By: Victor M. Sternberg, D.M.D. 

February 16, 2024 

More than 13 years ago a patient presented with a white lesion in the lower right buccal gingiva. 

A biopsy indicated mild dysplasia. 

Over the next 10+ years this lesion was removed and biopsied at least a dozen times. 

It kept returning, ranging from moderate to mild dysplasia. 

There were no other factors other than the patient’s age, mid-70’s. She was not a smoker and it only occurred in the lower right quadrant, particularly on the two molars. 

It turns out there is a syndrome of this recurrent dysplasia that is seen primarily on the facial aspect of lower molars in middle-aged women particularly. 

The pathologists that I consulted with have seen this at an increasing rate over the last number of years with no explanation. 

Despite repeated biopsies and total excisional removals, the lesion kept returning. 

I sought a consultation with a head and neck surgeon who wanted to remove the first molar and remove a block of bone. 

The patient protested and did not want to go that route. 

Subsequently, for one biopsy all the tissue was removed, including the periosteum down to bone on the buccal lingual aspects. After appropriate healing, the lesion recurred again.

Sometimes it recurred within weeks, as seen in some of these photographs. 

Eventually the lower first molar, which had been biopsied numerous times, became mobile and was removed. The biopsy of the tissue around it came back again a mild to moderate dysplasia. 

The oral pathologist was concerned that cases such as this have eventually morphed into severe dysplasia or frank carcinoma. 

Interesting enough, after the tooth was removed, the lesion occurred again on the ridge where the tooth had been. 

We had postulated that possibly the source of the cells was in the crevicular epithelium or connected tissue surrounding the tooth. Obviously after the tooth was removed that was not the case because the lesion recurred. 

Finally at the end of 2023 the lesion on the ridge was removed. 

Lo and behold, for the first time in 10 years she has not had a recurrence several months out now. 

This very unusual type of pathology which this author has never seen, has, in the words of the oral pathologists “become an increasing issue for perplexing dental diagnosis and treatment”. 

Fortunately, we had a patient who was extremely compliant and trusting and was willing to go the long journey from 2013 until now. 

Again, your comments are appreciated. 

Yours truly, 

Dr. Victor M. Sternberg 

/mp

By Westchester Center for Periodontal & Implant Excellence

December 22, 2023