Traumatic Ulcers Clinical Presentation

Updated: Oct 09, 2017
  • Author: Glen Houston, DDS, MSD; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Presentation

History

See the list below:

  • 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

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  • 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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