1. Sore gums

A 57-year-old IT negotiator complained of tender gums generally, first noticed about 5 years previously. The condition was persistent, worsening through the day, and sometimes associated with gingival bleeding and a salty taste. The condition was worse in the anterior mandible, and always facially. He denied any blistering or ulcers on the gingivae or elsewhere. Treatment with benzydamine and chlorhexidine mouthwashes and low dose corticosteroid mouthrinses (betametasone) had not significantly improved his symptoms.

There were no cutaneous, gastro-intestinal, genital, ocular or joint problems (apart from traumatic arthritis) and no history of fever. The medical history included knee arthritis from sports. He had a family history of hypercholesterolaemia. There were no other cardiorespiratory or bleeding problems. The patient was on medication with citalopram (for a work-related stress episode) and simvastatin, and had no known allergies. The social history included no tobacco use but alcohol consumption at 60 units weekly. Liver function had been normal when tested twice in the past year.