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 Table of Contents  
Year : 2016  |  Volume : 6  |  Issue : 1  |  Page : 7-10

Injuries to oral soft tissues by different factors: A clinical study

1 Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India
2 Department of Dentistry, M.D.M. Hospital, Jodhpur, Rajasthan, India
3 Department of Dentistry, Guru Kirpa Dental Clinic, Bhadaur, Punjab, India
4 Department of Oral Medicine and Radiology, A.J. Institute of Dental Sciences, Mangalore, Karnataka, India

Date of Web Publication11-Aug-2016

Correspondence Address:
Smit Singla
C/o Dr. Snehil, Guru Kirpa Dental Clinic, Jaid Market, Bhadaur - 148 102, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2229-6360.188217

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Background: Injuries to oral soft tissues are common. These can be caused by chemical, thermal, physical agents, self-mutilation, denture associated, etc., In this study, 110 patients were included from western Punjab population coming for routine checkup. Different causes for different types of injuries were noticed and tabulated to find the percentage of each cause, causing injuries to oral soft tissue.
Objective: To determine the quantitative analysis of different causes which are a causative factor of oral injuries.
Methods: The sample for the study consisted of 110 patients undergoing routine dental checkup in the dental center. Quantitative analysis of each causing factor was done by taking proper history from the patients and careful oral examination.
Results: Females are more prone to soft tissue injuries as compared to males, and chemical burn is most common cause of soft tissue injury found in 44 patients followed by denture associated ulcers in 36 patients out of 110 patients.

Keywords: Chemical burn; oral injuries; soft tissues; ulcers

How to cite this article:
Singla S, Verma A, Goyal S, Singla I, Shetty A. Injuries to oral soft tissues by different factors: A clinical study. Indian J Multidiscip Dent 2016;6:7-10

How to cite this URL:
Singla S, Verma A, Goyal S, Singla I, Shetty A. Injuries to oral soft tissues by different factors: A clinical study. Indian J Multidiscip Dent [serial online] 2016 [cited 2021 Dec 4];6:7-10. Available from: https://www.ijmdent.com/text.asp?2016/6/1/7/188217

  Introduction Top

Injuries to soft tissues can occur due to many causes but chemical, thermal, and physical agents are the main causative factors. Clinically, soft tissue injuries presentation differs but mainly present as erythema, edema, desquamation, burn, ulceration depending on the nature, type, concentration, quantity, duration of contact of causative agent with tissues, and extent of penetration of the causative agent to the tissue. Such injuries in different clinical forms may mimic other oral well-known diseases. [1],[2],[3] Clinical diagnosis of soft tissue injuries is usually be diagnostic challenge, and detailed history and review of the patient will help to diagnose the possible causative agent of that particular injury. Removal of that causative agent is necessary for proper healing. The early detection of the lesion and immediate therapeutic measures ensure a rapid cure which prevents further damage.

In this study, we have done quantitative analysis of the causative agents causing oral soft tissue injuries. All the patients thoroughly examined and causative agent was detected, which was causing injury and evaluated quantitatively. In the literature, there is no single study in which quantitative analysis of causative agents is done.

  Methods Top

One hundred and ten patients belonging to any age group having oral soft tissue injuries were included in the study, which came for dental checkup in the private dental center. Systemically, healthy patients based on the history were included in the study. Patients were informed and asked to provide informed consent for their voluntary participation in the study, and their identity will kept confidential. Ethical clearance is not required as said because only clinical examination was done neither any investigation nor any sample from the patient was taken, and only those patients were included in the study who gave informed consent form.

Full mouth examination was conducted for all the patients. Age, gender, medical, and dental histories were recorded for each patient. Thorough examination of oral soft tissue injuries was done. Clinical picture of soft tissue injuries vary from the erythema, edema, desquamation, and burn to ulceration. Thorough history for oral soft tissue injury was taken to detect the causative agent which is causing oral soft tissue injury.

  Results Top

Characteristics of the study population are shown in [Table 1]. Female constituted about 65.5% and male constituted about 34.5% of the study sample. The mean age of male and female patients participating in the study was 42.7 and 37.5, respectively. From the results, it is clear that females are more prone to oral soft tissue injuries as compared to males. In this study, we found most common soft tissue injury is due to chemical burn, i.e., with the use of acidic chemical agents which constitute 30 patients out of 110 patients and alkaline chemical agents causing burns in 14 patients out of 110 patients, so total chemical burn causing soft tissue injuries found in 44 patients followed by denture associated ulcer out of 110 patients 36 patients had denture associated ulcers as shown in [Table 2].
Table 1: The characteristics of the population which were included in the study group

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Table 2: The different causes of soft tissue injuries and site of the injuries

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Some patients had self-polymerizing acrylic filling in the interdental region which leads to irritation and causing injury in 4 patients out of 110 patients. We found six patients had injury due to self-infliction, three patients due to allergic reaction, and four patients due to nonallergic reaction, respectively. In this study, we found thermal burn causing injuries in five patients and sharp tooth causing injury in eight patients as shown in [Table 2].

  Discussion Top

Oral soft tissue injuries are relatively common finding in dental practice. Here, we are going to discuss each factor what we have found in our patients during study period. Chemical burn is most common causing agent for oral soft tissue as we found in our study. Chemical injuries of oral soft tissue may occurs due to large number of chemical agents, which come in contact with oral cavity such as alcohol, sodium hypochlorite, calcium hydroxide, cavity varnish, dentine bonding agent, phosphoric etching solution, iodine, ferric sulfate, chromic acid, hydrofluoric acid, formocresol, hydrogen peroxide, clove oil, silver nitrate, phenol, sodium perborate, trichloroacetic acid, and eucalyptus oil clinical presentation depends on the concentration, type, quantity, and time of contact of chemical agent with oral tissues. Chemical agent may be acidic or alkaline both can cause considerable damage to oral mucous membrane as they act with different pathological mechanism. Acidic chemical agents follow coagulation necrosis which causing oral injuries, whereas alkali agents follow liquefaction necrosis for oral soft tissue injuries. [1],[2],[4],[5],[6],[7]

Chemical injuries of oral cavity can be divided into nonallergic and allergic reactions. Nonallergic reactions may be due to the local use of different chemicals causing injuries at the site of application of chemicals. Nonallergic reaction can also occurs due to systemically administered compounds such as bismuth, arsenic, lead, silver, and mercury. Drugs used in the treatment of epilepsy, prophylaxis, and malignancies may cause gingival hyperplasia, discoloration of teeth, and mucosal injuries. [1],[8]

Allergic reactions of oral cavity may be (a) immediate or (b) delayed. Clinically, immediate reactions may include itching, swelling, pricking sensation, edema, vomiting, and pain. Delayed hypersensitivity reactions may clinically manifest as dermatitis medicamentosa or stomatitis medicamentosa, erythematic rashes, pruritus, desquamative dermatitis, arthralgia fever, lymphadenopathy, multiple areas of erythema, areas of erosion or ulcerations, and gingival ulceration mimicking acute necrotizing ulcerative gingivitis. [1],[2],[6],[9]

Self-polymerizing acrylic is also a causative factor for oral mucosal injuries; in this study, we found out of 110 patients four patients had injuries due to self-polymerizing acrylic. Cold cure acrylic when applied directly on oral mucosa, it will cause the chemical burn as it contains methyl methacrylate as a residual monomer which has potential to elicit irritation, inflammation, allergic response, and leads to oral mucosal injuries. Singh et al. in 2010 found a case where of cold cure acrylic used to fill the interdental space having impact on both hard and soft tissues of the oral cavity. [10] In our study in four patients, we found the similar results.

In our study, we found six patients had oral mucosal injuries due to self-infliction. Self-infliction is many types such as cheek biting, biting of lip, pricking with hairpin, needle and tooth pick, proper counseling of the patient is necessary for management. Woo and Lin in 2009 reported mucosal biting where they refer as morsicatio mucosae oris with a prevalence of 9.0% in a retrospective study. [11] Shimoyama et al. in 2003 found a Tourette's syndrome due to self-mutilation of the upper lip. [12] In some cases, patient is very addict to these type of habit, and proper counseling is needed to prevent further injuries.

Hilderbrand et al. in 2011 found 27 cases of oral self-mutilation in healthy pediatric patients. [13] Oral soft tissue injuries usually occur frequently after the insertion of new dentures. Clinically present as erythema, edema, keratotic, hyperplastic, inflammatory, and ulcerative lesions. We found 36 cases had denture associated injuries mostly involving the buccal and lingual vestibule. In 1985, Dorey et al. reported a positive relationship of oral mucosal abnormalities and denture wearing in 60% of their cohort of patients in a retrospective clinical study. [14] Cook in 1991, Dorey et al. in 1985, Budtz-Jorgensen in 1981 reported inflammatory papillary hyperplasia, a form of tissue overgrowth clinically present as a nodular or papillary surface in the areas of palate covered by a denture. [14],[15],[16],[17]

Mainly, lateral border of the tongue is involved in the traumatic ulcer caused by sharp lingual cusps of the tooth. We had reported eight patients having traumatic ulcers involving tongue. Symptomatic treatment was given after rounding the involved cusps. Traumatic ulcers due sharp cusps usually occur after 30 years of age and frequently found in patients having bruxism habit.

Thermal burn is common due to hot food items, especially hot pizza. In this study, we found five patients having thermal burns. Symptomatic treatment was given to the patients.

  Conclusion Top

Form this study, we concluded that chemical burn is most common cause of soft tissue injuries of oral cavity followed by denture associated injuries. Proper counseling should be needed to prevent the further unnecessarily trauma to oral cavity. Moreover, clinical diagnosis of soft tissue injuries is a challenge as mostly long-standing ulcers may mimic some serious pathology.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Aravind NK, Reddy S, Kumar Goud KA. Chemical injuries of the oral cavity in dental practice - A case report and review. Ann Essences Dent 2014;6:53-5.  Back to cited text no. 1
Dilsiz A. Self-inflicted oral tissue burn due to local behavior and treatment. J Clin Exp Dent 2010;2:e56-8.  Back to cited text no. 2
Vucicevic Boras V, Brailo V, Andabak Rogulj A, Vidovic Juras D, Gabric D, Vrdoljak DV. Oral adverse reactions caused by over-the-counter oral agents. Case Rep Dent 2015;2015:196292.  Back to cited text no. 3
Shetty K. Hydrogen peroxide burn of the oral mucosa. Ann Pharmacother 2006;40:351.  Back to cited text no. 4
Santos-Pinto L, Campos JA, Giro EM, Cordeiro R. Iatrogenic chemical burns caused by chemical agents used in dental pulp therapy. Burns 2004;30:614-5.  Back to cited text no. 5
Mamede RC, de Mello Filho FV. Ingestion of caustic substances and its complications. Sao Paulo Med J 2001;119:10-5.  Back to cited text no. 6
Girish MS, Anandakrishna L, Prakash C, Nandlal B, Srilatha KT. Iatrogenic injury of oral mucosa due to chemicals: A case report of formocresol injury and review. IOSR J Dent Med Sci 2015;14:1-5.  Back to cited text no. 7
Handley TP, McCaul JA, Ogden GR. Dyskeratosis congenita. Oral Oncol 2006;42:331-6.  Back to cited text no. 8
Witton R, Brennan PA. Severe tissue damage and neurological deficit following extravasation of sodium hypochlorite solution during routine endodontic treatment. Br Dent J 2005;198:749-50.  Back to cited text no. 9
Singh V, Mahalinga Bhat K, Subraya Bhat G. Food impaction cured with cold cure acrylic - An iatrogenic dentistry. Indian J Dent Adv 2010;2:294-5.  Back to cited text no. 10
Woo SB, Lin D. Morsicatio mucosae oris - A chronic oral frictional keratosis, not a leukoplakia. J Oral Maxillofac Surg 2009;67:140-6.  Back to cited text no. 11
Shimoyama T, Horie N, Kato T, Nasu D, Kaneko T. Tourette's syndrome with rapid deterioration by self-mutilation of the upper lip. J Clin Pediatr Dent 2003;27:177-80.  Back to cited text no. 12
Hildebrand LC, Carvalho AL, da Rosa FM, Martins MD, Sant'Ana Filho M. Functional oral self-mutilation in physically healthy pediatric patients: Case report and analysis of 27 literature cases. Int J Pediatr Otorhinolaryngol 2011;75:880-3.  Back to cited text no. 13
Dorey JL, Blasberg B, MacEntee MI, Conklin RJ. Oral mucosal disorders in denture wearers. J Prosthet Dent 1985;53:210-3.  Back to cited text no. 14
Cook RJ. Response of the oral mucosa to denture wearing. J Dent 1991;19:135-47.  Back to cited text no. 15
Budtz-Jørgensen E. Oral mucosal lesions associated with the wearing of removable dentures. J Oral Pathol 1981;10:65-80.  Back to cited text no. 16
Turker SB, Sener ID, Koçak A, Yilmaz S, Ozkan YK. Factors triggering the oral mucosal lesions by complete dentures. Arch Gerontol Geriatr 2010;51:100-4.  Back to cited text no. 17


  [Table 1], [Table 2]

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