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