The response of the oral cavity to different drugs and chemical elements often produces a serious chemical injury either intraorally to the gingiva and tongue or to the facial skin surface. Read the article to know more.
What Are the Common Oral Injuries Caused by Chemicals?
The serious or important reactions that usually occur with drug-related, heavy metal, or chemical burns have the most impact on the gingival (gum), intraoral mucosal tissue, and the tongue. The chemical injuries are responsible either for local irritation and gingival inflammation or swelling or a disturbance of microflora in the oral cavity. The dental surgeon can also observe specific features or alterations in mucosal physiology like gingival hyperplasia, mucosal pigmentation, and dry mouth or xerostomia. The tissue reactions to these chemicals, metals, or drugs can be categorized pathophysiologically into two types:
Local response to the irritant that causes the injury.
Systemic administration of a drug or element (that has an oral manifestation like a chemical injury).
How Are Oral Chemical Injuries Classified?
The categorization similarly for identifying chemical injuries after obtaining patients medical history and the consumption of the prescribed drug consumed is divided into:
Non-allergic reactions to drugs and chemicals used locally.
Non-allergic reactions to drugs and chemicals that are used systemically.
Angioneurotic edema (an allergic reaction or phenomenon).
1. Non-Allergic Reactions to Local Drugs:
Though prescription drugs by the physician and surgeon are an important mandatory and pivotal part of dental or medical treatment, sometimes, non-allergic reactions can be observed in a few cases. These materials or drugs would be used routinely by the dental surgeon or physician for therapeutic and technical procedures or might be occupationally hazardous when the dental surgeon uses them.
Aspirin or Acetylsalicylic Acid: Some patients mistakenly apply “powdered Aspirin “to relieve toothache, but this often causes an “Aspirin burn” that leads to sloughing of epithelium and bleeding because of gingival tissue trauma around the tooth.
Hydrogen Peroxide or Carbamide Peroxide: It is the most commonly used material for bleaching the tooth, but if improperly handled by the operator resulting in tissue contact, then tissue burns or cervical root resorption of the tooth is seen.
Endodontic Materials: These are mainly used in endodontic or root canal treatment (to save a badly infected or decayed tooth). If these materials leak into the soft tissue or the surrounding tissue from the pulp chambers, the necrosis of gingiva or bone is observed, which is more often a result of a poorly or incorrectly (iatrogenic error by the operator) performed endodontic treatment.
Phenols: Used as a cauterizing agent as well as for sterilization of cavities in dental procedures, but if handled carelessly, proves caustic in effect as it can cause traumatic and painful burns into the oral mucosa.
Cauterizing and Chemotherapeutic Agents: Trichloroacetic acid or TCA, silver nitrate, bleaching agents, barbiturates, or even gingival retracting agents can be harmful if handled improperly or without reading operator instructions for handling the product of use. Local irritation and discomfort, along with painful sloughing of the oral mucosa, are observed.
Volatile Oils: Volatile oils like eucalyptus oil, oil of wintergreen, or clove oil can often produce mild mucous membrane burns on the topical application in the oral cavity.
2. Non-Allergic Reactions to Drugs Used Systemically:
Systemic reactions often manifest orally as a side effect of certain drugs when it is prescribed or consumed for achieving systemic health. The reactions are mostly seen in cytotoxic drug therapies as in the treatment of leukemias, bone marrow depression, lichenoid reactions, Steven-Johnson syndrome, fixed drug reaction, or in toxic epidermal necrolysis.
Tetracycline therapies that are given either for acne or infections like cholera, malaria, and syphilis are harmful and teratogenic in pregnancy. Deciduous as well as permanent teeth are affected by tetracycline stains. As the discoloration is internal, a yellowish discoloration of teeth is a common find in patients on tetracyclines.
Heavy metals that are accumulated either form the environment or that are metabolized in our body either by accidental ingestion or an excess accumulation can result in metal poisoning/toxicity. For example, arsenic and lead cause excessive salivary secretions apart from painfully ulcerating the gingival and oral mucosa along with hyperpigmentation. Similarly, in bismuth poisoning, a bluish-black line is seen along the gingival margins (the bluish-black pigmentation in bismuth poisoning produces characteristic blue-black pigmentation on the lips, buccal mucosa, or the oral vestibule). In the same way, even mercury and silver produce discoloration of the skin and mucosa (dark black line in mercury poisoning on gingiva and ashen gray colored line of gingiva in silver poisoning).
3. Angioneurotic Edema:
This is an allergic and diffuse edematous swelling that is smooth and rapidly swelling in nature. The reaction is not life-threatening as it subsides within 36-48 hours usually, but in rare cases, when the reaction and allergy persist, then cases of “edema glottis” that can cause suffocation and death are reported. Angioneurotic edema can involve the swelling of the face, lips, eyes, tongue, or the other extremities of the face and skin. Several risk factors exist for the pathogenesis of this acute allergic swelling. The allergic reaction would be because of exposure to the following:
Drug allergy (often acute manifestations on the face is indicative of the diagnosis of angioneurotic edema).
Allergy to pollen.
Allergy to an insect bite.
Food allergies (berries, eggs, fish, meat, or even milk).
The disease can be hereditary as well (hereditary angioneurotic edema).
Infections like lymphoma and leukemia can also lead to angioneurotic edema.
How Are Oral Chemical Injuries Managed?
Though chemical injury of the mouth is far from being life-threatening, chemical burns, especially those that constitute emergency chemical injuries, require almost immediate evaluation and stabilization by the physician. Proper prevention and control of chemical injuries by the operator or dental surgeon can minimize the risk of iatrogenic errors. Superficial mucosal burns can be healed by topical application of hyaluronic acid gel and with oral antibiotics. If the lesion is to a greater or severe extent, intralesional corticosteroids or surgical intervention with electrocautery or laser along with a periodontal pack dressing will definitely help aid the faster-wound healing process in patients affected by severe chemical injuries. Postoperative oral hygiene is crucial to healing.
To conclude, though most chemical injuries can heal over a period of time, it is still important to observe and report the issue to your dental surgeon so that nonsurgical intervention can be done. It is vital not to ignore the allergic symptoms or reactions if you encounter an orofacial injury and to let your dental surgeon intervene at the earliest.
Last reviewed at:
11 Sep 2021 - 4 min read
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