A 35-year-old female presented to Apple Dental Clinic for a
routine checkup. She referred with complications such as burning
and redness of the tongue, pain and inflammation on the lips and
buccal mucosa. Examination revealed redness and a few ulcers on
her tongue and the right buccal mucosa area. She also had tingling
and burning sensation on her lips and buccal mucosa (Figures 1-3).
When questioned about the area, the patient claimed the ulcer
had been present for at least one month, maybe longer. Pain or
discomfort was noted on tongue, lips and buccal mucosa by the
patient. No history of trauma to the area was noted.Patient had a
previous history of regular and routine dental care. She denied a
history of smoking, but she had a history of drinking from time to
time. At the time of the dental appointment, the patient was not
taking medications of any kind. No significant problems were noted
during the health history.
The patient`s vital signs were all found to be within normal
limits. No other abnormal extra oral findings were noted. Oral
examination revealed a few ulcerative lesions on the tongue and
buccal mucosa, measuring more than 1 cm in diameter (see photos).
The lips were red and swollen, especially on the lower one.
a) Lichen planus.
b) Traumatic ulcer.
c) Recurrent herpes labialis.
d) Burning mouth syndrome.
e) Squamous cell carcinoma
If the lesion is suspected to represent SCC, the patient must
be promptly referred to an oral surgeon for biopsy. A biopsy and
histological examination is necessary to establish a definitive
diagnosis of SCC.Diagnosis of the BMS is mainly based on the history
of the patient and clinical features.After performing the necessary
clinical examinations and ruling out the differential diagnosis, all
the etiology factors were considered. In addition, pathobiological
tests were carried out which, fortunately, were adequately and
thoroughly investigated, led to the source of the agent, and the main
cause of this complication was the daily use of kiwis. One month earlier, the patient was accustomed to adding a few kiwis daily to
Clinical treatment is usually complex and there is no uniform
management protocol. In each case, all symptom components
must be addressed.In the presence of allergic reactions, the simple
removal of the suspected allergen might cause the complete
remission of the symptoms of BMS. After identifying the cause of
this complication, the patient was urged to cut off the use of this
fruit.In this case, eliminating the allergic reactions by not having
Kiwi in daily dietary, has promoted the patient condition.
A standard management protocol is still lacking to treat BMS
patients, and both the physiological and psychological aspects must
be kept in mind. Our colleagues should consider that the etiology of
the syndrome is very important so that should be able to manage
the patient effectively.Dental practitioner should keep in mind that
complete spontaneous remission is rare.
After a month, the patient referred to the clinic for a subsequent
examination and check-up. Fortunately, after discontinuation of
daily intake the fruit, the complications were completely eliminated.
Mohammad Karimi, DMD, BS is the technical manager of Apple
Dental Clinic, Sections of Pediatric Dentistry and Esthetic Dentistry