Fig. 3.8 Chronic mild biting, resulting in a linear mucosal elevation along the occlusal line of the buccal mucosa
Self-Induced Injury
Definition
• Self-induced injury, or factitious trauma, is deliberate injury to the oral mucosa by the patients themselves.
Etiology
• In children with serious psychological problems who want to attract attention, or are mentally retarded.
• The trauma is usually inflicted through repeated biting of the fingernails, or with toothpicks, pencils, knives, and other hard, sharp objects.
Occurrence in children
• Relatively common.
Localization
• Tongue, gingiva, lips, buccal mucosa.
Clinical features
• The lesions vary from erythema, to a deep, ill-defined, painful oral ulceration with sharp borders (Figs. 3.9–3.11).
• Similar lesions may be seen on the skin (Fig. 3.12).
• The lesions are slow to heal, due to perpetuation of the injury by the patient.
• The diagnosis is based on the history and on clinical suspicion.
• The patients usually deny that they produce the lesions themselves.
Laboratory tests
• Biopsy and histopathological examination only to rule out other specific lesions.
Differential diagnosis
• Traumatic ulcer from other causes
• Aphthous ulcers
• Tuberculosis
• Syphilis
• Neoplasms
Treatment
• Discontinuation of the habit.
• Collaboration with a pediatrician and a psychologist.
Electrical Burns
Definition
• Electrical burns are collectively the most common burns seen in the oral cavity in children.
Etiology
• Biting into an electric cable, or inappropriate use of a faulty electrical appliance.
Occurrence in children
• Fairly common.
• Most electrical burns occur in children below six years of age.
Localization
• Lips, commissures, and perioral areas are most frequently affected.
• Tongue, gingiva, alveolar ridge, floor of the mouth and mucobuccal folds may also be less frequently affected.
Clinical features
• Clinically, electrical burns in the oral mucosa present as a painless, white-gray, coagulated lesion with no bleeding and surrounded by a narrow rim of erythema. Progressively, the white-gray surface evolves into brown-black charred tissues and finally sloughs, leaving a deep ulcer that may hemorrhage (Fig. 3.13).
• The adjacent teeth may become non-vital.
• Scarring and microstomia are common complications.
• The diagnosis is based on the history and the clinical features.
Differential diagnosis
• Traumatic ulcers
• Severe thermal burn
• Noma
Treatment
• It is supportive.
• Surgical reconstruction may be necessary in severe cases.
Fig. 3.9 Two minor factitious injuries on the dorsum of the tongue
Fig. 3.10 Large factitious ulcer on the dorsum of the tongue
Fig. 3.11 Huge factitious ulcers on the tongue and the lower lip in a young boy with serious psychological problems
Fig. 3.12 Huge factitious ulcer on the skin in a young girl with serious psychological problems
Other Lesions
Various lesions caused by mechanical injury are frequently observed in children’s oral mucosa. Hyperplasia after continuous mild injury caused by orthodontic or prosthetic materials, traumatic hematoma, traumatic hemorrhagic bullae, erythema, and small erosions produced by the toothbrush are some of the most frequent oral lesions that may cause diagnostic problems (Fig. 3.14).
In such cases, the diagnosis is based on a detailed history, which helps to exclude oral lesions due to other causes, and biopsy and histological examination may rarely be necessary.
Fig. 3.13 Electrical bum on the lower lip and left commissure
Fig. 3.14 Traumatic hematoma of the upper lip
4 Chemical Burns and Allergies
Chemical Burns
Definition
• Chemical burns are oral lesions caused by direct contact between various chemicals and drugs and the oral mucosa.
Etiology
• The chemicals come into direct contact with the oral mucosa because of improper use.
• Common chemicals and drugs that may be placed in the mouth include aspirin, trichloroacetic acid, sodium perborate, hydrogen peroxide, silver nitrate, phenol, paraformaldehyde, alcohol, battery acid, chlorine, and other detergents and agricultural drugs.
Occurrence in children
• Common.
Localization
• Lips, tongue, buccal mucosa, floor of the mouth, gingiva, vestibular sulcus.
Clinical features
•