What is Physical and Chemical Lesions of the Oral Mucosa?
Different types of physical and chemical damage to the mouth are often found during routine check-ups. This is a common issue since our mouth is constantly exposed to things that can cause harm, such as accidental bites, food with sharp edges, food or drinks that are too hot or too cold, drugs, and other substances that are highly acidic or basic.
In this article, we’ll see different types of mouth injuries you might come across: mouth injuries from accidental bites, wounds from sharp foods, growths caused by inflammation called ‘inflammatory papillary hyperplasia’, damage caused by heat, chemical burns – particularly those caused by aspirin, and other similar injuries.
What Causes Physical and Chemical Lesions of the Oral Mucosa?
Traumatic fibromas are growths that form as a result of local injuries or irritation. They usually show up on the inside of the cheeks (buccal mucosa) and the tongue. These places often undergo repetitive injuries, especially from biting or chewing. They are also often found on the gums (which are a common place for overgrowth of oral tissues).
Traumatic ulcerative granulomas with stromal eosinophilia (TUGSE) are long-lasting sores that develop from mucosal trauma, meaning damage to the moist tissue that lines certain parts of the inside of your body.
Inflammatory papillary hyperplasia is generally seen as a type of gum disease caused by poor oral hygiene under a denture, poorly fitting dentures or patients who wear their dentures at all times, including while sleeping.
Extreme temperatures in foods or drinks can cause thermal injury, which is a burn due to heat or cold.
Aspirin-induced oral lesions are like chemical burns. They occur when individuals place aspirin directly on the wet surfaces inside the mouth intending to ease pain.
Risk Factors and Frequency for Physical and Chemical Lesions of the Oral Mucosa
Traumatic fibromas, also known as growths caused by injury, can happen to anyone, but are more often seen in middle-aged women. An extensive study found that out of nearly 15,000 biopsies taken over 54 years, about a third were traumatic fibromas, making them the most common type of lesion identified in the research.
TUGSE, a condition where the underside of the tongue becomes ulcerated, can happen to any age group, but is slightly more common in females between the ages of 60 and 70. For infants, if they are born with teeth already developed (natal teeth), they may develop a type of TUGSE known as Riga Fede disease. It has been found that 1 in every 2,000 to 3,500 babies are born with teeth, which means TUGSE is quite common in newborns.
Inflammatory papillary hyperplasia, a condition that causes growths in mouth tissues, is usually seen in people who use removable dental prostheses. However, there have been cases where it affects people with natural teeth. Approximately 4.4% of individuals who wear dentures have this condition. Ill-fitting dentures and smoking are the top risk factors for developing it.
Thermal injuries, or burns, can happen to anyone and are not more common in any gender or age group. Despite this, burns to the tissues inside the mouth happen quite often.
Oral lesions caused by aspirin can occur in anyone who takes aspirin. These types of chemical injuries to mouth tissues are common and can occur in anyone, regardless of gender.
Signs and Symptoms of Physical and Chemical Lesions of the Oral Mucosa
Traumatic fibromas are a type of oral issue often caused by irritation or injury. Generally, they appear as smooth, small nodules that are firm and blend in with the color of the surrounding mouth tissue. These nodules can also come with a related traumatic ulcer.
TUGSE, another mouth condition, usually manifests as a single ulcer with a rough membrane and hardened borders. This condition often heals on its own, but can sometimes resemble squamous cell carcinoma, a type of skin cancer.
Inflammatory papillary hyperplasia shows itself as several small, reddened bumps on the hard palate of the mouth, often compared to the look of a mulberry. The number of these bumps varies depending on how severe the inflammation is.
Thermal injuries to the mouth can result in localized or widespread tissue damage. These injuries can involve ulcers or erosion on the affected tissues, and they typically appear pink to red with a diffused or ulcerated edge.
Aspirin-induced oral lesions appear as white sores similar to ulcers. They are a result of the immune system’s response to the acidic components of aspirin. The tissue surrounding the lesion may peel off, usually leaving a localized red area.
Testing for Physical and Chemical Lesions of the Oral Mucosa
Traumatic fibromas are usually checked through a surgery to rule out or confirm its presence. This process will generally show an increased growth of the skin’s outer layer resting on top of a thick bunch of strong, dense tissues.
TUGSE may look like various harmful conditions. Therefore, a biopsy, which is a procedure to remove cells or tissue for examination, should be done to confirm its presence if the lesion, or abnormal tissue, hasn’t disappeared two weeks after eliminating any source of irritation or injury. Under a microscope, these lesions show an inflamed, damaged outer skin layer with pus, over an inflamed supporting tissue. There’s also a type of inflammation made up of cells that are part of your body’s immune system, like lymphocytes, cells that eat foreign substances, and eosinophils, cells that fight infection.
Inflammatory papillary hyperplasia might show as very few or many lesions that need to be evaluated. The patient should be asked how long they keep their removable dental gear in their mouth each day, and it should also be checked to make sure it fits correctly.
Heat injuries should be evaluated by talking to the patient to find out how the injury occurred.
Oral lesions caused by aspirin should be evaluated by asking the patient about the origin of the injury because the shedding of the oral lining could potentially look like an autoimmune disease or a harmful condition.
Treatment Options for Physical and Chemical Lesions of the Oral Mucosa
Traumatic fibromas are typically removed using a process called an excisional biopsy and enucleation, which helps to prevent them from recurring. This procedure can be carried out under local anesthesia. If a source of irritation causing the fibroma is identified and removed, it helps in preventing further occurrences.
Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE), another type of oral lesion, can be treated with an antibiotic to reduce the number of harmful microbes present. It’s important to keep a close eye on this type of lesion and remove the cause, which can be poorly positioned teeth, sharp edges on teeth, or other local irritants. If the lesion doesn’t heal within two weeks, a biopsy is advised to confirm the diagnosis. In babies, problematic milk teeth can be gently smoothed or reshaped under local anesthesia if needed.
The condition known as inflammatory papillary hyperplasia sometimes doesn’t require treatment, but in other situations, it may necessitate surgical removal of the inflamed tissue. Occasionally, the creation of a new removable dental device may be required.
Thermal injuries, or burns in the mouth, generally heal on their own as long as they’re protected from additional injury or exposure to extreme temperatures. Mild pain-relief treatments, like applying benzocaine cream or petroleum jelly, can be used to protect the injured area. There is no one-size-fits-all treatment for burns inside the mouth; however, managing inflammation or pain is always necessary.
Oral lesions caused by aspirin are chemical burns, which usually just require local comfort measures for healing, similar to other types of chemical burns. The key factor in treating and managing these burns is patient education. It should be explained that aspirin only relieves pain when it’s swallowed, not when it’s applied directly to mouth tissues.
What else can Physical and Chemical Lesions of the Oral Mucosa be?
If you experience symptoms of mouth or gum disorders, your doctor may consider a number of different conditions as a possible diagnosis. Here are a few examples:
For conditions similar to Traumatic Fibroma, your doctor may consider:
- Any benign growth like a lipoma (fat lump), neuroma (nerve lump), or neurilemmoma (nerve sheath tumor)
- Pyogenic granuloma (a type of skin growth)
- Peripheral ossifying fibroma, especially if it’s on the gums
In cases similar to Traumatic Ulcer, your doctor may think about:
- Recurrent aphthous ulcer (common mouth ulcer)
- Herpetic ulceration (ulcer caused by herpes virus)
- Traumatic eosinophilic granuloma (a lump caused by trauma)
- Squamous cell carcinoma (a type of skin cancer)
- Ulcerative mucosal disease, like lichen planus (a rash caused by an immune response)
If you show signs of Inflammatory Papillary Hyperplasia, conditions such as the following may be considered:
- Secondary pseudomembranous candidiasis (a fungal infection)
- HPV-associated papillary lesions (warts or abnormal cell growth caused by HPV)
- Erythema migrans (a rash often seen in Lyme disease)
For problems similar to Thermal Injury, your doctor might consider:
- Recurrent aphthous ulcer (common mouth ulcer)
- Herpes simplex virus (a common viral infection)
- Behçet’s disease (a rare disorder causing inflammation in blood vessels)
Lastly, if you have symptoms like Aspirin-induced Oral Lesions, potential conditions to be considered are:
- TUGSE (Toxic Ulcerative Granuloma with Stromal Eosinophilia, a rare mouth condition)
- Traumatic ulceration (an ulcer caused by injury)
- Recurrent aphthous ulcer (common mouth ulcer)
What to expect with Physical and Chemical Lesions of the Oral Mucosa
Traumatic fibromas, which are basically an overgrowth of normal tissues, usually have an excellent outcome. After suitable surgical removal and elimination of any local irritants, they rarely come back.
TUGSE (a type of oral lesion) also has a good outlook. It typically resolves on its own and doesn’t usually need aggressive treatment. However, if the cause of the lesion isn’t addressed, a traumatic ulcer may form and possibly keep coming back.
Inflammatory papillary hyperplasia is another condition that generally has a good outcome. This condition can often be resolved by simply stopping the use of dentures that don’t fit well and allowing the affected tissue to heal. Patient education is crucial to prevent the recurrence of this condition. Patients should be taught to take out their dentures daily for cleaning and to give their oral tissues a rest.
Thermal injuries in the mouth usually heal well, as the lining of the mouth is quite resilient and can recover on its own, as long as there are no further heat-related injuries.
Aspirin-induced oral lesions also have a good outcome. They typically heal once the aspirin is removed from the mouth tissue. The key to preventing these lesions from coming back is for the patient to quit the habit that caused them in the first place.
Possible Complications When Diagnosed with Physical and Chemical Lesions of the Oral Mucosa
Traumatic fibromas usually develop due to certain habits or traumas, like chewing on the cheeks or tongue, or exposure to a local irritant. If the person doesn’t stop these habits or the source of the trauma isn’t removed, traumatic fibromas are likely to come back. These fibromas are typically removed through a surgical procedure, and it is especially important for the patient to maintain good oral hygiene to promote healing.
- Frequent cleaning of mouth is necessary to promote healing of the surgical site
TUGSE is a type of sore that can often be painful and shares many similarities with squamous cell carcinoma (a type of skin cancer). This means that any sores that don’t heal within 2 weeks after removing the cause should be tested to make sure it’s not cancer. This is especially true for infants with Riga Fede disease, who are usually referred to a pediatric dentist since managing their condition can be challenging.
- Lesions or sores that do not heal within 2 weeks should be checked immediately
A condition known as inflammatory papillary hyperplasia can easily be mistaken for a cancerous process even though it’s not. Good oral hygiene and plenty of healing time are crucial in treating this condition, as treatment can vary from person to person.
- Patients should give their oral tissues enough time to heal properly
Thermal injuries, or burns in the mouth, are typically painful and can easily get irritated by the tongue or other oral tissues. To prevent further irritation, try to avoid any additional trauma to the area.
Lastly, mouth lesions caused by aspirin can be painful and can worsen if the habit isn’t stopped. Minimizing additional trauma to the area is highly recommended to prevent further aggravation.
- Avoid causing further injury or irritation to the area
Preventing Physical and Chemical Lesions of the Oral Mucosa
If a doctor finds what they suspect to be a traumatic fibroma, or a small, harmless lump, in your mouth, they will likely recommend a biopsy, or a test of the lump’s tissues, to confirm what it is. It’s important for you to know what may have caused this lump.
TUGSE is a kind of oral disease that tends to get better on its own. However, doctors still need to act quickly once it’s identified, because its symptoms can appear similar to those of serious conditions, like cancer. Doctors will advise you on habits or local irritants, like smoking or using certain toothpastes, that could make the condition return.
Inflammatory papillary hyperplasia, or swelling and growth of gum tissues, occurs more commonly in people who keep their dentures in all night. Therefore, doctors will advise that you remove your dentures for at least six to eight hours each day. This gives you a chance to clean the tissues in your mouth and gives your mouth a break from the pressure exerted by the dentures.
Thermal injuries, or burns in mouth, can be prevented through patient education and adherence to advice given. It’s important to make sure that any food or drink you consume isn’t too hot, as it can cause harm to and damage your mouth tissues.
Some people may get mouth sores from aspirin use. However, these tend to heal on their own once the person stops taking the aspirin. Doctors will inform you that applying aspirin directly to the mouth doesn’t help with pain, and instead may actually harm the mouth and cause more pain.