Case Report
A 24- year-old female was referred to the oral, maxillofacial and
diagnostic sciences department-collage of dentistry at Majmaah
university after surgical extraction of the lower left first molar at
oral and maxillofacial surgery clinic-Alzulfi general hospital for a
chief complaint of developing multiple painful ulceration in the mouth.
Patient history stated that she had a history of surgical extraction of
the lower left first molar a day before the lesion developed. During the
surgery, as the surgical handpiece is working patient feels a burning
sensation on the contralateral side of the mouth, which is not
anesthetized. The patient told the surgeon that, unfortunately, the
surgeon ignored the feeling and continued the procedure as there was no
patent reason. After 24h, the patient started to develop multiple
painful ulceration in the mouth, making the patient unable to eat or
drink.
Her medical and social history is unremarkable. The intra-oral
examination revealed diffuse painful ulceration affecting most of the
oral cavity: the socket of an extracted tooth, soft palate, buccal
mucosa, ventral side of the tongue, the floor of the mouth, and left
side of the lower lip (fig.1), (fig.2)
The patient was emotionally compromised, and she doesn’t eat or drunk
since the lesion started but stated she was on a limited soft diet. The
patient was informed and consented to take photos but refused to insert
any instrument in the mouth or hold the mucosa as she couldn’t tolerate
the pain. After discussing the case with her surgeon, he found the event
was caused by (a faulty solenoid valve) leading to leakage of hydraulic
fluid oil into the dental unit air, which was work with water during the
procedure. The final diagnosis is oral chemical ulceration induced by
iatrogenic hydraulic oil leakage from the dental unit.
The treatment plan given to relieve the inflammation and pain as
follows: Topical corticosteroid prednisolone Sodium phosphate (Predo
15mg/5ml JPI, Riyadh-Saudi Arabia) as syrup, instruction to keep it in
the mouth for at least three minutes and spit it out four times/day for
two weeks (patient rejected to swallow as she was fasting during
Ramadan). Lidocaine hydrochloride B.P (Xylphil 2% Philadelphia
Pharmaceutical Co, Amman-Jordan) as a gel applied every three hours to
control the pain. Follow-up after two weeks revealed most of the lesions
healed except for partial healing in the floor of the mouth(fig.3,4);
the patient explained as the tongue covers the floor of the mouth,
preventing the topical agent from reaching the affected area.
The patient was instructed to continue the topical corticosteroid two
times/day for two weeks and hold it below the tongue for one minute,
swish and spit for additional one minute; the patient given recall after
two weeks. At 2nd Follow-up, the visit showed complete resolution of
oral and lip ulcers with the exceptions of shallow erythematous area on
the tip of the tongue (fig.5). Patient able to eat and drink smoothly
and during the examination, the patient agreed to hold the mucosa.