International Journal of Medical Sciences And Clinical Research
36
https://theusajournals.com/index.php/ijmscr
VOLUME
Vol.05 Issue04 2025
PAGE NO.
36-38
10.37547/ijmscr/Volume05Issue04-07
Chronic Trauma of The Oral Mucosa: A Literature
Review
Kamilov Khaydar Pazilovich
DSc, Professor, Head of the Department of Hospital Therapeutic Dentistry, Tashkent State Dental Institute, Uzbekistan
Kadyrbayeva Aliya Arystanovna
DSc, Associate Professor, Department of Hospital Therapeutic Dentistry, Tashkent State Dental Institute, Uzbekistan
Gulyamnazarova Dilorom Gafurdjanovna
Assistant, Department of Hospital Therapeutic Dentistry, Tashkent State Dental Institute, Uzbekistan
Received:
28 February 2025;
Accepted:
29 March 2025;
Published:
30 April 2025
Abstract:
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.
Introduction:
1. Etiopathogenesis of Decubital Ulcers
Decubital ulcers in the oral cavity are caused by
prolonged pressure or mechanical trauma to the
mucosal tissue. Common contributing factors include
poorly fitted or damaged dentures, orthodontic
appliances, bruxism, and malocclusion. If left
untreated, these ulcers can lead to secondary
infections, chronic inflammation, or, in severe cases,
the development of precancerous lesions. Effective
treatment requires a comprehensive approach, and
numerous studies and strategies are available to guide
management [1,4].
Key factors contributing to decubital ulcer
development include:
•
Injury from sharp dental edges or poorly fitting
dentures;
•
Incorrectly positioned orthodontic appliances;
•
Prolonged
pressure
from
bruxism
or
malocclusion;
•
Weakened local immunity and reduced
salivation, especially in elderly patients [1].
According to Fitzpatrick (2020) and Kumar et al. (2019),
these ulcers form as a result of sustained pressure on
the mucosa, leading to impaired blood flow, ischemia,
and tissue necrosis. Without timely treatment, the
ulcers may become infected [5,8].
Fitzpatrick (2020) highlights the importance of
understanding the trauma mechanism to facilitate
accurate diagnosis and treatment, recommending the
adjustment of dentures and diligent oral hygiene [5].
Kumar et al. (2019) explain that ulcers typically appear
in areas where dentures, braces, or sharp tooth edges
come into contact with the mucosa. The use of
antiseptics and addressing local inflammation are
crucial elements of therapy [8].
The pathogenetic process involves tissue ischemia,
necrosis, and ulcer formation. Oral mucosa is
International Journal of Medical Sciences And Clinical Research
37
https://theusajournals.com/index.php/ijmscr
International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
particularly vulnerable to infection after trauma. The
severity and clinical course depend on the nature of the
irritant, the duration and intensity of exposure, and the
individual characteristics of the patient.
Traumatic agents can be mechanical, chemical,
thermal, or radiation-related.
2. Clinical Presentation and Diagnosis
Decubital ulcers typically have a round shape with clear
boundaries and are covered by a fibrinous layer. They
are located at the points of contact with the traumatic
source. Pain is common, especially during eating or
speaking, and swelling or secondary infection may also
occur.
Stages of ulcer development:
•
Initial (erythema): Redness and swelling at the
pressure site, moderate pain, burning, dryness, and
tightness.
•
Ulcer formation: A single ulcer with defined,
smooth edges and a fibrinous base (grayish-white or
yellowish). The depth of the ulcer depends on the
intensity and duration of the trauma.
•
Complicated course: If the traumatic factor
persists, the ulcer enlarges, its edges become indurated
and irregular, and secondary infection may occur,
leading to pus formation and halitosis.
If the ulcer does not heal within 2-3 weeks, malignancy
must be considered, especially in older patients or
smokers.
The differential diagnosis includes aphthous stomatitis,
herpes infections, allergic stomatitis, oral cancer,
syphilitic ulcers, and tuberculosis-related lesions [2].
The primary diagnostic methods include clinical
examination, patient history, and occasionally biopsy.
O’Brien et al. (2018) recommend using standardized
scales, such as the Bruna Scale, to assess the severity
and guide treatment [11].
3. Treatment of Decubital Ulcers
Despite advances in treatment, challenges remain due
to variability in therapeutic approaches and a lack of
comprehensive data on long-term outcomes.
Tanenbaum et al. (2020) and Turner et al. (2021) stress
the need for further research to enhance treatment
options [15,16].
Treatment involves both addressing the source of
trauma and local therapy:
Local treatment:
•
Antiseptics: Chlorhexidine, Miramistin, and
other disinfectants are used to prevent infection [6,9].
•
Pain relief and tissue regeneration: Anesthetic
gels (such as Calgel, Kamistad) to alleviate pain, and
epithelizing agents (such as Solcoseryl, Actovegin) to
aid healing.
Prosthesis correction:
When dentures cause trauma, adjustments or
replacements are necessary. Hsu et al. (2019) and
Smith et al. (2021) emphasize reducing pressure on the
mucosa by improving prosthetic designs [7,14].
Steps in treatment:
1.
Eliminate the source of trauma:
o
Adjust dentures;
o
Smooth sharp edges of teeth;
o
Correct or temporarily replace orthodontic
appliances.
2.
Local therapy:
o
Antiseptics: Chlorhexidine 0.05%, Miramistin;
o
Pain relief: Calgel, Kamistad, Lidocaine
ointment;
o
Epithelizing agents: Solcoseryl, Methyluracil,
Actovegin;
o
Anti-inflammatory medications: NSAIDs such
as ibuprofen or diclofenac.
3.
Treat secondary infections:
o
Topical antibiotics (e.g., tetracycline or
metronidazole ointments);
o
Systemic antibiotics if severe, based on
bacterial culture.
4.
General therapy:
o
Immunostimulants
(e.g.,
echinacea,
B
vitamins);
o
Nutritional support with vitamins A, C, E, and
zinc.
5.
Surgical intervention (rare):
o
Removal of suspected malignancy;
o
Reconstructive surgery to restore mucosal or
functional integrity.
4. Prevention and Prevention of Recurrence
Prevention is key and should include:
•
Ensuring proper fitting of dentures through
regular dental check-ups;
•
Practicing good oral hygiene, including daily
cleaning of dentures;
•
Using protective gels or creams when wearing
orthodontic appliances for extended periods.
Timely treatment can prevent complications such as
infections or chronic ulcers. Proactive measures
significantly reduce recurrence.
International Journal of Medical Sciences And Clinical Research
38
https://theusajournals.com/index.php/ijmscr
International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
According to Rosenblum et al. (2021), the following
measures are important:
•
Routine check-ups for denture adjustments;
•
Regular orthodontic evaluations;
•
Educating patients on proper hygiene and
appliance care [13].
Zhu et al. (2019) highlight the advantages of using
mucosal protectants in high-risk patients [17].
CONCLUSION
Treating decubital ulcers in the oral cavity requires a
comprehensive approach involving early diagnosis,
removal of the traumatic factor, local treatment, and
prevention. Key treatment strategies include the use of
antiseptics, anesthetics, epithelizing agents, and
prosthetic or orthodontic corrections. Further research
is necessary to optimize treatment and prevention
methods.
REFERENCES
Zholobov B.M. Oral Mucosa. St. Petersburg: SpecLit,
2018.
Kamilov Kh.P., Kadyrbaeva A.A., Aripova D.U., Ganieva
Kh. Diagnosis of Precancerous Diseases of the Oral
Mucosa. Stomatology. 2021; No.3: 17
–
18.
Murashko V.Yu., Nikityuk D.B. General Practice
Dentistry. Moscow: GEOTAR-Media, 2020.
Solovyov A.I., Sergeev A.Yu. Lesions of the Oral Mucosa.
Moscow: MEDpress-Inform, 2019.
Fitzpatrick, J. (2020). Oral Pressure Ulcers: Diagnosis
and Management. Journal of Oral Health, 12(3), 150
–
158.
Hass, A. L., & Nguyen, T. (2020). Topical Treatments for
Oral Ulcers. Therapeutic Advances in Dental Practice,
8(4), 122
–
130.
Hsu, Y. C., & Chen, L. M. (2019). Prosthetic Design and
Oral Mucosal Health. Prosthodontic Journal, 17(2), 88
–
95.
Kumar, R., Patel, S., & Mehta, H. (2019). Traumatic
Ulcers in Oral Mucosa: A Review. International Dental
Journal, 69(5), 400
–
406.
Lee, C. H., & Park, Y. S. (2017). Efficacy of Chlorhexidine
in Oral Wound Management. Oral Medicine &
Pathology, 22(2), 90
–
96.
Neville B.W., Damm D.D., Allen C.M., Chi A.C. Oral and
Maxillofacial Pathology. Elsevier, 2015.
O’Brien, M., & Singh, P. (2018). Clinical Evaluation of
Oral Mucosal Lesions. Journal of Clinical Dentistry,
23(1), 45
–
52.
Regezi J.A., Sciubba J.J. Oral Pathology: Clinical
Pathologic Correlations. 7th ed. Elsevier, 2016.
Rosenblum, B. I., et al. (2021). Prevention of Oral
Pressure Sores: Guidelines and Protocols. Journal of
Preventive Dentistry, 13(1), 25
–
33.
Smith, D. J., & Taylor, R. (2021). Denture-Induced
Trauma and Management. Dental Review, 55(3), 200
–
210.
Tanenbaum, H., & Levy, M. (2020). Innovations in Oral
Ulcer Therapy. Journal of Dental Research, 95(6), 1345
–
1351.
Turner, K. L., et al. (2021). Future Directions in Oral
Lesion Treatment. Advances in Dental Science, 18(4),
302
–
309.
Zhu, H., & Wang, J. (2019). Mucosal Protectants in Oral
Wound Healing. Clinical Oral Investigations, 23(7),
1779
–
1786.
