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Edward Stevens, 37 years old, has arrived at your office after being out of the country for several years while on military duty. He is most concerned about the rough "sandpaper-like" areas on the inside cheek and also on his lower inner lip. He says that they do not appear to heal and have been this way for some time. At times, he has sensitivity to spicy foods and notices that food temperature causes moderate discomfort.
As you review the health history, Edward is taking several medications. For the past few years, he has been prescribed omeprazole (20 mg.) for GERD, and also takes medication for seasonal allergies. He is a nonsmoker and occasionally drinks alcoholic beverages.
Edward has no other significant health history findings. He exerCises but reports that he eatS a lot of processed foods and also fast foods because of his schedule. Edward is concerned that the white, raised patches on his inside cheek area are malignant.
After completing your extraoral exam, you begin to inspect the lip tissues and the buccal mucosa. The tissues in the buccal mucosa areas appear thickened, keratinized, and somewhat striated (see Figure 1). Edward has extreme tissue damage along the occlusal plane and also in the lip area next to the wet line tissues. 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 area (see Figure 2) and morsicatio linguarum is chewing on the borders of the tongue (see Figure 3). The habit may be chewing, biting, or chronic pressure of the tissues. Thicker areas of keratosis may be observed as noted in Figure 3 when the patient continually causes an assault on the oral 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 upon the degree of trauma, the tissue may also become ulcerative and eroded in areas. Tissue in the wet areas of the body become whiter in color, just as the skin does when kept in water too long.