Doctors Revision

Oral & Dental Health

Oral Trauma - Burns, Sharp Teeth, LA Ulceration

Oral mucosal lesions caused by specific types of trauma: thermal or chemical burns, irritation from sharp teeth/restorations, or self-inflicted biting after local anaesthesia.

Also known as: Mouth Burns, Traumatic Oral Ulcers

Open in the interactive guide
On this page

Referral and warning signs

When to refer

Refer to Dental personnel (HC4+/RR) to address sharp teeth/restorations. Refer if diagnosis uncertain, lesion persists >2 weeks, or secondary infection suspected needing antibiotics.

Red flags

  • Ulcer persisting > 2-3 weeks (consider biopsy).
  • Signs of significant secondary infection (spreading cellulitis, fever).

Signs and symptoms

  • Thermal/Chemical Burns: Redness, blistering, or white/grey necrotic slough on mucosa. Painful. Location related to cause (e.g., palate/tongue for hot food; adjacent to tooth for chemical burn like aspirin placement).
  • Trauma from Sharp Teeth/Restorations: Ulceration or irritation corresponding directly to location of sharp edge.
  • Local Anaesthetic (LA) Ulceration: Painless biting of numb lip, cheek, or tongue during anaesthesia leads to large, often irregular ulceration appearing after anaesthesia wears off. Usually significant swelling.
  • Common feature: Pain/discomfort, difficulty eating.

Risk factors

  • Burns: Consuming very hot food/liquids. Improper use of chemicals in mouth (e.g., holding aspirin against tooth, caustic substances).
  • Sharp Teeth: Fractured teeth, broken fillings, ill-fitting dentures.
  • LA Ulceration: Dental procedures involving local anaesthesia (especially children, patients with intellectual disability).

Diagnosis

Clinical assessment

Diagnosis based primarily on history relating the lesion to a specific traumatic event (burn, sharp edge, recent LA) and the clinical appearance and location of the lesion.

Differential diagnosis

  • Aphthous ulcer.
  • Herpetic stomatitis.
  • Infectious ulcers.
  • Erosive lichen planus.
  • Malignancy (persistent ulcer).

Investigations

  • Clinical examination.
  • Dental examination to identify sharp edges.

Diagnostic criteria

Clinical lesion consistent with history of specific trauma.

Management

Non-pharmacological management

  • Burns: Reassurance (usually heals without scarring). Avoid further irritation. Soft diet.
  • Sharp Teeth: Smooth the sharp edge of tooth/restoration or repair/replace faulty restoration. (LOC: HC4+/RR - Dental)
  • LA Ulceration: Reassurance (will heal). Soft diet. Maintain hygiene.

Pharmacological treatment

  • Symptomatic Relief:
  • - Topical Anaesthetic: Lidocaine 2% gel/viscous solution applied before meals may help with eating. (LOC: RR - as per UCG, but may be available HC4)
  • - Antiseptic Mouthwashes: Chlorhexidine or Warm Salt Water rinses to prevent secondary infection.
  • Antibiotics: Generally NOT needed unless clear signs of secondary bacterial infection develop (increasing pain, swelling, pus, fever).
  • - If secondary infection suspected (e.g., for LA ulcer): Amoxicillin 500mg PO Q8H for 5-7 days. (LOC: RR - as per UCG, likely applicable HC4 if infection)

Monitoring

Monitor healing of lesion (typically 7-14 days). Ensure source of trauma (sharp tooth) is addressed.

Complications

  • Secondary infection.
  • Pain impacting nutrition/hydration.
  • Delayed healing.
  • Scarring (rare, severe burns).

Prevention

  • Caution with hot foods/liquids.
  • Avoid holding medications against oral tissues.
  • Regular dental care to address sharp teeth/restorations.
  • Warning patients (especially parents of children) about risk of biting numb tissues after LA; advise soft diet until sensation returns.

Patient education

  • Explanation of the cause of the lesion (burn, bite, irritation).
  • Reassurance about healing.
  • Symptomatic relief measures.
  • How to prevent recurrence (avoid cause, smooth teeth, care after LA).
  • Signs of infection requiring review.

Uganda-specific notes

Traumatic ulcers common. Need to differentiate from infectious causes. Addressing sharp teeth requires dental referral. Educating patients post-LA is important.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 23, Section 23.4.2

Scroll to Top