Thank you for the opportunity to respond to Dr. William K. Kopp’s comments. While we respect that Dr. Kopp is sincere in his belief that this process represents a simple traumatic injury, we must respectfully disagree with his rationale for this assertion.
In the first paragraph of our article, we noted that the periodontist (M.F.) who initially managed this case placed traumatic injury at the top of his differential diagnosis, and he immediately constructed a palatal stent to protect the lesion from further trauma. This stent was used by the patient for a four-month period without resolution. Dr. Kopp states that, in his experience of 44 years, once covered, these lesions display "total healing in four to six weeks."
Dr. Kopp accurately describes the pathophysiology by which a traumatic injury of the palate is induced and repaired. He also accurately points out that this occurs when a palatal torus is "subjected to trauma." After repeated attempts to elicit a traumatic event from the patient, she denied any incident that might have precipitated this process. Further to this, there were absolutely no cardinal signs of inflammation present during the entire time this patient was followed, including the pain, erythema and/or soft-tissue swelling that accompany a traumatic event.
Dr. Kopp also points out that any time superficial bone is exposed, the surface will become necrotic following loss of the periosteal blood supply. However, bony sequestration, as was present in this case, would not be expected. We would like to thank Dr. Kopp for taking the time to read our "Diagnostic Challenge" and to respond to the Editor with his opinion.
