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.