We would like to thank Dr. Albrecht for her interest in our recent article. We agree that considering alternate diagnoses is always of the utmost importance. In this case, however, we believe that a diagnosis of chemical burns or contact mucositis secondary to food is extremely unlikely.
A presentation of diffuse ulcers throughout the oral mucosa may be consistent with exposure to a caustic substance,1 but we have found no reported cases in the literature associated with salad dressing or spicy foods. It is true that there are reports of contact mucositis secondary to eating, in which patients may complain of a burning sensation. Objective examination of these patients typically reveals the oral mucosa varies in appearance from mild to severe erythema with or without edema.2 This is inconsistent with the clinical picture seen in our case.
While it is true that primary herpetic gingivostomatitis is seen most often in children, there have been numerous cases reported in older individuals as well. The patient’s positive viral culture also supports this diagnosis, as swabbing lesional tissue for viral culture is an appropriate technique for identifying herpes.3
That our patient has had no recurrences one year later is also consistent with this diagnosis, as the disease presents as a solitary episode. Contact mucositis, on the other hand, is a condition that commonly recurs.
We appreciate Dr. Albrecht’s interest in our patient. However, we believe that she received the correct diagnosis and are comfortable with the treatment provided.
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