Oral Medicine is one of the specialities of dentistry where in we oral physicians not only look into the lesions occurring primarily in the oral cavity but also are concerned with the oral manifestations of systemic disorders which occur secondarily to the underlying systemic abnormality. Here with reporting a similar case report where in a 26 year old male patient by name Shivaraj was referred to us from an ENT surgeon for the evaluation of the painful oral ulcers. His history of present illness revealed that the ulcers were present since fifteen days and to start with it was insidious in onset, gradually increasing in size. Patient also had reduced mouth opening. ENT surgeon thought in terms of malignancy and performed a incisional biopsy from the ulcerated site, which suggested non specific inflammatory lesion. Patient was also advised for an endoscopy which had revealed gastritis and esophagitis. They had prescribed him antibiotics and analgesics (tab Ofloxacin 500mg and tab Diclofenac sodium 50mg) and there after referred to us. Patient did not have any relief on taking these medications. His past medical history was significant where in the patient was hospitalized one month back for a period of eight days for the complaint of hemetemesis and was diagnosed as having a gastric ulcer and was treated with intra venous hemocoagulase and also antacids like Mucaine (oxythazine + aluminium hydroxide + magnesium hydroxide) and Pantakind 40mg .

General physical examination revealed that patient was moderately built, with signs of anemia like pallorness of conjunctiva and pitting edema of lower limbs (Fig 2). All the vital signs were under normal limits and blood pressure measured in supine position was 130/80 mm of Hg. His right and left submandibular lymph node was palpable. Extra oral examination revealed dried and cracked lips and bleeding from the cracks was evident. Intra oral examination revealed marked halitosis of a fishy odor, mouth opening measured was 2.5 cm. There was an ulcer present on the right side of the soft palate measuring about 2 × 3 cm, which was grayish white in color, with surrounding erythematous halo and also tissue tags were present at the periphery(Fig 3). On palpation the lesion was tender, borders were non indurated and also bleeding spot were evident on trying to scrape the lesion. Other soft tissue findings included a thick band of calculus on the palatal aspect of upper posterior teeth. Gingiva was inflamed and covered with pseudomembrane at few areas. we thought of a non healing ulcer on the palate and the following differential diagnosis were considered, which included chronic hyperplastic candidiasis, deep fungal infection of palate and also uremic stomatitis, since the patient was a compromised host with evident pedal edema which is more often seen in a renal disorder but patient did not have any complaints regarding the functions of the kidney. We advised for a chlorhexidinegluconate 0.2% mouth wash and a topical analgesic (dentogel) as a symptomatic treatment. Patient was then referred to a general physician for opinion regarding the systemic health of the patient and physician had advised for a complete hemogram, random blood sugar, serum urea and creatinine and also urine examination. Complete hemogram suggested an impression of normocytic hypochromic anemia with leukocytosis. Serum biochemistry profile revealed that blood urea was 60mg%, Creatinine was 3.4mg%. Urine examination revealed a urine albumin which was of 2+, Sugar was 1%, Pus cells were 8-10 in number and epithelial cells about 2-4 in number. Ultrsonography of the abdomen revealed grade I nephropathy. Cytosmear was nondiagnostic. Considering all these, we arrived at a final diagnosis of uremic stomatitis secondary to chronic renal failure. Patient was then admitted to Bapuji hospital for medical line of treatment for chronic renal failure. When patient reviewed after 3 weeks , the palatal lesions showed signs of healing and only an erythematous base was left behind. On subsequent appointment the lesions had healed completely (Fig 4). Patient then underwent the necessary dental treatment.