International Journal of Dental Sciences and Research, 2014, Vol. 2, No. 1, 9-11 Available online at http://pubs.sciepub.com/ijdsr/2/1/3 © Science and Education Publishing DOI:10.12691/ijdsr-2-1-3 Management of Unhealing Ulcers on Bilateral Borders of the Tongue Asaad Javaid Mirza 1,* , Musa Khalil Alfadaleh 1 , Maaz Asad 2 1 Department of Restorative Dental Sciences, College of Dentistry, Almajmmah University, Alzulfi, Saudi Arabia 2 Department of Restorative Dentistry, university of Malaya, Kuala Lumpur, Malaysia *Corresponding author: asaadjmirza@gmail.com Received December 25, 2013; Revised January 03, 2014; Accepted January 16, 2014 Abstract Presence of long standing unhealing ulcer in an oral cavity, not only makes eating and chewing difficult but puts the patient under tremendous mental stress leading to cancer phobia. This case report describes management of unusual occurrence of bilateral unhealing ulcers on the tongue of a young lady. The ulcers developed after insertion of fixed partial dentures four year ago. Despite visiting many physicians, dentists and an ENT specialist, she didn’t find the relief. Due to long illness, she has become very irritable, anxious and uncooperative. It was therefore, necessary to treat her in a logical order that her confidence in us is not lost. First of all, to reduce her anxiety, she was put on 0.25 mg Alprazolam tablets which also helped her in sleeping at night. Repair or replacement of her previously deteriorated intracoronal restorations was performed next. Finding no relief with this, a bridge present on right side was removed first. It reduced redness in the ulcer on right side of tongue. The other bridges present on left side were also removed. The ulcers had become less painful and stopped progressing but not found healing. Biopsy of the lesion was done which reported as “Pseudoepithliomatous Hyperplasia”. An oral surgeon was requested to excise the lesion. After excision, both the ulcers healed within two weeks. Keywords: oral Metal allergy, oral Pseudoepitheliomatous hyperplasia, ni cr alloy allergy Cite This Article: Asaad Javaid Mirza, Musa Khalil Alfadaleh, and Maaz Asad, “Management of Unhealing Ulcers on Bilateral Borders of the Tongue.” International Journal of Dental Sciences and Research 2, no. 1 (2014): 9-11. doi: 10.12691/ijdsr-2-1-3. 1. Introduction A 32-year old lady was referred to us with complaint of inability to eat normal diet due to burning mouth. The cause of mouth burning was non- healing ulcers present on lateral border of her tongue for last four years. There was nothing significant in her medical history. Family history revealed that she was unmarried living with her brother as parents had expired. She was under intense mental stress due to traditional cold-war with brother’s wife and for not having her own source of income. Owing to anxiety and mental stress, she used to clench (Bruxism) her teeth during sleep and while working. She was in the habit of sucking borders of her tongue to get relief from burning. History of present illness showed that she had two ulcers, one on each side of her tongue. The lesions started as a small abrasion after having her teeth restored with several intracoronal and extracoronal restorations four years ago. The attending dentist prescribed her some gel for local application when the abrasion was brought to his notice. The lesion remained unhealed and enlarged in size with more redness in its base and pain. She then visited many general practicing dentists but did not get relief. Her family physician referred her to an ENT specialist who took a biopsy of the lesions. The histopathologist reported that they were hyperplastic chronically inflamed ulcers with presence of fungus thread. The doctor prescribed some antifungal medicines but of no avail. Figure 1. Unhealed ulcer on right lateral border of tongue On intraoral examination, an ulcer measuring 10x8 mm with red base and white margins was found on the right lateral border of her tongue (Figure 1). A similar lesion was present on the left lower border with much smaller dimension (Figure 2). Caries history was very significant leading to many restored teeth with amalgam and composite. Some of the restorations appeared deteriorated