles in Dental Update, in which published articles are peer reviewed by two experts in the field of the article, this page is not subjected to review other than by the Editorial Director.
When I was a newly qualified dentist, an older gentleman attended for his 6-monthly routine dental check-up. He had no complaints. He lay back in the chair and I began the check-up. He had an upper denture in place and asked if I would like him to remove this. ‘Yes please’, I replied. Out the denture came. I began to examine him again and was immediately worried. On the buccal aspect of the maxillary alveolar ridge was a poorly defined patch of erythema with several white speckles overlying it, which had previously been hidden by his denture. Thinking back to my oral medicine lectures, I knew that a white and red patch, in an older patient, who also smoked, was bad news. I asked the patient if he was aware of the patch or it had given him any symptoms; ‘I didn't know there was anything there at all’, he replied. ‘Painless’ I thought – another bad sign. I called a (very busy) senior associate dentist to come and have a look. When he arrived (mid-extraction with his own patient), I tried to convey my concern to him in ‘dental code’ and with my worried facial expression. He sat down and looked at the patch. He then wiped it clean off with a glove, revealing totally normal mucosa beneath. He examined the red debris that had come away on his glove. ‘That's a bit of old mouldy cherry tomato skin that's been sitting beneath the denture’, he explained. The patient then recalled the last time he ate cherry tomatoes (a full week ago) and, needless to say, I went the colour of the cherry tomato.
I learnt always ‘to get stuck in’ when examining mucosal abnormalities, something which is now the bread and butter of my job in oral medicine. Don't be scared by a mucosal abnormality – touch it, feel it, see if it rubs off! These are all essential for a provisional diagnosis!
