Traumatic Ulcers Clinical Presentation

  • Author: Glen Houston, DDS, MSD; Chief Editor: William D James, MD   more...
 
Updated: Jan 18, 2012
 

History

  • Patients may report a history of ulceration after a traumatic event such as the following:
    • Biting oneself while talking, sleeping, or secondary to mastication
    • Mechanical trauma
    • Chemical, electrical, or thermal insults[6]
  • In most cases, the source of the injury is identified.
  • The patient's usual complaint is pain or a painful ulceration.
  • Traumatic ulcers are usually sensitive to hot, spicy, or salty foods.
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Physical

  • Surface ulcerations usually heal within 10-14 days, but occasionally, they may persist for a significantly longer time due to systemic factors.
  • Ulcerations can occur throughout the oral cavity.
  • Individual lesions usually appear as areas of erythema that surround a removable, central, yellow, fibrinopurulent membrane.
  • In some patients, a rolled border is apparent adjacent to the area of ulceration.
  • Ulcers may have varying features depending on their cause.
    • Mechanical trauma: Ulcers associated with mechanical trauma are often found on the buccal mucosa, the labial mucosa of the upper and lower lips, and the lateral border of the tongue. The mucobuccal folds, gingiva, and palatal mucosa may also be involved.
    • Electrical insults: Most lesions associated with electrical burns occur in the pediatric population and involve the lips and commissure areas.
    • Thermal insults: Injuries related to hot foods typically occur on the posterior buccal mucosa and the palate.
    • Chemical insults: Chemicals can damage any area of the oral mucous membrane. Examples include aspirin, hydrogen peroxide, silver nitrate, and phenol.[7, 8, 9]
    • Factitial injuries: Self-inflicted ulcerations may arise on any oral mucosal surface and are most frequently observed on the lips, tongue, and buccal mucosa. On the contrary, ulcerations caused by foreign objects most commonly involve the palate and gingiva.
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Causes

The clinical presentation of an ulcer often suggests its etiology.[10]

  • Traumatic ulcers may result from events such as accidentally biting oneself while talking, sleeping, or during mastication.
  • Fractured, carious, malposed, or malformed teeth or the premature eruption of teeth may lead to surface ulcerations.
  • Poorly maintained and ill-fitting dental prosthetic appliances may also cause trauma. Iatrogenic trauma also can occur.[11]
  • Other forms of mechanical trauma (eg, irritation with sharp or hard foodstuffs), as well as chemical, electrical, or thermal insults, may result in ulceration.
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Contributor Information and Disclosures
Author

Glen Houston, DDS, MSD  Chair, Professor, Department of Oral and Maxillofacial Pathology, University of Oklahoma Health Sciences Center

Glen Houston, DDS, MSD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel Mark Siegel, MD, MS  Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physician Executives, American Society for Dermatologic Surgery, American Society for MOHS Surgery, and International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS  Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

  1. Butler J, Fleming P, Webb D. Congenital insensitivity to pain--review and report of a case with dental implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jan 2006;101(1):58-62. [Medline].

  2. Bouquot JE. Common oral lesions found during a mass screening examination. J Am Dent Assoc. Jan 1986;112(1):50-7. [Medline].

  3. Baroni A, Capristo C, Rossiello L, Faccenda F, Satriano RA. Lingual traumatic ulceration (Riga-Fede disease). Int J Dermatol. Sep 2006;45(9):1096-7. [Medline].

  4. Ceyhan AM, Yildirim M, Basak PY, Akkaya VB, Ayata A. Traumatic lingual ulcer in a child: Riga-Fede disease. Clin Exp Dermatol. Mar 2009;34(2):186-8. [Medline].

  5. Padmanabhan MY, Pandey RK, Aparna R, Radhakrishnan V. Neonatal sublingual traumatic ulceration - case report & review of the literature. Dent Traumatol. Dec 2010;26(6):490-5. [Medline].

  6. Gilvetti C, Porter SR, Fedele S. Traumatic chemical oral ulceration: a case report and review of the literature. Br Dent J. Apr 10 2010;208(7):297-300. [Medline].

  7. Maron FS. Mucosal burn resulting from chewable aspirin: report of case. J Am Dent Assoc. Aug 1989;119(2):279-80. [Medline].

  8. Rees TD, Orth CF. Oral ulcerations with use of hydrogen peroxide. J Periodontol. Nov 1986;57(11):689-92. [Medline].

  9. Shetty K. Hydrogen peroxide burn of the oral mucosa. Ann Pharmacother. Feb 2006;40(2):351. [Medline].

  10. Rawal SY, Claman LJ, Kalmar JR, Tatakis DN. Traumatic lesions of the gingiva: a case series. J Periodontol. May 2004;75(5):762-9. [Medline].

  11. Ozcelik O, Haytac MC, Akkaya M. Iatrogenic trauma to oral tissues. J Periodontol. Oct 2005;76(10):1793-7. [Medline].

  12. Hirshberg A, Amariglio N, Akrish S, et al. Traumatic ulcerative granuloma with stromal eosinophilia: a reactive lesion of the oral mucosa. Am J Clin Pathol. Oct 2006;126(4):522-9. [Medline].

  13. Ganesh R, Suresh N, Ezhilarasi S, Rajajee S, Sathiyasekaran M. Crohn's disease presenting as palatal ulcer. Indian J Pediatr. Mar 2006;73(3):229-31. [Medline].

  14. Edlich RF, Farinholt HM, Winters KL, Britt LD, Long WB 3rd. Modern concepts of treatment and prevention of electrical burns. J Long Term Eff Med Implants. 2005;15(5):511-32. [Medline].

  15. Hashem FK, Al Khayal Z. Oral burn contractures in children. Ann Plast Surg. Nov 2003;51(5):468-71. [Medline].

  16. Hitchings A, Murray A. Traumatic ulceration mimicking oral squamous cell carcinoma recurrence in an insensate flap. Ear Nose Throat J. Mar 2004;83(3):192, 194. [Medline].

  17. Gallego L, Junquera L, Llorente S. Oral carcinoma associated with implant-supported overdenture trauma: a case report. Dent Traumatol. Feb 2009;25(1):e3-4. [Medline].

 
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