Are You Confident of the Diagnosis?
Characteristic findings on physical examination
Mosicatio buccarum is typically not a presenting complaint but an interesting diagnosis made as an aside during a complete oral examination. The shaggy, macerated cheeks seen (not removed by wiping) are asymptomatic or at most minimally uncomfortable (Figure 1). There is variability in the location of biting with cheeks+lips > cheeks alone > lips alone and bilateral > unilateral. Patients are not concerned about the clinical findings because they are aware of the cause.
Figure 1.
Morsicatio buccarum.
Expected results of diagnostic studies
Morsicatio buccarum is a clinical diagnosis requiring no diagnostic studies. If there is concern for yeast overgrowth, a potassium hydroxide (KOH) or culture may be helpful but both need to be interpreted in light of a 50% commensal candida colonization rate. If there is concern or confusion about lichen planus, leukoplakia or bullous diseases, a biopsy may be helpful. Hematoxylin and eosin (H&E) specimens would show acanthosis with an irregular, torn and debris-ridden parakeratosis in the absence of any significant dermal process (Figure 2). Direct immunofluorescence testing as well as desmoglein and bullous pemphigoid antigen studies would be negative.
Figure 2.
Morsicatio buccarum histology (H&E). (Courtesy of Bryan Anderson, MD)
Who is at Risk for Developing this Disease?
Chronic, habitual cheek biters. M=F and teens>adults. Those affected are thought to have higher rates of anxiety or be “high achieving.”
What is the Cause of the Disease?
Etiology
Low grade, chronic mechanical trauma
Systemic Implications and Complications
None
Treatment Options
No intervention is required. If treatment is desired, the habitual cheek biting needs to be stopped.
Optimal Therapeutic Approach for this Disease
Reassure the patient that this is a benign condition due to mechanical factors, such as biting, and that no treatment is necessary.
Patient Management
Due to the benign nature of morsicatio buccarum, , no patient follow-up is required.
Unusual Clinical Scenarios to Consider in Patient Management
Morsicatio buccarum is a subset of frictional oral changes specific to cheek biters that just bite .. not friction from another activity such as pipe smoking, pen chewing, etc. In other words … not all frictional changes are morsicatio buccarum but all morsicatio buccarum is frictional change.
Morsicatio labiorum refers to lip biting alone.
What is the Evidence?
Kocsard, E, Schwartz, L, Stephen, BS, D’Abrera, VS. “Morsicatio buccarum”. Br J Dermatol. vol. 74. 1962. pp. 454-7. (Original description in the dermatology literature.)
Sciubba, JJ, Regezi, JA, Rogers, RS. PDQ oral disease diagnosis and treatment. 2002. pp. 24(Rapid reference text with photos.)
Glass, LF, Maize, JC. “Morsicatio buccarum et labriorum (excessive cheek and lip biting”. Am J Dermatopathol. 1991. pp. 271-4. (Histopathology of a case of morsicatio buccarum misdiagnosed as pemphigus vulgaris.)
Sewerin, I B. ” A clinical and epidemiologic study morsicatio buccarum/labiorum”. Scand J Dent Res. vol. 79. 1971. pp. 73-80. (A large Danish epidemiologic study.)
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