Oral lesions

image captured with TelScope Telehealth System

Oral lesion

image captured with TelScope Telehealth System


A 12-year-old male complains of pain for three days. His mother is concerned that he has an “infection in his gums.” A clinical exam performed in the dental office was documented using a TelScope. The first image reveals two oral lesions above the teeth and gum tissue in the upper right quadrant, located in what is called unattached mucosa. The appearance of a white center surrounded by a red halo is similar to an aphthous ulcer (canker sore), but the shape of the larger lesion is not typical of a mouth ulcer, which is usually more ovoid.

Careful extra-oral examination reveals an area of contusion (bruising) of the upper lip near the sores. Directly behind this discolored area is the irregular, linear oral lesion measuring approximately 7.5mm. A smaller lesion is located more distal.

Questioning the patient provided the answers to the mystery. Three to four days earlier, the patient was chewing on a small straw and he was bumped in the mouth by another child.


The lesions in question are “traumatic ulcerations” caused by the edge of an object (in this case a straw) scraping the soft tissue. Traumatic ulcerations can also occur elsewhere in the mouth from accidentally biting your lip or cheek, or from a toothbrush abrasion or other foreign object.
The typical appearance is a whitish-yellow central area surrounded by an inflammatory red (erythematous) halo, often on a rolled border. They are painful, and “sting” when exposed to high acid products such as ketchup, tomato based sauces, and citrous products. They typically heal in 10-14 days. Ibuprofen can help with pain if needed, and an over the counter oral paste can be used to cover the ulceration to improve comfort if desired. Your dentist can also prescribe an oral paste with a topical steroid.


This case is an excellent example of how TelScope could be utilized to pre-screen or triage a problem without having to initially make the physical trip to the dental office. If a parent, caregiver, school or a medical office (if the patient was taken there) had a TelScope, similar images could be taken and shared with the family dentist, or uploaded for an immediate consult with an on call dentist with The Teledentists. A diagnosis and recommended treatment could then be rendered, as well as any recommendations for follow up – all for lower costs, more convenience, and providing peace of mind for the patient and parent.
Dr. Richard will be LIVE on Facebook this Tuesday, February 23 at 9 p.m. EST to discuss teledentistry and perform a live teledentistry demonstration using TelScope Telehealth System with inventor Jennifer Holland. RSVP here.

About the Author: Dr. Richard Simpson, DMD

Dr. Richard is a board certified pediatric dentist in private practice.
His achievements include:
• Diplomate in the American Board of Pediatric Dentistry
• Fellow in the American College of Dentists
• Fellow in the International College of Dentists
• Fellow in the American Academy of Pediatric Dentistry
• Advisory Board Member of The TeleDentists
• Advisory Board Member of Holland Healthcare
Dr. Richard’s experience and active interests include telehealth, child advocacy, health disparities, policy, and advancing improved medical-dental access to care. Dr. Richard is also a veteran with 15 years of military service.

This content is for information only. This content is not for advice, diagnosis, or
guarantee of outcome for patients. No patients should use the information,
resources, or tools contained within to self-diagnose or self-treat any health-related

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