Case #8
A 24-year-old male visited a general dentist for a checkup. Oral examination revealed multiple red spots on the soft palate.
Joen Iannucci Haring, DDS, MS
History
The patient was questioned about the lesions on the soft palate. The patient claimed that he was unaware of the affected area and was uncertain of how long the lesions had been present. He denied any recent trauma or thermal injury to the area. He also denied any pain, burning, or sensitivity associated with the soft palate area. When questioned about tobacco use, the patient stated that he smokes one to two packs of cigarettes per week.
When questioned about his last medical visit, the patient stated that he last saw a physician several days earlier for bronchitis. The patient denied any history of serious illness. A review of the medical history revealed no significant findings. At the time of the dental appointment, the patient was taking an antibiotic for bronchitis and using a prescription cough syrup.
Examination
The patient`s blood pressure, pulse rate, and temperature were all found to be within normal limits. No enlarged lymph nodes in the head and neck region were detected upon palpation. Physical examination of the head and neck region revealed no unusual findings. Intraoral examination revealed multiple, flat, pinpoint-sized red spots on the soft palate (see photo). Further examination revealed no other lesions present.
Clinical diagnosis
Based on the clinical information presented, which of the following is the most likely clinical diagnosis?
* herpangina
* petechiae
* ecchymosis
* nicotine stomatitis
* hematoma
Diagnosis
petechiae
Discussion
Petechiae are submucosal hemorrhages characterized by the pooling of extravasated blood in soft tissue. The term extravasated refers to the fact that the blood has been forced out of the blood vessel into surrounding tissues. Because the blood is no longer in the blood vessel, these lesions do not blanch with pressure.
The causative factor for submucosal hemorrhage may be iatrogenic, factitial, or accidental trauma to the vascular tissues contained within the submucosa. Submucosal hemorrhage initially appears bright red and then tends to fade over time, becoming purple-blue and then brown-yellow.
There are different terms that are used depending on the size of the submucosal hemorrhage. The term petechiae refers to flat, pinpoint-size red hemorrhages. These non-blanching hemorrhages may occur on the skin or oral mucosa. The soft palate is the most common intraoral location for petechiae. Palatal petechiae may be seen in assocation with diseases such as infectious mononucleosis, measles, scarlet fever, leukemia, thrombocytopenia, and disseminated intravascular coagulation (DIC).
Palatal petechiae may also represent rupture of capillaries caused by repeated coughing, sneezing, or vomiting. In addition, palatal petechia may be caused by suction. For example, if an individual with seasonal allergies and an "itchy throat" clicks the palate against the tongue, petechiae are formed as a result of the suction.
The term purpura refers to submucosal hemorrhage that is slightly larger than the pinpoint-size petechiae. These non-blanching hemorrhages are flat and are most often caused by trauma.
Joen Iannucci Haring, DDS, MS, is an associate professor of clinical dentistry, Section of Primary Care, The Ohio State University College of Dentistry.
