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White Tongue Lesions: Candida, Contact Stomatitis, Oral Lichen Planus?

White Tongue Lesions: Candida, Contact Stomatitis, Oral Lichen Planus?

An otherwise perfectly healthy 35-year-old man presents with a 3-month history of white lesions that covered the dorsolateral aspect of his tongue. The patient would brush his tongue and rinse with mouthwash, which removed most of the white material, but the lesions would recur within a few days. 

There was no oral pain, except for some irritation of the tongue if it was brushed too vigorously. The patient denied habitual tongue-biting habits and skin lesions. He was not currently a smoker, and had not smoked for several years. He frequently chewed cinnamon-flavored gum.

No extra-oral lesions were detected, and there was no lymphadenopathy.

Thick whitish plaques were noted on the right and left dorsolateral aspects of the tongue, as show in Figure 1, above. Some of these plaques could be rubbed or pulled off of the tongue; detachment was not associated with red or bleeding surface. There was minimal erythema of the anterior dorsal aspect of the tongue where there were no white plaques. The tongue was not tender and was not indurated with palpation. The teeth and restorations were not sharp, nor did they impinge on the tissue of the tongue. No other significant oral changes were noted.

Which of the following key differential diagnostic contenders do you suspect was the cause of these lesions?

A. Contact stomatitis from cinnamon flavoring in gum
B. Chronic hyperplastic candidiasis
C. Morsicatio linguarum (habitual chewing of the tongue)
D. Oral lichen planus

Answer and Discussion on next page...

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