Discussion:
This case report represents a patient with oral chemical ulceration
causing sloughing of the mucosa as a result of the unanticipated event
for leakage of hydraulic fluid oil inside the air of the dental unit
where admix with water during surgery. Oral chemical ulceration is
mainly reported by iatrogenic trauma caused by dentists from various
dental materials such as Sodium Hypochlorite, Formocresol, or etching
material.11 Also, it is reported that a wide range of
over-the-counter dental products such as (chlorohexidine, hydrogen
peroxide) mouthwash, and cautery ingredients known as Silver Nitrate are
used for treating aphthous ulcers.22 The chemical material
potentially affects contact oral mucosa due to multiple factors: 1-How
the chemical agent works. 2-quantity exposed to the offending tissue.
3-time elapsed of contact tissue. 4- (PH) strength of this
material.33
In this case, it clearly happens from unintentional leakage of hydraulic
fluid oil in the present faulty solenoid valve, which controls the
dental unit during surgical extraction of the lower left first molar
tooth leading to exposure to the causative agent. According to the
dental chair manufacturer (VIC dental), hydraulic fluid oil is used in
the dental chair for operating and changing positions. One of the
disadvantages of hydraulic fluid is that it’s corrosive and can cause a
catastrophic event if contact with the skin.44
The diagnosis of oral chemical ulceration is based upon careful history
taken of the patient and precise clinical presentation.55
However, the diagnosis can be challenging if a previous history can’t be
achieved. In this case, clinical history obtained from the patient
likely judged oral chemical ulceration as strongly the final diagnosis.
The biopsy is usually not indicated as an additional diagnostic tool
with no specific feature for oral chemical ulceration will be
revealed.66 However, excluding other lesions might be helpful
if the diagnosis is obscure.77
The histopathological finding consists of coagulation necrosis focally
in the epithelium, intracellular edema, and altered cell morphology,
where underlying connective tissue has a mild inflammation infiltration.
88
Management of Oral chemical ulceration consists of stopping or
preventing the offending agent, maintaining the fluid-food intake,
reducing inflammation, controlling the pain, and accelerating healing
time. In mild to moderate cases of oral chemical ulceration, usually, no
treatment is required concerning patient reassurance.99
However, a short course one to two weeks of topical steroids will reduce
the inflammation and help the patient recovery. In our case, we extend
the course of treatment due to partial healing in the floor of the mouth
for additional time to ensure complete healing. 1010Topical
anesthetic, either as gel or rinse, will reduce pain and increase the
quality of life. Accelerating healing can also be achieved with
hyaluronic acid. 1111A prophylactic antibiotic with surgical
debridement is warranted in severe cases of oral chemical ulceration.
1212