Case 34 - A sore mouth

A 55 year old complete denture wearer develops a progressively sore mouth with bilateral red, white, and ulcerated patches. Is this denture trauma, an acrylic allergy, or an underlying mucosal disorder? In this episode, we deconstruct Case 34: A Sore Mouth from Odell’s Clinical Problem Solving in Dentistry to optimize your oral medicine and pathology readiness for the ADC OSCE examination. We explore the clinical history and cognitive architecture needed to evaluate bilateral buccal mucosal lesions featuring reticular white striae, erythematous areas, and painful ulcerations in a patient with Type 2 diabetes taking concurrent systemic medications. Listeners will learn step-by-step clinical reasoning to navigate the differential diagnosis—differentiating Oral Lichen Planus (OLP) from Oral Lichenoid Drug Reactions (OLDR), contact lichenoid reactions, chronic hyperplastic candidosis, and mucosal dysplasia. We explain why bilateral symmetry strongly favors an inflammatory or drug-induced condition rather than localized mechanical trauma from new dentures, and why OLP and OLDR are often clinically indistinguishable without a thorough medication review and histopathological evaluation.Furthermore, we outline essential diagnostic protocols, including representative incisional biopsy, direct immunofluorescence, fungal swabs, and liaison with the patient's general practitioner. We highlight critical cancer red flags (induration, fixation, unilateral changes) and high-yield ADC exam tips to prevent common errors, such as misdiagnosing lichenoid lesions as simple denture sore spots or prescribing treatment without considering secondary candidosis. This content is for educational purposes only and does not constitute clinical advice. “If this case supports your learning, like the video, subscribe on YouTube, follow us on Spotify, and share it with the global dental community.” Keywords: #ADCExam #OSCE #OralMedicine #OralLichenPlanus #LichenoidReaction #OralPathology #OdellsDentistry #DentalStudents #AustralianDentalCouncil#metformin #lichenoid