Persistent Oral Tenderness

Additional Clinical History

Review of the patient’s medical history reveals he had been diagnosed with Crohn’s disease 16 years previously. Two weeks ago he completed a course of prednisone prescribed to manage an exacerbation of Crohn’s disease. His current medications are dicyclomine hydrochloride, an anticholinergic agent, and mesalamine, an antiinflammatory agent, both for the management of this gastrointestinal disease. He also takes calcium and folic acid supplements.

Review of the patient’s dental history reveals he has worn a maxillary complete denture and a mandibular complete overdenture for 3 years. He has complained frequently of localized areas of soreness; however, in the past these have been relieved by minor denture adjustments.

Clinical Findings

Head and neck examination reveals no visible extraoral abnormalities and no palpable lymphadenopathy. Intraoral examination reveals moderate to severe erythema of the palatal and alveolar mucosa. (Figures 1, 2, and 3) The dorsal tongue exhibits moderate erythema with atrophy of the filiform papillae. (Figure 4) The intraoral soft tissues appear dry and manipulation of the major salivary glands reveals minimal salivary flow.

image showing erythamatous palatal mucosa
Figure 1. Erythematous palatal mucosa
Erythematous maxillary alveolar
Figure 2. Erythematous maxillary alveolar mucosa
bitewing xray showing slight bone loss
Figure 3. Erythematous mandibluar alveolar mucosa
Erythematous mandibluar alveolar mucosa
Figure 4. Erythema and atrophy of fillform papillae of the dorsal tongue


A cytologic preparation stained with periodic acid-Schiff stain reveals numerous fungal hyphae and occasional ovoid yeast forms. (Figure 5)

image showing photomicrograph of tissue
Figure 5.

Laboratory Studies

The patient reports he has recently undergone a complete physical examination including blood studies.

Table 1. Blood Studies
Test Results Normal Range
Hemoglobin 15 g/dL 14-18 g/dL
Hematocrit 43% 40-52%
Red blood cell count 5.1 x 1012/L 4.5-6.2 x 1012/L
Mean cell volume 84 fL 80-94 fL
Mean cell hemoglobin 30 pg 27-32 pg
Mean cell hemoglobin concentration 33 g/dL 32-36 g/dL
White blood cell count 6.2 x 109/L 5-10 x 109/L
Neutrophils 55% 40-60%
Lymphocytes 37% 20-40%
Eosinophils 2% 1-3%
Basophils 0% 0-1%
Monocytes 6% 4-8%
Platelet count 0.28 x 1012/L 0.15-0.4 x 1012/L
Vitamin B12 390 pg/mL >200 pg/mL
Folic acid 18 pg/mL 2-20 ng/mL
Fasting blood glucose 88 mg/dL 65-110 mg/dL
Iron 94 mg/dL 50-175 mg/dL
Iron binding capacity 334 mg/dL 250-410 mg/dL