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Chemical Burns

Definition

Red or red and white mucosal lesion resulting from contact to the oral mucosa with chemical agents.

Etiology

Common culprits include phenol, trichloroacetic acid, eugenol, aspirin, iodine, alcohol, acrylic resin, sodium perborate, silver nitrate, sodium hypochlorite, paraformaldehyde, chlorine compounds, and agricultural chemical agents.

Main Clinical Features

•Improper use of chemical agents in the oral cavity may result in inflammation, ulceration, and coagulative necrosis of the epithelium (white, desquamating lesion)

•Lesions may be painful or not, depending on the severity of the burn

•Chemical burns are usually localized to the area of contact with the chemical agent

•Severity depends on the extent and duration of the contact as well as the concentration and quantity of the compound

Diagnosis

The diagnosis is based on the history and the clinical features.

Differential Diagnosis

•Vesiculobullous diseases

•Candidiasis

•Mechanical trauma

•Thermal burns

•Erythroplakia

•Squamous cell carcinoma

Treatment

Basic Guidelines

•Avoid spices, hard and hot foods.

•Mild chemical burns such as those due to alcohol, iodine, sodium hypochlorite, or sodium perborate usually heal within a week.

•More severe burns such as those caused by chlorine, trichloracetic acid, and other more caustic agents usually take up to 2 weeks to heal.

Suggested Therapies

•Usually none needed.

•In severe persistent cases oral corticosteroids in low doses for a short time. e.g., prednisone 10-15 mg/day for 3-5 days, dramatically improve the symptoms.

References

Fantasia JE, Damm DD, White mucosa. Chemical burn. Gen Dent 2001;49:265, 324.

Flaitz CM. Chemical burn of the labial mucosa and gingiva. Am J Dent 2001;14:259–260.

Milano M. Oral electrical and thermal burns in children: Review and report of case. J Dent Child 1999;66:116–119.

Mordjikian E. Severe microstomia due to burn by caustic soda. Burns 2002;28:802–805.

Nahlieli O, Eliav E, Shapira Y, Baruchin AM. Central palatal burns associated with the eating of microwaved pizzas. Burns 1999;25:465–466.

Treharne LJ, Kay AR. The initial management of acute burns. J R Arm Med Corps 2001;147:198–205.