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Morsicatio buccarum
Morsicatio buccarum (also termed chronic cheek biting
and chronic cheek chewing) is a condition characterized

Morsicatio buccarum

by chronic irritation or injury to the buccal mucosa (the lining

Classification and external resources

of the inside of the cheek within the mouth), caused by

ICD-10

repetitive chewing, biting or nibbling.[1]

K13.1

(ILDS K13.110)

Contents
Classification
Signs and symptoms
Causes
Diagnosis
Treatment and prognosis
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Epidemiology
References

Classification
Since the lesion occurs on the buccal mucosa in the mouth, the ICD-10 classifies morsicatio buccarum
under "diseases of oral cavity, salivary glands and jaws" and then under "other diseases of lip and oral
mucosa". It could be considered a cutaneous condition,[1] and really is a type of frictional keratosis.[2]
The term is derived from the Latin words, morusus meaning "bite" and bucca meaning "cheek".[3] This
term has been described as "a classic example of medical terminology gone astray".[4]

Signs and symptoms

The lesions are located on the mucosa, usually bilaterally in the central part of the anterior buccal
mucosa and along the level of the occlusal plane (the level at which the upper and lower teeth meet).
Sometimes the tongue or the labial mucosa (the inside lining of the lips) is affected by a similarly
produced lesion, termed morsicatio linguarum and morsicatio labiorum respectively.[4] There may be a
coexistent linea alba, which corresponds to the occlusal plane,[2] or crenated tongue. The lesions are
white with thickening and shredding of mucosa commonly combined with intervening zones of erythema
(redness) or ulceration.[4] The surface is irregular, and people may occasionally have loose sections of
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mucosa that comes away.

Causes
The cause is chronic parafunctional activity of the masticatory system, which produces frictional,
crushing and incisive damage to the mucosal surface and over time the characteristic lesions develop.
Most people are aware of a cheek chewing habit, although it may be performed subconsciously.[4]
Sometimes poorly constructed prosthetic teeth may be the cause if the original bite is altered. Usually
the teeth are placed too far facially (i.e. buccally and/or labially), outside "the neutral zone", which is the
term for the area where the dental arch is usually situated, where lateral forces between the tongue and
cheek musculature are in balance. Glassblowing involves chronic suction and may produce similar
irritation of the buccal mucosa.[4] Identical, or more severe damage may be caused by self-mutilation in
people with psychiatric disorders, learning disabilities or rare syndromes (e.g. Lesch-Nyhan syndrome
and familial dysautonomia).[2]

Diagnosis
The diagnosis is usually made on the clinical appearance alone, and biopsy is not usually indicated.
The histologic appearance is one of marked hyperparakeratosis producing a ragged surface with
many projections of keratin. Typically there is superficial colonization by bacteria. There may be
vacuolated cells in the upper portion of the prickle cell layer. There is a similarity between this
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appearance and that of hairy leukoplakia, linea alba and leukoedema.[4] In people with human
immunodeficiency virus, who are at higher risk of oral hairy leukoplakia, a tissue biopsy may be
required to differentiate between this and frictional keratosis from cheek and tongue chewing.

Treatment and prognosis

The lesions are harmless, and no treatment is indicated beyond reassurance, unless the person
requests it. The most common and simple treatment is construction of a specially made acrylic
prosthesis that covers the biting surfaces of the teeth and protects the cheek, tongue and labial mucosa
(an occlusal splint). This is either employed in the short term as a habit breaking intention, or more
permanently (e.g. wearing the prosthesis each night during sleep). Psychological intervention is also
reported, but does not appear to be beneficial.[4]

Epidemiology
This phenomenon is fairly common, with one in every 800 adults showing evidence of active lesions at
any one time. It is more common in people who are experiencing stress or psychologic conditions. The
prevalence in females is double the prevalence in males, and it is two or three times more prevalent in
people over the age of thirty-five.[4]

References
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1. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St.
Louis: Mosby. ISBN 1-4160-2999-0.[page needed]
2. Scully, Crispian (2008). Oral and maxillofacial medicine : the basis of diagnosis and treatment
(2nd ed. ed.). Edinburgh: Churchill Livingstone. pp. 223, 349. ISBN 9780443068188.
3. "Online Etymology Dictionary" . Retrieved 4 February 2013.
4. Bouquot, Brad W. Neville , Douglas D. Damm, Carl M. Allen, Jerry E. (2002). Oral & maxillofacial
pathology (2. ed. ed.). Philadelphia: W.B. Saunders. pp. 253254. ISBN 0721690033.
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