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John Stevens, 40, arrives in your office for the first time in several years after being out of the country on military duty. He says he doesn't think he was diligent in his home care while he was gone. He tells you that he is most concerned about the rough, "sandpaper-like" areas on his inside cheek and lower inner lip. They won't heal and have been this way for some time.
As you review the health history, you learn John takes several medications. For the past few years he has been prescribed omeprazole 20 mg for an active duodenal ulcer, and also takes loratadine most of the year for his allergies. John has no other significant health history findings. He exercises but says he eats a lot of processed and fast foods because of his schedule. He's now an engineer in a fastpaced company with a demanding schedule.
After completing an extraoral exam, you inspect the lip tissues and buccal mucosa. The tissue in these areas appear thickened, keratinized and somewhat striated (see Figures 1-2). John has extreme tissue damage along the occlusal plane and lip area next to the wet line tissues (see Figure 3). You also notice some tooth wear that could be due to bruxism.
Diagnosis: Morsicatio buccarum and morsicatio labiorum. Morsus in Latin means bite. Morsicatio buccarum is biting or chewing of the buccal mucosa, morsicatio labiorum is chewing the lip tissue, and morsicatio linguarum is chewing the borders of the tongue. The habit may involve chewing, biting, or chronic pressure of the tissues.
Etiology: Chronic trauma to the tissue causes a defense mechanism to occur in the body. The tissue responds to friction by producing keratin and becoming thickened in what is termed hyperkeratosis. Depending on the degree of trauma, the tissue may also become ulcerative and eroded in areas.
Epidemiology: Evidence of trauma may be present at select times and with varying degrees. The dental practitioner may notice hyperkeratosis during some exams and may not observe the characteristics at other times. Some patients may be chronic...