bubble_chart Overview

Traumatic ulcer refers to an ulcer formed in the oral cavity due to long-term chronic mechanical injury caused by residual roots, sharp tooth edges, malpositioned teeth, or poorly fitted dental restorations; or ulcers resulting from self-injurious habits such as chronic cheek or lip biting. The shape of the ulcer perfectly matches the stimulating factor.

bubble_chart Etiology

According to the duration of mechanical stimulation, it can be divided into persistent and non-persistent stimulating factors.

1. Persistent mechanical stimuli include residual crowns or roots formed due to caries destruction in the oral cavity, sharp edges, pointed cusps, and poor restorations.

2. Non-persistent mechanical stimuli such as hard and brittle food irritation, accidental biting during chewing, toothbrush injury, or improper use of instruments by dentists during treatment can all cause trauma to the mucous membrane and lead to ulcerative lesions.

bubble_chart Clinical Manifestations

(1) Physical injury

This is the most common type of traumatic ulcer, such as sharp edges of residual roots or crowns caused by caries, poorly fitted restorations, or sharp cusps that can lead to ulceration or erosion of the corresponding mucous membrane. Initially, there may be only mild pain or swelling, but over time, inflammatory reactions develop around the ulcer, with a hardened base and even tissue hyperplasia. When occurring on the tongue margin in elderly individuals, it is often suspected to be carcinoma of the tongue. The size, location, and depth of the ulcer vary but correspond to the irritant. The severity of the condition depends on the duration of the irritant and the patient's overall health. Secondary infection can exacerbate pain, cause regional lymph node swelling and tenderness, and lead to functional impairment.

Sharp edges of restorations or excessively long baseplates can compress the vestibular groove mucous membrane, forming an ulcer. Commonly, not only ulcers but also tissue hyperplasia are observed at the margins of denture baseplates, known as decubital ulcer (bedsore ulcer). If a fixed bridge compresses the gums, an ulcer may form beneath the pontic.

In infants, the bilateral mucous membrane near the pterygoid hamulus can develop ulcers due to friction from overly hard rubber nipples during artificial feeding, termed Bednar ulcer. Prolonged breastfeeding after primary teeth eruption can also cause ulcers due to friction between the lingual frenulum, ventral tongue, and incisal ridges. Initially, localized congestion occurs, followed by small ulcers. Persistent irritation can lead to ulcer enlargement, increased pain, and even tissue hyperplasia.

Acute or accidental mechanical injuries are also common, such as trauma, bites, overly hard or improperly used toothbrushes, or improper use of dental drills or abrasives, causing acute injury, ulceration, or even laceration of the mucous membrane.

(2) Chemical injury

Chemical injury to the oral mucous membrane results from improper topical medication or accidental ingestion of strong acids or alkalis. During dental treatment, corrosive agents like arsenic trioxide devitalizing agents, iodine phenol, or silver nitrate solution can inadvertently injure the mucous membrane if used carelessly. For example, arsenic trioxide may leak due to inadequate temporary cement sealing, leading to grayish-brown tissue necrosis of the mucous membrane or even alveolar bone necrosis. Improper use of silver nitrate or trichloroacetic acid can also cause mucous membrane necrosis. Additionally, patients sometimes place painkillers like aspirin on the gums for toothache relief, leading to chemical injury with localized congestion, erosion, and a white pseudomembrane.

(3) Mucous membrane hematoma

Clinically, hematomas often form immediately on the soft palate, buccal mucosa, or pharyngeal mucosa due to friction from consuming overly hot or hard foods during chewing or swallowing, though the exact cause remains unclear. Patients may experience a foreign sensation or stabbing pain, and upon opening the mouth, a purplish-red hematoma with a thin wall, varying in size and shape, is visible. After rupture, the hematoma membrane covers the area, later necrotizing and shedding to reveal a clearly demarcated, bright red ulcer with slight exudate and surrounding mucosal congestion. Patients report burning pain, exacerbated by speaking or eating. If the injury is extensive, healing is slow, with gradual granulation tissue growth and eventual epithelial coverage.

bubble_chart Diagnosis

There is a history of mechanical irritation or the presence of mechanical irritants near the lesion. The shape of the ulcer matches the morphology of the irritant. If the irritant is removed, the ulcer can heal within a short period.

If the ulcer does not heal after removing the irritant, further examination and diagnosis should be conducted.

bubble_chart Treatment Measures

(1) Physical Injury

First, remove local irritants, such as extracting residual roots or crowns, modifying or removing unsuitable restorations, and smoothing sharp cusps or incisal edges. Blunt the incisal edges of deciduous incisors. If ulcers have not healed, use a spoon for feeding. Replace rubber pacifiers.

Use anti-inflammatory and analgesic medications to prevent infection and relieve pain: apply 2% Chinese Gentian Violet, 2.5% aureomycin glycerin, or various antibiotic membranes topically. Gargle with Dyclonine solution or Procaine solution. Apply Chinese medicinal powders externally: Nourishing Yin to Promote Tissue Regeneration Powder, Xi Lei San, etc.

(2) Chemical Injury

If detected promptly, rinse with a corresponding neutralizing solution, apply topically, or rinse with warm water. For large and painful ulcers, use anti-inflammatory and analgesic agents, along with Chinese medicinal powders or medicated membranes for topical application.

(3) Mucosal Blood Blister

For fully distended blood blisters, puncture with a sterilized needle to drain the blood or aspirate with a syringe. When the ulcer surface is exposed, use intraoral ultraviolet light therapy or other physical therapy measures. Apply local anti-inflammatory and analgesic treatments, and gargle with antibiotic mouthwash.

bubble_chart Differentiation

1. Differential Diagnosis from Recurrent Aphtha

Table: Differential Diagnosis between Traumatic Ulcer and Recurrent Aphtha

2. Cancer

For proliferative lesions on the tongue margin, especially those with ulceration, the possibility of cancer should first be considered. Traumatic ulcers caused by residual roots or crowns clinically resemble cancer. Apart from differentiating through medical history and examination, the most crucial step is to first remove local irritants rather than perform a biopsy. If an irritant is found at the corresponding site, it should be removed. Even if the lesion is severe, rapid improvement can occur after irritant removal. If the ulcer does not heal after removal, a timely biopsy should be performed for definitive diagnosis. 3. Periadenitis Aphtha

First, carefully search for irritants at the corresponding site of the lesion. After excluding local factors, consider the diagnosis based on medical history and intraoral examination. Periadenitis aphtha has a prolonged ulceration phase and should be closely monitored. 4. Subcutaneous Nodule-Associated Ulcer

The first step is also to thoroughly examine the corresponding site of the lesion for any irritants. Then, based on medical history and ulcer characteristics—such as a granulation-like base and irregular margins—conduct further examinations, including a chest X-ray if necessary. A biopsy can aid in definitive diagnosis.