Chronic Trauma of The Oral Mucosa: A Literature Review

Аннотация

This article explores the causes and pathogenesis of decubital ulcers in the oral cavity, examining their clinical presentation, diagnostic methods, and treatment strategies. It places particular emphasis on distinguishing these ulcers from other types of ulcerative lesions of the oral mucosa. Modern treatment and prevention techniques are discussed, alongside potential complications arising from delayed intervention. The importance of early detection and the removal of the traumatic cause is underscored to prevent the development of chronic conditions or oncological issues. Keywords: Decubital ulcer, oral mucosa, removable dentures, mechanical trauma, treatment, prevention, differential diagnosis. malocclusion; Introduction: 1. Etiopathogenesis of Decubital Ulcers • Weakened local immunity and reduced Decubital ulcers in the oral cavity are caused by salivation, especially in elderly patients [1]. prolonged pressure or mechanical trauma to the mucosal tissue. Common contributing factors include According to Fitzpatrick (2020) and Kumar et al. (2019), poorly fitted or damaged dentures, orthodontic these ulcers form as a result of sustained pressure on appliances, bruxism, and malocclusion. If left the mucosa, leading to impaired blood flow, ischemia, untreated, these ulcers can lead to secondary and tissue necrosis. Without timely treatment, the infections, chronic inflammation, or, in severe cases, ulcers may become infected [5,8]. the development of precancerous lesions. Effective Fitzpatrick (2020) highlights the importance of treatment requires a comprehensive approach, and understanding the trauma mechanism to facilitate numerous studies and strategies are available to guide accurate diagnosis and treatment, recommending the management [1,4]. adjustment of dentures and diligent oral hygiene [5]. Key factors contributing to decubital ulcer Kumar et al. (2019) explain that ulcers typically appear development include: in areas where dentures, braces, or sharp tooth edges • Injury from sharp dental edges or poorly fitting come into contact with the mucosa. The use of dentures; antiseptics and addressing local inflammation are crucial elements of therapy [8]. • Incorrectly positioned orthodontic appliances; The pathogenetic process involves tissue ischemia, • Prolonged pressure from bruxism or necrosis, and ulcer formation. Oral mucosa is International Journal of Medical Sciences And Clinical Research 36 https://theusajournals.com/index.php/ijmscr International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265) particularly vulnerable to infection after trauma. The epithelizing agents (such as Solcoseryl, Actovegin) to severity and clinical course depend on the nature of the aid healing. irritant, the duration and intensity of exposure, and the Prosthesis correction: individual characteristics of the patient. When dentures cause trauma, adjustments or Traumatic agents can be mechanical, chemical, replacements are necessary. Hsu et al. (2019) and thermal, or radiation-related. Smith et al. (2021) emphasize reducing pressure on the 2. Clinical Presentation and Diagnosis mucosa by improving prosthetic designs [7,14]. Decubital ulcers typically have a round shape with clear Steps in treatment: boundaries and are covered by a fibrinous layer. They 1. Eliminate the source of trauma: are located at the points of contact with the traumatic o Adjust dentures; source. Pain is common, especially during eating or speaking, and swelling or secondary infection may also o Smooth sharp edges of teeth; occur. o Correct or temporarily replace orthodontic Stages of ulcer development: appliances. • Initial (erythema): Redness and swelling at the 2. Local therapy: pressure site, moderate pain, burning, dryness, and o Antiseptics: Chlorhexidine 0.05%, Miramistin; tightness. o Pain relief: Calgel, Kamistad, Lidocaine • Ulcer formation: A single ulcer with defined, ointment; smooth edges and a fibrinous base (grayish-white or o Epithelizing agents: Solcoseryl, Methyluracil, yellowish). The depth of the ulcer depends on the Actovegin; intensity and duration of the trauma. o Anti-inflammatory medications: NSAIDs such • Complicated course: If the traumatic factor as ibuprofen or diclofenac. persists, the ulcer enlarges, its edges become indurated 3. Treat secondary infections: and irregular, and secondary infection may occur, leading to pus formation and halitosis. o Topical antibiotics (e.g., tetracycline or metronidazole ointments); If the ulcer does not heal within 2-3 weeks, malignancy must be considered, especially in older patients or o Systemic antibiotics if severe, based on smokers. bacterial culture. The differential diagnosis includes aphthous stomatitis, 4. General therapy: herpes infections, allergic stomatitis, oral cancer, o Immunostimulants (e.g., echinacea, B syphilitic ulcers, and tuberculosis-related lesions [2]. vitamins); The primary diagnostic methods include clinical o Nutritional support with