What is the treatment for traumatic ulcers on the tongue?

Treatment for Traumatic Ulcers on Tongue

The most effective first-line treatment for traumatic ulcers on the tongue is elimination of the causative trauma factor combined with topical corticosteroids such as 0.1% triamcinolone acetonide in orabase to promote healing. 1, 2

Diagnosis and Assessment

Before initiating treatment, confirm the diagnosis of traumatic ulceration by:

• Identifying the shape and location of the ulcer corresponding to a potential traumatic stimulus (sharp tooth edges, dentures, etc.) 3, 1
• Noting the duration of the ulcer (acute: <2 weeks; chronic: >2 weeks) 1
• Ruling out other causes if the ulcer persists beyond 2 weeks or doesn't respond to 1-2 weeks of treatment 3

Treatment Algorithm

Step 1: Remove the Traumatic Source

• Extract or grind down sharp tooth edges or retained roots 2, 4
• Place composite resin over offending teeth if needed 4
• Adjust ill-fitting dentures or dental appliances 1

Step 2: Apply Topical Medications

• First-line: Topical corticosteroids 1, 2

  • 0.1% triamcinolone acetonide in orabase
  • Apply 2-4 times daily after meals and before bedtime
  • Continue until healing is complete (typically 7-14 days)

• For pain management:

  • Topical anesthetics such as lidocaine 2% viscous solution 1
  • Standard dose: 15 mL swished and expectorated every 3 hours as needed
  • Important caveat: Do not exceed 8 doses in 24 hours due to risk of lidocaine toxicity 5

• Barrier preparations for additional pain control:

  • Gengigel or Gelclair applied to affected areas 1

Step 3: Supportive Care

• Rinse with warm saline solution 4-6 times daily 1
• Use a soft toothbrush and mild non-foaming toothpaste 1
• Avoid spicy, acidic, rough foods that may further irritate the ulcer 1
• Stay hydrated to promote healing 1

Expected Outcomes and Follow-up

Most traumatic ulcers heal within 7-15 days with appropriate treatment 2, 6. If the ulcer persists beyond 2 weeks despite treatment:

• Consider biopsy to rule out malignancy or other pathology 3, 1
• Perform blood tests (full blood count, coagulation, fasting blood glucose, HIV antibody, syphilis serology) 3

Special Considerations

• For chemical burns causing traumatic ulceration, most heal spontaneously within 7-15 days without scarring 6
• Antimicrobial agents like chlorhexidine 0.12% or povidone-iodine 10% may help reduce microbial load and optimize healing 7
• For denture wearers, remove dentures before applying medications and at night to ensure proper healing 1

Potential Pitfalls

1. Misdiagnosis: Traumatic ulcers can mimic more serious conditions like oral squamous cell carcinoma or traumatic ulcer granuloma with stromal eosinophilia (TUGSE) 2

2. Lidocaine toxicity: Excessive use of viscous lidocaine can lead to toxicity, especially when exceeding recommended doses 5

3. Persistent ulceration: Failure to identify and remove the traumatic source will result in non-healing ulcers 2, 4

4. Inadequate follow-up: Ulcers that don't respond to treatment within 2 weeks require further investigation 3, 1