What are the recommendations and precautions for buccal (mucous membrane of the cheek) mucosa contouring?

Buccal Mucosa Contouring: Management and Precautions

Primary Recommendation

Eliminate all sources of mechanical trauma through dental evaluation before any buccal mucosa contouring procedure, and implement rigorous oral hygiene protocols to prevent mucosal injury and infection. 1, 2

Pre-Procedural Assessment and Preparation

Mandatory Dental Evaluation

• Have a dental team systematically evaluate and eliminate all sources of mechanical trauma, including ill-fitting dental prostheses, fractured teeth, and sharp dental restorations before any contouring procedure. 1, 2
• Address any contributing factors such as chronic cheek biting habits or tongue thrusting against the buccal mucosa, as these increase risk of complications. 1, 2

Nutritional Optimization

• Maintain optimal nutritional support throughout the entire treatment period, as this is a key strategy for mitigation of oral mucosal injury. 3

Intraoperative Protection Strategies

Tissue Protection During Surgery

• Place double-layered Vaseline dressing gauze strategically over the lip and mucosal tissues before applying retractors to prevent traumatic and thermal injury during surgical manipulation. 4
• This technique has demonstrated zero incidence of thermal injury or mucosal tears in 400 consecutive intraoral osteotomy procedures. 4

Postoperative Oral Hygiene Protocol

Daily Oral Inspection and Care

• Inspect the oral mucosa daily for any signs of injury, infection, or complications. 3
• Brush teeth twice daily (after meals and at bedtime) using a soft toothbrush with the Bass or modified Bass method to maintain oral hygiene and prevent secondary complications. 1, 2
• Replace the soft toothbrush monthly to reduce bleeding risk. 3

Mouth Rinsing Regimen

• Rinse mouth with alcohol-free mouthwash at least four times daily for approximately 1 minute (15 ml per rinse) to keep the oral mucosa clean. 1, 2
• Avoid eating or drinking for 30 minutes after rinsing to maximize effectiveness. 3

Hydration and Lubrication

• Maintain adequate hydration by drinking ample fluids to keep the oral mucosa moist and promote healing. 1, 2
• Lubricate lips with sterile petroleum jelly, lip balm, or lip cream, but avoid chronic use of petroleum jelly as it promotes mucosal cell dehydration and increases secondary infection risk. 3

Critical Precautions and Avoidance Strategies

Substances and Behaviors to Avoid

• Eliminate smoking and alcohol consumption, as these impair mucosal healing. 3
• Avoid painful stimuli including tomatoes, citrus fruits, hot drinks, and spicy, hot, raw, or crusty foods that can irritate healing mucosa. 3

Denture Management (if applicable)

• Remove dentures before performing oral care and defer wearing dental prostheses as much as possible until mucosal tissues are completely healed. 3
• If dentures must be worn, soak them for 10 minutes in antimicrobial solution (e.g., chlorhexidine 0.2%) before insertion. 3

Common Complications and Their Prevention

Expected Complication Rates

• Postoperative complications occur in approximately 25% of buccal procedures, with edema (38.4%), trismus (30.1%), and pain (19.4%) being most common. 5
• More serious complications include asymmetry (11.7%), facial nerve paralysis (0.97%), infection (0.48%), and hematoma (0.48%). 5

Infection Prevention

• Maintain meticulous oral hygiene as outlined above, as infection risk is heightened in the seborrhoeic region and with any breach of the epithelial barrier. 3
• Do not initiate new interdental cleaning practices (flossing, toothpicks) during the healing period if not previously performed regularly, as this can break the epithelial barrier and cause gingival bleeding. 3

Key Clinical Pitfall

The most critical error is failing to address pre-existing sources of mechanical trauma before contouring procedures, which significantly increases the risk of mucosal tears, delayed healing, and infection. 1, 2