The following is the initial report sent to this emergency patient:

Monday, June 17, 2013.

This  patient called this office yesterday with a chief complaint of swollen gums. He was prescribed an antibiotic (amoxicillin, 500 mg. # 20 tabs ) and was given an appointment for Monday morning.

Patient presents with  generalized oral pain. Clinical exam shows multiple white lesions extending from the tongue to the left side buccal mucosa and into the oralpharynx.

The periodontal tissues appear normal ( though there is inflammation surrounding an upper left wisdom tooth. This tooth should be extracted in the near future ).

Cervical lymph nodes appear normal  and not sensitive to touch. It appears that this is a viral infection.

Dr. Jose L. Vazquez ( Internal Medicine physician ) who has an office next door came over to examine this patient. Dr. Vazquez also thought that this was a viral infection and recommended that this patient be prescribed the following rinse: Lidocaine ( viscous ) / Maalox / Benadryl compound at 1 to 1 to 1 ratio ( rinse three times a day ). This rinse was prescribed  and the patient was also given  a supply of narcotic analgesics ( Vicodin ES, # 12 tabs, to be taken only if necessary for severe pain ).

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Discussion.

As dentists we are trained to evaluate oral pathology. We do this with visual examination most times, however, in order to truly identify and perform an accurate diagnosis a biopsy and histological evaluation is necessary. In this case, since a physician’s office was next door having a  second opinion from someone more familiar with these types of lesions seemed like a more practical solution. His diagnosis and treatment  recomendation made sense.

Most times these viral lesions are self limiting and resolve within 10 to 12 days.