07/24/09 Palatal Erythema in Patients Using Listerine Cool Mint PocketPaks

Resident: Jason Hencler Date: 07/24/09
Article title: Palatal Erythema in Patients Using Listerine Cool Mint PocketPaks Oral Care Strips: Case Reports
Author(s): Chris L. Pham, DDS; A. Jeffrey Wood,DDS; Michael B. Lambert, DMD; William Carpenter, DDS, MS
Journal: Journal of Dentistry for Children
Volume #72; Number 2; Page #52-55
Year: 2005
Major topic: Palatal Erythema
Minor topic(s):
Type of Article: Case Report
Main Purpose: Present 2 cases of similar erythematous lesions in patients using Listerine Cool Mint PocketPaks Oral Care Strips
Overview of method of research: Review of 2 similar cases including diagnosis, treatment, and outcome.
Findings: Case 1: 44yo Caucasian female presents with asymptomatic rectangular lesion on mid-hard palate. Patient was unaware of lesion. Upon questioning patient revealed frequent use of strips. When patient discontinued strips, erythematous lesion was not present at next evaluation. Patient was asked to resume use of strips and at the next appointment the lesion had returned. An exfoliative cytology specimen was obtained to rule out suspicion of Candida albicans. Periodic acid-schiff test was negative for C. albicans. Case 2: 7 yo Hispanic female with no significant med history, no systemic diseases, and age appropriate dental development. Patient had no unusual habits. A very symmetrical square shaped lesion was located on the mid palate. The anterior border was feathered with subtle gradation toward the anterior 1/3 of the palate. Lesion was almost identical to case 1. After discontinuation of cool strips the lesion disappeared.
Key points in the article discussion: Possible differential diagnosis for erythematous lesions of th epalate include: 1) Chemical or Physical allergy/irritation 2) yeast infection (C. albicans) 3) sexual abuse 4) foreign object trauma. With evidence gathered from removing and reapplying Listerine cool strips, there is support for these strips to be the causative agent. These oral aids adhere to the palate after applications, so prolonged exposure to these strips and the various chemical compositions they contain, was a likely suspect. The lesion’s feathered anterior border is consistent with use of this agent due to the swallowing reflex. It is unlikely that this is a case of allergy contact dermatitis. Past studies indicate menthol, thymol, and propylene glycol as possible causative agents. Shape of the lesions found in this study indicate that Listerine cool strips. Type III hypersensitivity is implied which may take 48hrs to develop.
Summary of conclusions: Patients presenting with asymptomatic, square shaped, erythematous macular lesions on the mid-hard palatal gingival who report use of Listerine strips, a differential diagnosis of sensitivity to this oral aid should be considered. These cases presented here provide clinicians with one more differential diagnosis to consider.
Assessment of article: Article presented some good points but not particularly groundbreaking. I thought after patients revealed using strips, characteristics of lesion, especially shape, made the diagnosis quite obvious.