Dear Dr.

I have experienced dry patches of rough skin on the inside of my cheeks near were my teeth connect for the past 6 weeks. It has moved around and even been on the inside of my bottom lip. I have not experienced any coating of the tongue, however, the areas always seem to have a very light white coating which comes and goes. Is this thrush, leukoplakia etc?

As I am sure your realize, it is very difficult to formulate an accurate diagnosis over the Internet, but what you describe does not sound like thrush or leukoplakia. What I can do is give out a few of our "secret tricks" as to how we come up with a diagnosis based on clinical appearance alone:

1. If you have a white line or white area on the insides of your cheeks, the first thing I would look for is if these lines match up with where your teeth come together. If they do, I would immediately suspect cheek biting.

2. I would take a look at the area on the lower lip you described and again see if this white area matched up to your bite

3. Then I would see if these areas wipe away, just to make sure you do not have thrush.

4. I would check to see if you had a history of smoking or using smokeless tobacco as both increase the incidence of oral cancer. I would also check to see if there was pain associated with the areas.

5. If the areas are limited to where your teth come together I would rule out diseases such as erosive lichen planus.

What can be done? For the most part, cheek biting is a habit that is usually increased by stress. If possible your occlusion or how your teeth come together can be adjusted. For some severe cases we have made night guards for our patients to give them something else to bite on. If the problem persists, please take the time to visit your dentist.

Take care!

DR