Oral Ulceration

Physical injuries

Common physical injuries may include biting the cheek or tongue, mal-fitting denture irritation, trauma from a foreign object or even trauma from a toothbrush following over-zealous brushing. Direct mucosal contact with any number of drugs, most commonly aspirin, may cause ulceration. Chemical burns can also be seen in patients who have used phenol or silver nitrate for treating recurrent aphthous ulcers. These and other noxious chemicals cause oral ulcerations, often in the form of a generalized sloughing of the oral mucous membranes that produces a painful, raw, bleeding lesion. Hot foods or liquids may cause oral ulceration also. The classic example of this type injury is the “pizza burn” from hot melted cheese contacting the palate, tongue, or lips.

Traumatic injuries to the oral mucosa are treated by removing the responsible irritant, after which healing is usually uneventful. Healing may be expedited by cleansing the tissues with a mild saline rinse with half strength peroxide.

Chemical and thermal injuries

Chemical and thermal injuries to the oral mucosa are often more painful, requiring analgesics during the healing period. Supportive therapy, including attention to oral hygiene and the use of cleansing mouth rinses, is indicated. Although healing of thermal injuries is usually uneventful, supportive therapy, medications for pain, or topical cortcosteroids, or all, may be indicated.

Cancer chemotherapy agents are extremely powerful drugs that have as a side effect the potential for disruption or destruction of the oral tissues. Chemotherapy-induced stomatitis is a common side effect of many of the antineoplastic drugs and may present as an excruciatingly painful mucositis involving any of the oral mucous membranes either in a localized or generalized fashion. Also, the concomitant suppression of the immune system by these agents may make the patient unable to fight secondary opportunistic infections that may develop in areas in which the mucous membrane has become ulcerated. These oral manifestations of chemotherapy occur shortly after the beginning of therapy, peak within a week after its cessation, and slowly resolve unless otherwise complicated by infection, hemorrhage, or restarting therapy. These lesions are treated palliatively with cleansing mouth rinses, topical anesthetics, antimicrobial agents, or with the use of analgesics.