Article
A 25-year-old woman complained of severe pain in the floor of her mouth for 3 days following toothache from a lower anterior tooth. This lesion was not associated with fever, malaise or cervical lymphadenopathy and appeared one day after an episode of toothache from a necrotic central right lower incisor. That pain was relieved by an aspirin put directly by the patient lingual to the responsible incisor. No other similar lesions were seen on the day of the examination or from the past and the patient had no serious diseases and was not on any other medication.
Clinical examination revealed a white slough which could be easily removed leaving an haemorrhagic, painful ulceration unfixed to the surrounding tissues, with a diffuse erythema in the floor of her mouth.
Q1. Which is the likely diagnosis?
A1. The answer to which is the likely diagnosis?
The history and clinical information suggest a chemical burn is most likely. Direct application of aspirin to the mucosa can cause severe local necrosis seen as a large ulceration covered with white exudate.
Major aphtha is unlikely due to the absence of similar lesions in the past. Syphilitic ulcerati on is always a possibility but more commonly associated with malaise and lymphadenopathy. Tuberculosis is a rare cause of an ulcer in the floor of mouth but is usually a secondary lesion whose origin comes from the lungs. Carcinoma of the floor of the mouth can also present as an ulcer but is hard, like a rubber, and often associated with cervical lymphadenopathy.
Q2. Which is the best management?
A2. The answer to which is the best management?
The dentist should advise the patient with a chemical burn in his/her mouth to have a soft diet without hot or spicy foods that may cause irritation and delay healing, and check the patient again after one week. The use of antiseptic mouthwashes could help the healing. In more severe burns, wide spectrum antibiotics and/or steroids, together with painkillers may be needed to control the inflammation and symptomatology.
