Morsicatio Buccarum — ORE Part 1 MCQ

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EasyOral MedicineMorsicatio BuccarumORE Part 1

A patient has bilateral, linear white spongy plaques on the buccal mucosa at the level where the teeth meet. The lesions correspond to the areas of tooth contact. What is the most likely diagnosis?

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Correct answer: B — Morsicatio buccarum

The diagnosis is morsicatio buccarum, a frictional keratosis caused by habitual cheek biting or repetitive trauma from the teeth. The decisive features are the bilateral buccal distribution and the linear lesions precisely at the occlusal line. UK guidance describes frictional keratosis as a white change in areas where teeth meet, commonly affecting bilateral buccal mucosa. Oral leukoplakia is a diagnosis of exclusion and is not characteristically confined to tooth-contact areas. Oral lichen planus usually has a reticular pattern with Wickham striae, often with erythema or soreness. Oral hairy leukoplakia is typically on the lateral tongue in immunosuppression. White sponge naevus can cause bilateral white spongy buccal lesions, but is inherited and diffuse rather than specifically restricted to the occlusal line.

Reference: BMJ. Practice Pointer: Assessing oral ulcers and patches in primary care, Table 1 (2025). https://pubmed.ncbi.nlm.nih.gov/22545331/