Difficulty In Mastication Research Articles

Association between mandibular prognathism and Matrilin-1, bone morphogenic protein, Tyr67Asn, homeobox protein hox-A2, Rho-GTPase activating protein, and Myosin 1H genes in the Indian population.

Mandibular prognathism (MP) patients present with aesthetic concerns and functional issues, including difficulties in mastication and pronunciation. Studies revealed that mandibular prognathism had definitive Mendelian inheritance patterns. This study aimed to ascertain distinct genetic markers associated with mandibular prognathism in individuals of Indian descent, focusing on exploring the prevalent genetic variations associated with certain genes. This study sought to identify the association of the following gene markers with mandibular prognathism: 1) Matrilin-1 (MATN1) (rs1065755), 2) Bone morphogenic protein 3 (BMP-3) (Tyr67Asn), 3) Homeobox protein hox-A2 (HOXA2) (Val327Ile), 4) Rho-GTPase activating protein (ARHGAP 21) (Gly1121Ser), 5) Myosin 1H (MYO1H) (rs10850110).

Impaired autophagy-mediated macrophage polarization contributes to age-related hyposalivation.

Age-related dysfunction of salivary glands (SGs) leading to xerostomia or dry mouth is typically associated with increased dental caries and difficulties in mastication, deglutition or speech. Inflammaging-induced hyposalivation plays a significant role in aged SGs; however, the mechanisms by which ageing shapes the inflammatory microenvironment of SGs remain unclear. Here, we show that reduced salivary secretion flow rate in aged human and mice SGs is associated with impaired autophagy and increased M1 polarization of macrophages. Our study reveals the crucial roles of SIRT6 in regulating macrophage autophagy and polarization through the PI3K/AKT/mTOR pathway, as demonstrated by generating two conditional knock out mice. Furthermore, triptolide (TP) effectively rejuvenates macrophage autophagy and polarization via targeting this pathway. We also design a local delivery of TP-loaded apoptotic extracellular vesicles (ApoEVs) to improve age-related SGs dysfunction therapeutically. Collectively, our findings uncover a previously unknown link between SIRT6-regulated autophagy and macrophage polarization in age-mediated hyposalivation, while our locally therapeutic strategy exhibits potential preventive effects for age-related hyposalivation.

A comparative analysis of older patients with chewing difficulties due to temporomandibular disorders and tooth loss

Background/purposeChewing difficulty can contribute to psychological stress, which reduces the quality of life for older adults. The purpose of this study was to investigate and analyze the severity of masticatory discomfort, stress response, and sleep disturbance in older patients experiencing masticatory discomfort due to tooth loss or temporomandibular disorders (TMD), to find the further treatment direction for these patients. Materials and methodsA total of 392 patients aged 50 years and older with mastication difficulties were analyzed. Two group of patients, those seeking prosthetic treatment due to tooth loss (n = 193) and those who were referred due to TMD-related pain discomfort (n = 199), were identified. Numeric rating scale (NRS), stress response inventory (SRI), and insomnia severity index (ISI) were used as tools to measure patients’ subjective chewing discomfort, stress response, and sleep status. ResultsChewing discomfort and age were found to be much higher in the prosthetic group than in the TMD group. The TMD group had significantly higher scores in five SRI parameters (tension, anger, depression, fatigue, and frustration) as well as total score and a higher percentage of clinical insomnia compared to prosthetic patients. ConclusionSince the number of remaining teeth has a significant impact on the masticatory discomfort severity, restoring the occlusion through prosthodontic treatment is important to improve masticatory function. In patients with TMD, it is necessary to assess stress response and sleep quality, and a multidisciplinary treatment approach may be necessary to effectively address masticatory discomfort.

Prosthetic Rehabilitation of a Hemi-mandibulectomy Patient with Interim Mandibular Guide Flange and Maxillary Twin Occlusion: A Case Report

ABSTRACT In hemi-mandibulectomy patients, the fabrication of a successful prosthesis is a challenging task. Segmental resection of the mandible causes deviation toward the resected side resulting in facial disfigurement, difficulty in speech, mastication, swallowing, respiration, and restricted mandibular movements. Such a condition affects the daily life of the patient and might also result in a disturbed psychological state. The primary goal of treating these patients was to achieve facial aesthetics and restore function and phonetics. Such a scenario can be tackled more efficiently with good patient cooperation and a well-fabricated prosthesis.

Treating Trigeminal Schwannoma through a Transorbital Approach: A Systematic Review.

Background: Trigeminal schwannomas (TSs) are uncommon tumors found along any segment of the fifth cranial nerve (CN V). Typically located at the skull base, these benign tumors carry substantial morbidity due to the extent of traditional surgical methods. Minimally invasive endoscopic surgery such as the endoscopic transorbital approach (ETOA) presents promising new avenues for treatment, with the transorbital approach emerging as a potentially successful alternative. Methods: This review systematically assesses the application of the ETOA in treating TSs. PubMed, Ovid MEDLINE, and Embase were thoroughly searched for articles detailing the use of the ETOA in clinical case studies. The outcomes of interest encompassed epidemiological profiling, surgical results, and complication rates. Results: This study included 70 patients with TSs (from six studies), with 22 males (31.4%) and 58 females (68.6%). Patients averaged 55 years and were monitored for around 16.4 months (on average). In most tumors, the middle cranial fossa was involved to some degree. The majority (87.2%) were large (3-6 cm) and underwent gross total resection (GTR) or near-total resection in 87.2% of patients. Preoperatively, sensory alterations were common, along with proptosis, neuropathic pain, and diplopia. Postoperatively, complications included ptosis, diplopia, sensory impairment, corneal keratopathy, masticatory difficulty, and neuralgia. The pure ETOA was the primary surgical technique used in 90% of cases, with no recurrence observed during the follow-up period. Conclusions: Using the ETOA to treat TSs demonstrated an oncologic control rate of 87.2%. Postoperative complications including ptosis, diplopia, and sensory disturbances have been observed, but careful monitoring and management can mitigate these problems. The ETOA emerges as a viable surgical option, especially for tumors involving the middle cranial fossa, capable of adapting to individual patient needs and demonstrating efficacy in TS management.

Interdural extra-arachnoidal resection of fifth nerve schwannomas with tailored petrous drilling: Eliminating the blind spot

Background and objectives Around 20-40% of trigeminal schwannomas (TS) are dumbbell shaped, spanning the middle and posterior cranial fossa The petrous apex is often truncated in these patients, aiding surgical resection of both compartments through the middle fossa approach. However, a less eroded petrous creates a blind spot, making total resection difficult. This study describes the feasibility of an approach combining expanded Meckel cave access with tailored petrous bone drilling to optimize tumor visualization and resection. Methods Eleven patients with dumbbell TS and minimal petrous apex erosion underwent the described surgery. Surgical steps included temporo-orbito-zygomatic craniotomy, middle fossa floor drilling, navigation aided (tailored) extradural petrous bone drilling and extra-arachnoidal tumor excision. Extent of resection and postoperative outcomes were recorded. Results Patients presented with trigeminal nerve dysfunction (n = 9; sensory −9 and motor − 5), headache(8/11), ataxia (7/11) and pseudobulbar palsy (3/11). Complete tumor resection was achieved in all patients. Postoperatively, 8 out of 9 patients had transient increase in facial hypoesthesia with conjunctival injection in 3. It improved within 3-6 months, except in four cases wherein mild hypoesthesia persisted. Motor symptoms improved in 2 of 5 patients. Two developed transient 6th nerve paresis, that resolved in 2 months. Cerebellar and brainstem pressure symptoms resolved in all. No patients developed new onset permanent neurological deficit. Two patients reported mild post-craniotomy masticatory difficulty. Conclusions The additional tailored petrous bony drilling enhances the surgeon’s view, allowing a higher chance of total resection with no major operative morbidity.

Case Study: Facemask Protocol for Growing Patient

This case report describes the orthodontic treatment of a 9-year-old Egyptian male with a Class III incisor relationship and skeletal Class III base, characterized by a -3 mm reverse overjet, 70% reverse overbite, and masticatory difficulties. The patient exhibited full unit Class III molar relationship, unclassified canine relationship, lower and upper crowding, concave profile, acute nasolabial angle, and competent lips. Treatment involved two phases: Phase 1 utilized an orthopaedic appliance (facemask) with banded hyrax and posterior acrylic bite planes, while Phase 2 employed upper and lower fixed pre-adjusted edgewise appliances with MBT prescription and class III elastics. This comprehensive approach aimed to address the malocclusion effectively and achieve improved dental alignment and facial aesthetics.

Unraveling the Ayurvedic Protocol in the Management of Ranula

Shalakya tantra is the branch of Ayurveda which deals with Urdhwajatrugata rogas i.e., diseases occurring in supraclavicular region. Acharyas have mentioned various Mukharogas (diseases pertaining to oral cavity) which are further subdivided into various categories. Acharya Sushruta has mentioned five Jihwagata rogas (diseases of tongue) and their management. Upajihwika which is caused by vitiation of Kapha and Rakta, is the Jihwagraroopa shwathu cystic swelling under the ventral aspect of tongue. In modern, it can be correlated with Ranula which is a translucent swelling in the floor of the mouth formed due to sublingual gland trauma or obstruction of the ducts. It further leads to extravasation and accumulation of saliva in the surrounding tissue thus forming a cyst. Case and Intervention- A 49-year-old male patient presented to ENT OPD of Patanjali Ayurveda Hospital with swelling in left submandibular region for 2 months. There was no difficulty in mastication and swallowing with no history of trauma. The patient was diagnosed with plunging Ranula sized 4x3 cm based on USG findings. He underwent three months and 10 days course of Ayurvedic regime and two follow ups showing reduction in size of the cystic swelling. Conclusion: Several surgical techniques have been introduced to treat Ranula ranging from marsupialization, excision of Ranula, excision of sublingual glands, sclerotherapy with varying success and recurrence rate. Ayurvedic protocol aimed at holistic approach by pacifying the vitiated Doshas and showing marked regression in the cystic growth without making the patient undergo the pain and high cost and adverse effect as that of a surgical procedure.

Lipoma in the Mouth – Revelation of a Rare Possibility

Benign lesions involving the floor of the mouth are a rare encounter. In this case, a middle-aged female presented to the outpatient department with a swelling involving the floor of the mouth which occupied enough space to displace the tongue. There was difficulty in mastication, and on examination, it was brilliantly transilluminant. After sonography, the patient underwent an excision of the mass which on histopathology surprisingly was revealed as a lipoma. Having an idea about the complicated nearby anatomy, it is imperative to dissect accurately to prevent morbidity arising out of the complications associated with damage to the various structures.

Enzymatic impregnation by high hydrostatic pressure for preparing shape-retaining softened broccoli and carrot

This study examined the feasibility of utilizing high-pressure processing (HPP) with enzymatic impregnation to soften vegetables. Freeze–thaw (FT) processing was used as a positive control to compare the hardness, physicochemical characteristics, and cell microstructure of vegetables. Carrot and broccoli samples were subjected to 200 MPa pressure for 15 min and then impregnated using a Viscozyme L enzyme solution. Compared with the hardness of fresh samples, the hardness of the carrot and broccoli samples that underwent HPP and enzymatic impregnation decreased by 84.6% and 95.5%, respectively, and the hardness of the carrot and broccoli samples that underwent FT processed decreased by 73.6% and 91.3%, respectively. In particular, HPP with enzymatic impregnation reduced the content of insoluble dietary fibers (18%), increased the content of soluble dietary fibers (3%), and considerably increased the concentration of carotene (1.9 times) and isothiocyanate (4.5 times) in carrots and broccoli, respectively. Scanning electron microscopy reveals that HPP physically damaged the intercellular compartments of the vegetables, thereby increasing the impregnation of enzymes. In addition, the level of HPP and the holding time increased, and the amount of vegetable residue and the degree of moisture retention substantially decreased, indicating a negative correlation between damage and hardness. Moreover, HPP pretreatment require a short processing time then FT, which promoted the penetration of enzymes and the internal microstructural biodegradation of vegetables, and it also helped these vegetables release more soluble nutrients. Overall, HPP can be used with enzymatic impregnation to obtain texture-modified vegetables for older consumers with mastication difficulties.

Investigating the Impact of Perceived Masticatory Difficulty with Previous Dentures on Subsequent Food Intake with New Dentures: A Prospective Study

Investigating the Impact of Perceived Masticatory Difficulty with Previous Dentures on Subsequent Food Intake with New Dentures: A Prospective Study

Association between occlusal features and masticatory function in Hong Kong preschool children: a survey with one-year longitudinal follow-up

BackgroundMastication is important for breaking down food, aiding swallowing and nutrients absorption, and is therefore fundamental to a child’s development. Studies have shown poor masticatory function to be associated with younger age and presence of caries. However, studies of the association between masticatory function and malocclusion yielded contradictory results. The aim of this study is therefore to investigate the association between three-dimensional occlusal features with masticatory function, among preschool children in Hong Kong.MethodsSelf-administered questionnaires on masticatory function in three domains, namely general chewing difficulty, requiring help when eating different food types and increased preference for soft food were completed by parents. Information on non-nutritive sucking habits and basic demographics were also collected in the questionnaire. Clinical examinations were conducted to record three-dimensional occlusal features and presence of caries. Baseline investigations and one-year follow-ups were undertaken for 1,566 and 996 preschool children. Association of poor masticatory function with occlusal features, sucking habits and caries was investigated using chi-squared tests. Binomial logistic regressions were then carried out incorporating any significant factors identified. Longitudinal analysis of the one-year follow-up data was carried out to investigate whether improved occlusal features, sucking habits and caries resulted in better masticatory function.ResultsIn the cross-sectional study, the first domain of general chewing difficulty was associated with caries and thumb/digit sucking. The second domain of requiring help when eating different food types was associated with the male sex, younger age, caries and pacifier use. The last domain of increased preference for soft foods was associated with caries and thumb/digit sucking. Occlusal features, including abnormal overjet and unilateral permanent molars not in contact, were significantly associated with poor masticatory function in the bivariate analyses, but were not significant in the logistic regressions. In the longitudinal analysis, general chewing difficulty was found to improve in those of older age and those with resolved anterior crossbite. Less help was required to eat meat in those with fewer caries. Similarly, less help was required to eat food containing bones in those with reduced pacifier use. Preferences for eating soft foods was reduced in those who developed a normal overjet.ConclusionsThe study identified significant relationships between masticatory difficulties and factors associated with age, gender, active caries, and non-nutritive oral habits such as thumb/digit sucking and pacifier use. Younger children and males required more assistance with certain food types. Active caries and thumb/digit sucking habits contributed to general masticatory difficulties and preference for soft foods. The one-year follow-up indicated that improvement in masticatory function varies across age cohorts and were associated with improved occlusal features, such as resolution of anterior crossbite and normalized overjet, reduced pacifier use, and a decrease in the number of decayed teeth.

Oral Lymphangioma: An Original Series of Three Cases with Review

Lymphangiomas are benign hamartomatous tumors of lymphatic origin which results from sequestration of lymphhatic tissues that do not communicate with other lymphatic channels. They may occur with hemangiomas and have high predilections for head and neck region (50-70%). They may occur at birth (60-70%) or till two years of age (90%) and rarely in adults. The most common site of occurrence in the mouth is dorsum of tongue being followed by lips, buccal mucosa, soft palate and floor of mouth. Tongue lymphangioma may present as localized or diffused growth that may result in macroglossia, impaired speech and difficulty in mastication. There are different treatment options; surgical excision being the most effective mode of treatment. Here we have reported three different cases of oral lymphangiomas, two of which occurring in the tongue and one in the buccal mucosa.

Relationship between mastication and malnutrition in community-dwelling older adults: a meta-analysis.

To determine the relationship between mastication and malnutrition in community-dwelling older adults. To establish the eligibility criteria, the acronym PECOS was used: Population: non-institutionalized older adults; Exposure: older adults with malnutrition; Control: older adults without malnutrition; Outcome: masticatory problems in malnourished older adults; Study types: observational studies. It selected studies assessing malnutrition and mastication difficulties in non-institutionalized adults over 60 years old, of both sexes. Mastication and malnutrition were evaluated with questionnaires on self-reported symptoms and clinical and instrumental assessments. There were no restrictions on language, year of publication, or ethnicity. The included studies were evaluated for methodological quality with the Joanna Briggs Institute tool for cross-sectional studies. For the cross-sectional studies included, the odds ratio (OR) was calculated with 95% confidence intervals. After searching the databases, 692 references were retrieved, with three studies selected for quantitative and qualitative analysis. The values obtained in the meta-analysis for association show that malnutrition and mastication difficulties were 2.21 times as likely to occur (OR = 2.21; 95%CI = 0.93 - 5.26; I2 = 94%) as individuals without malnutrition (p < 0.001). The assessment of the risk of bias presented a high-risk, a moderate-risk, and a low-risk study. The certainty of evidence was rated very low with the GRADE tool. Individuals at risk of malnutrition are 2.21 times as likely to have mastication difficulties.

Development of cooking method for senior-friendly food using fruits suitable for older adults with masticatory dysfunction.

The purpose of this study was to establish a fruit-cooking method suitable for older adults with masticatory dysfunction. Five types of fruits were selected to make fruit jelly and puree: apple, sweet persimmon, mandarin, Korean melon, and watermelon. Recipes were selected based on the Korean Industrial Standard (KS) for senior-friendly foods (KS H 4897), which classifies foods into 3 levels (L1-L3) based on their hardness and viscosity. In South Korea, senior-friendly foods are classified into 3 stages based on their hardness. Stage 1 is for foods that are able to eat with teeth (hardness greater than 50,000 N and less than 500,000 N), Stage 2 is for foods that are able to eat with gums (hardness greater than 20,000 N and less than 50,000 N), and Stage 3 is for foods that are able to eat with the tongue (hardness less than 20,000 N). As a result of measuring the hardness by varying the shape of the fruit, it was found that nearly all fruits could be eaten fresh by chewing with the teeth (L1) but did not meet the KS for mastication using the gums (L2) or tongue (L3), so the cooking method was selected as fruit jelly and fruit puree. Only sweet persimmon, which had a hardness of 61,624-496,393 N, was not suitable for consumption in fresh fruit, unprocessed form. Based on their hardness measurements, fruit jellies (27,869 to 36,343 N) and fruit purees (315 to 1,156 N) met the L2 and L3 requirements, respectively. The viscosity results of all fruit purees met the L3 requirement. These results offer a simple cooking method to prepare texture-modified fruits suitable for safe consumption by older adults living with masticatory difficulties in general households and nursing facilities.

Amlodipine Induced Gingival Enlargement- A Case Report

Exuberant proliferation of gingival soft tissues in response to local and systemic conditions leads to gingival overgrowth which may create speech problems, difficulty in mastication, altered tooth eruption, and esthetic problems. Gingival enlargement can also occur as a side effect of certain drugs like calcium channel blockers, anti-convulsants and immunosuppressants given for systemic diseases. Hypertension is the major risk factor for cardiovascular diseases. Amlodipine has been widely used from past 2 decades in the management of hypertension and stable angina because of its good efficacy and safety compared with other antihypertensive medications. Here we report a rare case of Amlodipine induced severe gingival enlargement in a 61year old hypertensive male patient taking a dose of 10 mg per day in two divided doses.

Does the application of autologous injectable Platelet-Rich Fibrin (i-PRF) affect the patient’s daily performance during the retraction of upper canines? A single-centre randomized split-mouth controlled trial

BackgroundPrevious studies have assessed different aspects concerning the applications of i-PRF in the oral cavity. However, nothing is known regarding patients’ perceptions of the injection of autologous platelet-rich fibrin (i-PRF).ObjectivesTo investigate patients’ perceptions after injecting platelet-rich fibrin (i-PRF) in the course of retracting upper canines.MethodsTwenty-one patients, whose treatments required extractions of both upper first premolars, were recruited. Extraction side was randomly allocated to the intervention or control sides. After the alignment phase, i-PRF was injected twice with a one-month interval on the buccal and palatal aspects of the extraction sites (intervention side). Patients’ perceptions were evaluated with two questionnaires: the first was used to assess the level of pain, discomfort, swelling, eating and swallowing difficulties as well as jaw movement restriction after 1 h (T1), 2 h (T2), 6 h (T3), 24 h (T4) and 48 h (T5) of the second injection; the second questionnaire was used to assess the acceptance of the i-PRF injection and overall satisfaction with this technique at the end of canine retraction phase. Visual Analogue Scale (VAS) was adopted for this purpose. Wilcoxon Signed Rank Test was used to compare between both sides at all time points while Friedman’s Test was the selected test for detecting variables’ changes over time. Post-hoc Wilcoxon Matched-Pairs Signed-Rank Tests were applied when any of the results were significant. As to the multiplicity of tests, Bonferroni Correction was implemented.ResultsPain and swelling levels were significantly higher on the experimental compared to the control sides at T1, T2, and T3 (P < 0.05), whereas they declined sharply and went back to almost normal values at T4 (after 24 h). At T5 they were 0. Discomfort and difficulty in mastication on intervention sides were significant only at T1 and T2. Pain, swelling, and chewing difficulties were significant (P < 0.001) during the 4 assessed time points. The increase was insignificant regarding swallowing difficulties and jaw movement limitations at all time intervals.ConclusionsInjecting autologous (i-PRF) during orthodontic canine retraction is a well-perceived and well-tolerated method due to the limited discomfort which significantly diminishes 24 h afterwards.Trial’s registrationClinicalTrials.gov (Identifier Number: NCT03399422. 16/01/2018).

A case of early-onset periodontitis with vitamin D deficiency: A case report and literature review.

Periodontitis is an inflammatory disease with multifactorial etiology. Vitamin D, a fat-soluble vitamin, has protective effects on inflammatory response in various systemic conditions. The clinical features of vitamin D deficiency include growth failure, hypotonia, pathologic fractures, rachitic rosary, tetany and so on. Here we present a case of 12-year-old girl affected by early-onset periodontitis accompanied with vitamin D deficiency. A 12-year-old girl with gingival redness, bleeding associated with tooth brushing, and mandibular anterior teeth movement, with difficulty in mastication for the past 2 months. There is no relevant family history or special systemic disease history. The serological microelement test showed vitamin D levels were significantly lower than normal range. Immunological test showed abnormal CD4+/CD8+(CD3+CD4+/CD3+CD8+) ratio as well. Based on the clinical and serological findings, this patient was ultimately diagnosed with early-onset periodontitis accompanied with vitamin D deficiency. The main treatments for this patient were 3-fold: periodontal therapy, vitamin D supplement and oral hygiene instructions. Following 1-year therapy, periodontal conditions recovered and became stable. And serological vitamin D levels returned to normal range. The case of interest serves as an important reminder to clinicians, that the early-onset periodontitis may be associated with micronutrients abnormalities, and early-diagnosis and treatment could avoid the body heathy disorders.

EVALUATION OF TRAUMATIC ULCERATIONS FREQUENCY AND SITE IN POST-INSERTION ADJUSTMENT RECALL VISITS IN COMPLETE DENTURE PATIENTS VISITING A DENTAL COLLEGE IN CHITWAN

Background: During the initial days after complete denture insertion, patients can face various difficulties like traumatic ulcerations, loss of retention, unstable denture, difficulty in mastication and speech etc. The aim of the study was to assess the site and number of traumatic ulcerations in maxillary and mandibular denture bearing area in post-insertion adjustment recall visits and also to find out the total number of adjustments recall visits required until the patients become comfortable with the denture. Methods: A cross-sectional study was conducted among 75 complete denture patients to look for the number and site of traumatic ulcerations and the number of post-insertion recall visits required until they became symptom free. Descriptive (frequency and percentage) statistical analysis was done using SPSS Statistical Software Package (version 21.0). Results: In the mandibular arch 49.33% (N=34) and in the maxillary arch 12.5% (N=9) patients required adjustment visits for traumatic ulcerations. In the first recall visit after 24 hrs, 34 patients showed traumatic ulcerations on mandibular arch while only 6 patients experienced traumatic ulcerations on the maxillary arch. Conclusions: The patients required more post insertion adjustments for traumatic ulcerations in the mandibular arch in comparison to maxillary arch. Traumatic ulcerations was most frequently found in distobuccal sulcus area in the maxillary arch and labial sulcus in the mandibular arch.

Oral Manifestation of Viral-Induced Erythema Multiforme Major: A Rare Presentation.

Erythema multiforme is an acute inflammatory mucocutaneous disease manifested as macules, vesicles, bullae, erosion, and papular lesions. In the present case, a 55-year-old female patient reported painful growth in the oral cavity and difficulty in mastication. The patient gave a history of prodromal symptoms before the onset of lesions On intra-oral examination, elevated plaque-like lesions were present bilaterally on lateral borders of the tongue and buccal mucosa near the retromolar region. Extraoral examination revealed concentric erythematous target (or) bull's eye lesions in palms, forearm, and foot. Based on history, clinical examination, and laboratory investigations, recurrent herpes-associated erythema multiforme was diagnosed. We report a rare clinical presentation of recurrent herpes-associated erythema multiforme manifesting as an extensive plaque-like lesion intra-orally.