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CORRESPONDENCE |
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| Year : 2022 | Volume
: 67
| Issue : 6 | Page : 756-759 |
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| White oral lesions of morsicatio linguarum |
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Preeti C Arora1, Aman Arora2, Saurabh Arora3
1 Department of Oral Medicine, Diagnosis and Radiology, SGRD Institute of Dental Sciences and Research, Amritsar, Punjab, India
2 Department of Prosthodontics, SGRD Institute of Dental Sciences and Research, Amritsar, Punjab, India
3 Department of Pathology, GMC Amritsar, Punjab, India
| Date of Web Publication | 23-Feb-2023 |
Correspondence Address:
Preeti C Arora
Department of Oral Medicine, Diagnosis and Radiology, SGRD Institute of Dental Sciences and Research, Amritsar, Punjab
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.ijd_483_21
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How to cite this article:
Arora PC, Arora A, Arora S. White oral lesions of morsicatio linguarum. Indian J Dermatol 2022;67:756-9 |
Sir,
We present two rare cases of bilateral white lesions of morsicatio linguarum on the lateral borders of tongue.
 Case 1 | |  |
A 24-year-old male patient reported with the history of dental pain. While examining the patient, white linear areas were observed on the lateral borders of tongue bilaterally [Figure 1]a and [Figure 1]b. The white lesions were slightly raised, nonscrapable, nontender and not associated with burning. Medical and dental history was noncontributory. The patient was unaware of the white lesions on his tongue and did not give history of any chemical application. The lesions were not present on any other site intraorally or on the skin. There was no history of similar lesions in other family members. Leukoplakia, oral lichen planus, oral candidiasis, chemical burn and white sponge nevus were considered as the differential diagnosis. The site and the clinical presentation also favored the diagnosis of oral hairy leukoplakia. The patient refused any form of tobacco use. Routine blood investigations were within normal limits and viral markers for HIV were negative. Because most of the oral white lesions were ruled out, white lesions associated with chronic tongue biting were considered. He was enquired about any cheek or tongue chewing habits. The patient was unaware of any such habits and did not give history of anxiety disorders or stress. The patient and his family members were counseled and asked to keep a note of any such involuntary habits and biopsy of the lesion was advised. | Figure 1: (a and b) Bilateral white lesions on tongue in patient 1. (c and d) Regresssion of morsicatio linguarum lesions in 6 weeks
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Incisional biopsy of the lesion was performed from the right lateral border of tongue. The histopathological examination of the lesion revealed mild acanthosis, hyperkeratosis, and orthokeratosis with mild inflammatory cell infiltration, without any evidence of epithelial dysplasia [Figure 2]. PAS stain was negative for candida infection. All the other lesions were ruled out by history, investigations and histopathological examination and a final diagnosis of morsicatio linguarum (ML) was confirmed after clinicopathological correlation. The patient was counseled and made aware of the habit and was advised to discontinue it. The patient was recalled after 15 days and he agreed to the habit of chewing the tongue unconsciously. After 3 weeks follow-up, the white lesions had regressed with discontinuation of habit. The patient was advised for follow-up every month and the lesions had regressed completely without any pharmacological intervention [Figure 1]c and [Figure 1]d. | Figure 2: Acanthosis and hyperkeratosis in H and E section 100× (400 × inset)
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| Case 2 | | |
A 48-year-old female patient reported with the complaint of slight burning and rough surface on the sides of her tongue. On clinical examination, there was presence of bilateral nonscrapable white lesions [Figure 3]a and [Figure 3]b. The lesions were rough and nontender on palpation and measured 2 × 0.7 cm on right side and 1 × 0.7 cm in size, on left side. There was no history of tobacco use or application of any chemical agent. Her medical, dental, and family history was not significant. The patient was not aware of any tongue chewing habits, but gave history of mild stress. After ruling out other lesions based on clinical history and investigations, a provisional diagnosis of ML was given. The patient was counseled and was asked to keep a check on any tongue chewing habit. The patient was recalled after 3 weeks and she realized a tendency to bite her tongue unconsciously. She was advised to discontinue the habit and during the second recall visit, her lesions had slightly improved. In subsequent visits, she gave history that she was unable to control the habit. She was advised antianxeity agents, to which she refused. A habit breaking appliance was then fabricated for her in the form of night guard and she was asked to wear it during the day to control the involuntary habit. In further recall visits, her lesions had almost disappeared and she responded well to this treatment [Figure 3]c and [Figure 3]d. | Figure 3: (a and b) White raised areas on lateral borders of tongue bilaterally, which slightly improved with counseling. (c and d) Further improvement achieved with occlusal splints after 2 months
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White lesions on the tongue are an alarming sign for the clinician, as they may be potentially premalignant. In rare circumstances, they may be caused by chronic biting of the oral mucosa and are termed as morsicatio mucosae oris. The word morsicatio is derived from the word “morsus,” which means “bite” in Latin. Morsicatio is a condition caused by repeated sucking, nibbling, or chewing.[1],[2]
Habitual chewing of the lips is referred to as morsicatio labiorum, buccal mucosa as morsicatio buccarum, and tongue as morsicatio linguarum (ML).[1] It appears as a frayed/macerated appearance of the oral mucosa presenting as shaggy white areas with poorly defined borders, which may often show ulceration and or erythema.[1] ML typically appears as a thick white plaque on the lateral borders of the tongue. Patients may sometimes complain of rough surface on the cheeks or they may notice white loose areas shredding off from their tongue and most often consult a dentist or a dermatologist.
It is said to be common in individuals who are tense or anxious and patients experience release of stress by doing such behavior.[3] The occurrence of ML is twice as prevalent in females and three times more common after the age of 35 years.[1] Pereira et al.[4] have reported a case of ML in a 7-year-old female patient.
Patients with ML are most often noticed on a routine examination and are usually misdiagnosed as leuoplakia. It is a challenge to identify the cause of white lesions on the tongue caused by ML than to treat it. Most patients with this condition are not aware of their habits and do not associate these lesions with them, thus posing a diagnostic dilemma. Careful history taking is needed for clinical decision making and ruling out the clinically similar entities [Table 1]. Once other lesions are ruled out and the habit of tongue biting is identified, treatment can be behavioral intervention, pharmacological and/or use of habit breaking appliances. Azrin and Nunn[5] have given the concept of habit reversal training, which is done by counseling to discontinue the habit by reassurance and relaxation. Antianxiety and antidepressants have been used for pharamacologic management of habit breaking in ML. An occlusal night guard may be fabricated in patients who are unable to control their tongue chewing habit.[1]
Thorough case history and clinical examination are of paramount importance to differentiate this condition from other white lesions of the oral mucosa. Repeated questioning and analysis serves the basis for the diagnosis of this entity.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Bhattacharya I, Cohen DM, Silverman SJ. Red and white lesions of the oral mucosa. In: Greenberg MS, Glick M, editors. Burket's Oral Medicine: Diagnosis and Treatment. 10 th ed. Canada: B C Decker Inc. Elsevier India; 2003. p. 88.  |
| 2. | Min KW, Park CK. Morsicatio Labiorum/Linguarum- three cases report and a review of the literature. Korean J Pathol 2009;43:174-6. |
| 3. | Doval N, Bhatia NK, Bhatia MS. Morsicatio linguarum: A case report. Eur J Pharm Med Res 2016;3:361-2. |
| 4. | Da Silva Pereira NS, Brazão-Silva MT, Pinheiro TN, Cabral LN. Morsicatio linguarum in a pediatric patient: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2017;124:e85. |
| 5. | Azrin NH, Nunn RG. A method of eliminating nervous habits and tics. Behav Res Ther 1973;11:619-28. |
[Figure 1], [Figure 2], [Figure 3]
[Table 1] |
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