bubble_chart Overview

Traumatic stomatitis is a nonspecific acute or chronic inflammation caused by mechanical, chemical, or physical factors leading to oral mucosal injury.

bubble_chart Etiology

1. Mechanical Factors
   This is the most common cause of traumatic stomatitis, often resulting in traumatic ulcers. Depending on the duration of the stimulus, it can be divided into persistent and non-persistent irritants. Persistent irritants include residual crowns or roots after dental caries destruction, sharp cusps, worn tooth edges, clasps or sharp edges of poorly fitted prostheses, overextended baseplates, and friction caused by a short lingual frenulum against newly erupted mandibular deciduous incisors—all of which can remain in the oral cavity for long periods and cause chronic traumatic damage. Non-persistent mechanical irritants include hard or brittle foods (such as fried or baked hard foods), rubber nipples made of hard material, accidental bites while chewing, old toothbrushes with uneven bristles, improper brushing force, improper use of instruments by dental professionals, or other external injuries, all of which can cause acute injury to the oral mucosa.
2. Chemical Factors
   Common chemical irritants include corrosive strong acids or alkalis, as well as dental treatment agents such as phenol, silver nitrate, and arsenic trioxide that come into contact with the oral mucosa. Clinically, these injuries often occur due to accidental ingestion or improper use, and sometimes result from self-harm.
3. Physical Factors
   Thermal injuries to the oral mucosa are relatively rare, occasionally caused by excessively hot beverages, tea, or food. Exposure to radiation beyond a certain dose, whether systemic or localized to the head and face, can cause systemic and oral tissue injuries, leading to acute radiation sickness and/or radiation-induced stomatitis, with inflammation being the primary manifestation. In wartime, such injuries occur after nuclear weapon explosions, while in peacetime, they are mostly caused by radiation therapy for malignant tumors or radiation accidents.

bubble_chart Diagnosis

1. Traumatic ulcer
Mechanical irritants can cause injury to the oral mucosa, most commonly resulting in traumatic ulcers. The characteristics of the ulcer may vary depending on the nature of the injury, the duration of the ulcer, its location, and whether there is secondary infection.
1. Decubital ulcer (decubital ulcer)
A decubital ulcer is a deep ulcer of the oral mucosa caused by persistent mechanical irritation. It is more common in adults, especially the elderly. Long-term chronic irritation from residual roots, residual crowns, or poorly fitting dentures can lead to lesions in adjacent areas, most commonly on the lingual margin and the mucosa of the lips and cheeks. In the early stages, the irritated mucosa becomes red, with grade I swelling and pain. If the irritation is promptly removed, the mucosa can return to normal; otherwise, an ulcer forms. The ulcer is round or irregular in shape, matching the size and shape of the irritant. For example, pressure from a denture base can cause round or narrow, elongated ulcers in the floor of the mouth or vestibular groove that correspond to the base. Due to prolonged mucosal irritation, some ulcers may extend to the submucosal layer, forming deep ulcers. The ulcer edges are slightly raised, with a central depression and a surface covered by a pale yellow or gray-white pseudomembrane. Local lymph nodes may be palpable.

In children with chronic periapical inflammation of deciduous teeth, if the alveolar bone is already damaged, the pressure from erupting permanent teeth may sometimes cause the root apex of the deciduous tooth to perforate the gingival surface, exposing the ulcer in the oral cavity and irritating the mucosa, leading to a decubital ulcer. The root apex often protrudes directly into the ulcer, with this condition more commonly seen in the upper lip and cheeks.

Because the irritation causing decubital ulcers is mild and long-term, the ulcer surface is mostly composed of inflammatory granulation tissue and lacks nerve fibers, so the pain is not very pronounced. However, pain may worsen with secondary infection.

2. Hyperplastic lesion (hyperplastic lesion)
More common in the elderly, long-term and mild chronic irritation from ill-fitting denture bases can lead to proliferative inflammatory lesions in the tissue. The mucosa becomes tough and granulomatous, sometimes accompanied by small ulcerated surfaces, or only inflammatory hyperplasia without ulceration. Patients generally do not exhibit significant pain symptoms.

3. Acute injury lesions
These often cause lacerations or abrasions of the oral mucosa. For example, children often insert foreign objects into their mouths, and if they fall while running, the objects can easily puncture the mucosa, causing abrasions and soft tissue lacerations. Bite injuries are also a common clinical trauma, typically occurring on the tongue, cheeks, or lips, usually resulting in small ulcers. A rare type of bite injury occurs in epileptic patients during seizures, where the tongue may be bitten, leading to larger ulcers or even tissue loss in severe cases.

4. Riga disease
Also known as Riga-Fede disease, this refers specifically to ulcers on the lingual frenulum of infants caused by trauma. It is more common in infants with a short lingual frenulum. The sharp edges of newly erupted lower incisors, combined with the short frenulum limiting tongue movement during suckling, cause friction between the incisors and the ventral tongue or frenulum, leading to ulcers. The ulcer edges are clear, the surface is uneven, and covered with a gray-white pseudomembrane. Over time, the edges may become raised with inflammatory hyperplasia.

5. Bednar aphtha
The palatal mucosa of infants is thin, especially near the pterygoid hamulus. Friction or pressure from a hard rubber nipple or other foreign objects can cause round or oval shallow ulcers.

II. Mucosal Blood Blister
Clinically, mucosal blood blisters (mucosal hematoma) often result from friction caused by brittle or hard foods or accidental biting of the oral mucosa. They commonly occur on the soft palate, pharyngeal wall, buccal mucosa, tongue, and corners of the mouth. Patients may suddenly experience localized discomfort or severe pain while chewing, and upon opening the mouth, a blood blister can be observed on the mucosa. The blister appears purplish-red with a thin wall, measuring approximately 1–3 cm in size. Large blisters may rupture quickly, leading to bleeding. After rupture, the blister membrane covers the area, which later undergoes necrosis and sloughing, leaving a clearly demarcated, bright red erosion with minimal exudate. The surrounding mucosa becomes congested, and the patient experiences a burning pain that worsens with speaking or eating. The condition typically heals within 7–14 days. Smaller blood blisters are less prone to rupture. If the blood is aspirated from the blister and no secondary infection occurs, healing can be achieved within 1–2 days.

III. Chemical Burns
Corrosive chemicals primarily cause coagulation of mucosal tissue proteins, leading to tissue necrosis. A thin white necrotic membrane forms on the lesion surface, which, if wiped away, reveals a bleeding red erosion with accompanying pain. For example, when sealing arsenic trioxide for pulp devitalization, if the temporary cement is improperly sealed and the arsenic agent leaks, it not only damages the gums and adjacent mucosa, causing grayish-brown tissue necrosis, but may even lead to alveolar bone necrosis.

IV. Thermal Burns
Grade I burns only present with mucosal redness, mild pain, or numbness, without erosion or ulcer formation. However, severe thermal injury can cause blisters, which, upon rupture, form erosions or shallow ulcers with significant pain.

V. Radiation Injury
Typically, reactions appear around the second week post-irradiation when the dose reaches approximately 1.29C/kg, resulting in radiation-induced stomatitis. Initially, diffuse erythema occurs, followed by blood blisters that rupture to form ulcers or erosions covered by grayish-yellow pseudomembranes, potentially leading to secondary infections. Additionally, it may cause gingival bleeding, gingivitis, pericoronitis, dry mouth, and other symptoms.

bubble_chart Treatment Measures

1. Elimination of Local Irritants
   First, remove residual roots or crowns, modify or remove unsuitable restorations, and grind down sharp cusps or edges. For Riga disease, blunt the incisal edges of mandibular deciduous incisors. When ulcers are unhealed, use a spoon for feeding. After the ulcers heal and the child grows older, surgically correct a short lingual frenulum and replace overly hard rubber nipples.
2. Local Treatment
   The principles are to prevent secondary infection, relieve pain, and promote ulcer healing. Options include gargling with 1% procaine solution or applying 0.5% dyclonine solution for pain relief; rinsing with anti-inflammatory mouthwash; applying 2% Chinese gentian violet or 2.5% aureomycin glycerin; or placing various anti-inflammatory membranes. Traditional Chinese medicinal powders such as ulcer powder or nourishing yin to promote tissue regeneration powder may also be applied externally. For chemical burns, rinse thoroughly with saline. Puncture tense blood blisters with a sterile needle; if already ruptured, treat as above.
3. Systemic Treatment
   For secondary infections, localized lymphadenopathy, or pain, administer antibiotics and vitamins as needed.

bubble_chart Differentiation

Traumatic stomatitis, although varying in manifestations due to different irritants and lesion sites, is mostly straightforward in terms of etiology, making diagnosis relatively easy.

1. There is a history of injury, or obvious irritants are present at the corresponding site of the lesion.

2. The characteristics of the lesion are consistent with the irritant.

3. The lesion heals once the local irritant is removed. For chronic ulcers that do not heal after the irritant is removed, or for ulcers that are deep, large, and have a hard base, a biopsy should be performed to differentiate them from cancer.