old case of speckeled leukoplakia -need followup

35 year old male working in up roadways came with the complaint of tooth ache.he was refered to pg clinic due to presence of oral lesion.he was quiet,tense..on asking about his general health ..he gave history of sum neck swelling since 5-6 years.but it was not diagnosed by any docter.he has visited so many docters.underwent all the diagnostic testings like usg,barium meal study for git..but all the reports were normal..he was from a joint family..but he was not going to the social gatherings since 4-5 years.decreased talking nesss..he was lethargic on dental chair..his problem in neck was just causing suffocation..on dental history he was reported 4 years back in the dept for a white lesion on his right bucccal mucosa.an incisional biopsy was done the report was hyperkearatotic area with mild dysplasia.but he was continous with his smoking habit..so in this case we sent him to pshychiatry department for management of his depressive symptoms..and now at present red and white lesion was present on buccal mucosa ..we think about candidal leukoplakia .adviced complete stoppage of habit and topical antifungal and then reguler follow up in this case for early diagnosis of any change in the current lesion.becoz lesion was persisiting on records since more than 4 years.

beauty in this case was our corelation of his neck and stomach tightness problem without any significant pathology with his change in mood and social habits.which were indicating the depression state of his mind..

again stress is also an imporatnt factor for conversion of normal cell into malignant one by its effect on genes.as proposesd by leading cell biologist.

progressing malignancy and its effect on mandible

1st opg showing osteolytic area in region of 37.not very frank radiolucency.hard to detact radiologically without clinical information because of edentulous area.clinically patient was having a small ulceroproliferative growth in the same region.incisonal biopsy suggested moderately differentiated epithelial squamous cell carcinoma.patient was refered to higher centers for mangment of malignancy.
opg of same patient after 6 month showing displaced pathological fracture at angle of mandible.showing progressive nature of malignant process.opg was taken at aiims.
final opg u can see the severe destruction of cortex in form of diffuce radiolucency with ill defined borders.tooth also showing floating tooth appearance.patient again reported for biopsy slide for revaluation before the treatment.mri was also adviced for this patient .

patient with habit only ..without any active complaint

30 year old shopkeeper with betel nut habit-u can see prelukoplakia..without any erosion or atrophy of epithelium..no burning..no signs of early osmf.just some periodontal problem.but you need to continously follow uo these kind of patients with adequate counselling for cessation of habits..as we dont understand the excat etiology of oral cancer ..multifactorial nature..risk increases with habits,genetic predisposition..role of viruses..so as universelly precaution we shud treat and manage -counsel every patient of habit as a patient of risk of developing malignancy.

typical smoking induced changes on tongue and buccal mucosa
lady with soft sessile growth at buccal mucosa-fibroepithelial polyo or irritaional fibroma
apthous ulcers on lower labial mucosa-necrotic halo surrounded by erythematous areas

difficult case of burning in a old lady

this was a very intresting and difficult case.we completely missed the diagnosis..
this lady came with the complaint of continous burning from edentulous upper alveolar arches since 2 months.she was weak,bidi smoker,poor ,70 year old.widow..ex lady sweeper .and not in very gud mental state to coperate us. on examination unhelaed socket were there.pain was not neutralgia like ..but it was present wen we touch the sockets...her muscles of mastications were also mildly tender.so we also think of probability of mpds secondery to ineffisency of chewing the food due to long edentulos span.
we started with topical analgesics,muscle relaxants,gum paints,cessation of habit,and topical antifungals.radiographs were taken to rule out any remaining root piece or sharp bony cusp..but no abnormality detected in radiographs

she came after 15 days with healed sockets with same problem of pain..we were not thinking of neuralgia bcoz although triggers were there but pain was not so severe and was continous..and second reason was we were thinking by keeping her age and overall status in mind that she was little bit overapprehensive..

here we miss the diagnosis..we shud note every sign adequately..we refered the patient for alveloplasty for sharpening of bone in the pain area although clinically we were not able to detectit it.

after sum days i realized she might be a patient of burning mouth syndrome..bcoz this was my first case so i completely missed it..i had no clue at that time.

soft tissue changes in disease

25 year old boy with history of right hemiparalysis
and on antiepileptic medicines since 15 years having inflammatery and drug induced gingival hyperplasia with tobacco pouch keratosis in lower vestibule -showing typical staining of teeth due to chronic tobacco use with gingivval recession.


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geographic tongue with indentations on lateral
surface possibly due to tongue thrusting habit also
seen in stressed and depressed patients.

sunken soft palate in osmf 45 year old female with herpetic labialis
and bald tongue secondery to anemia

small discussion on patient counselling for quitting of habit

Report · 6:23pm

sir nicotine ya gutka chudane ka koi substitute bataiye............

Report · 6:24pm

a gud
counselling

first of all u must see the cause of habit

then u must see will of patient

if the patient is willing then half work is done

Report · 6:26pm

cause of habbit means................

Report · 6:26pm

so for a gud counselling u need to know about ur patient

what is his occupation

why he is using it

is he aware of the harmful effects of the habits

and since how long he is using it

then after understanding it from the patient s prospective

u just propse ur suggestion

then it is important

u must tell him why u are telling him to quit the habit

another important part is u must do a oral checkup

bcoz patiuents are of two types

1 with active complaint

and second with only asymptomatic lesions

so better u reach upto the depth

more will be the chances of ur win

if the patient is having lesion and also having complaint

then u can start ur counselling with explaining the problem

then by considering everything in ur mind like socioeconomic status of patient,education level of patient

u just order himj to quit it

u can show him statuary warning printed on gutka packs

or cigrette packets

ithen there is one class of patient

who are not willing for quitting of habit

they are the most difficult one

now in these patients u need to ask for social persomel and family history

bcoz sumtimes they are just taking all this stuff becoz they dont want to live,are depressed or nt happy.

Report · 6:33pm

i hv. one pt. he is a butcher.......he is 25/m he said me he wants to quit the habbit he asked me for any medicine to quit gutka......

Report · 6:34pm

see there is no better medication than will power to quit this

uy need to properly counsell him

but before doing that u need to understand the concept completely

all mediction will provide temprory relief

and medicine is a drug so it must be having some pharmacological values and in the long run it would be having harmful effect

and it is dangerous to provide these medication to those kind of patient who are ignorent

there is a greter chanc eof drug abuse

so this time u are making him an addict

so my friend there is no shortcut to sucess

u hav to understand the need of the patient

than counsell him

thats wat we learn in our branch

see i mtelling u very imp lesson

wat mistake we normally do we are treating our patients like a mchine

like servicing of a bike

that is not true

u hav to deal with him by making hi m partner in the treatment

it will create an understanding,trust

and would lead to ultimate healing

so u just understand need of the patient than counsell him and explainn him the importance of quitting of habit

then see the magic

.taht s all

positive thing in ur patient is he is willing for quitting

Report · 6:41pm

i hv to learn councelling from u sir...bcos i hv. not councelled any pt. bfore..........

Report · 6:41pm

anytime dear

u can get all these point note down

these are the basics of a gud counselling

and learned by working hard in clinical encviroment

so u will get the maximum benefit if u will be able to follow them

Report · 6:43pm

thank u sir for explaining me....n i thing it is not an easy job.....

a good councelling really needs hard work ......i hv. seen u ........

i will try to learn it frm u..........

Report · 6:46pm

yarin this we hav to completely understand the pshycology of the patient

its like making a dish by knowing what the custumer want

everyone has different expectations,different taste

u cant give everyone the same thing

although ingredient would be same

but technique would be different

or u can compare it with cricket one ball and one bat

but there are plenty of shots

plenty of styles so

thats the fun in doing that

and believe me it gives u agreat feeling wen u are suceesful in counselling of a ptient

but u shuld also avoid overcounselling