eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa
Traumatic Ulcers
Updated: Jun 17, 2009
Introduction
Background
Traumatic injuries involving the oral cavity may typically lead to the formation of surface ulcerations. The injuries may result from events such as accidentally biting oneself while talking, sleeping, or secondary to mastication. Other forms of mechanical trauma, as well as chemical, electrical, or thermal insults, may also be involved. In addition, fractured, carious, malposed, or malformed teeth, as well as the premature eruption of teeth, can contribute to the formation of surface ulcerations. Poorly maintained and ill-fitting dental prosthetic appliances may also cause trauma.
Pathophysiology
Nocturnal parafunctional habits, such as bruxism (ie, grinding of the teeth) and thumb sucking, may be associated with the development of traumatic ulcers of the buccal mucosa, the labial mucosa, the lateral borders of the tongue, and the palate. In addition, local irritants such as fractured or malposed teeth and ill-fitting dentures may cause mucosal ulcers of the buccal mucosa, the lateral and ventral surfaces of the tongue, and the alveolar mucosa overlying the osseous structures. Healing of the ulcerated mucosa is usually delayed when the lesions overlie the maxillary or mandibular alveolar process. Ulcerations may be the result of voluntary, self-induced, and deliberate acts by patients with physical or psychological symptoms who are seeking medical attention. Butler et al report a patient with a congenital insensitivity to pain. The patient presented with self-mutilation bite injuries to the oral tissues and to his hands.1
Frequency
United States
Although the exact incidence is unknown, traumatic ulcerations are considered the most common oral ulcerations.2
Mortality/Morbidity
- Rarely, infection is a consequence of a traumatic event.
- Chronic ulcerations as a result of trauma (from fractured, carious, malformed teeth, as well as ill-fitting dentures) have not been associated with premalignant/malignant transformation in the oral mucosa.
Age
- Newborns and infants: Sublingual ulcerations (as in Riga-Fede disease) may occur as a result of chronic mucosal trauma due to adjacent anterior primary (baby) teeth. The trauma is often associated with breastfeeding.3,4
- Children: The major traumatic injuries in this group include electrical and/or thermal burns of the lips and commissure areas. Extensive ulcerations with necrosis may develop. Children tend to be curious about electrical cords and other items unknown to them, and as they explore these items, they tend to put them in their mouth.
- Adults: Ulcers are typically the result of traumatic injuries related to carious, fractured, or abnormal teeth; involuntary movements of the tongue and mandible; ill-fitting maxillary and/or mandibular dentures; overheated foods; and xerostomia (ie, dry mouth).
Clinical
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
- 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.
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.5,6,7
- 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.
Causes
The clinical presentation of an ulcer often suggests its etiology.8
- 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.9
- Other forms of mechanical trauma (eg, irritation with sharp or hard foodstuffs), as well as chemical, electrical, or thermal insults, may result in ulceration.
More on Traumatic Ulcers |
 Overview: Traumatic Ulcers |
| Differential Diagnoses & Workup: Traumatic Ulcers |
| Treatment & Medication: Traumatic Ulcers |
| Follow-up: Traumatic Ulcers |
| References |
| Next Page » |
References
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].
Bouquot JE. Common oral lesions found during a mass screening examination. J Am Dent Assoc. Jan 1986;112(1):50-7. [Medline].
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].
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].
Maron FS. Mucosal burn resulting from chewable aspirin: report of case. J Am Dent Assoc. Aug 1989;119(2):279-80. [Medline].
Rees TD, Orth CF. Oral ulcerations with use of hydrogen peroxide. J Periodontol. Nov 1986;57(11):689-92. [Medline].
Shetty K. Hydrogen peroxide burn of the oral mucosa. Ann Pharmacother. Feb 2006;40(2):351. [Medline].
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].
Ozcelik O, Haytac MC, Akkaya M. Iatrogenic trauma to oral tissues. J Periodontol. Oct 2005;76(10):1793-7. [Medline].
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].
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].
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].
Hashem FK, Al Khayal Z. Oral burn contractures in children. Ann Plast Surg. Nov 2003;51(5):468-71. [Medline].
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].
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].
Further Reading
Keywords
traumatic oral ulcers, oral ulcers, oral ulcerations, sublingual ulcerations, Riga-Fede disease, electrical burns, thermal burns, bruxism, food sensitivity
