Gingival necrosis due to the ill-fitting denture

Abstract

We present a case of an 80-year-old male who was referred to the Department of Oral Medicine, School of Dental Medicine University of Zagreb, Croatia due to gingival ulcer which was present for eight days. Clinical examination has revealed exposed bone on the toothless alveolar ridge in the lower molar region on the right side of 0.8 cm in diameter. Otherwise, the patient was taking doxazosin due to urinary problems and ipatropium bromide due to respiratory problems. The patient wore a 6-year-old partial lower denture. He was initially treated with periodontal bandage (Resopack, HagenWerken, Germany) for the first three days and was instructed not to wear the denture; however, no benefit could be seen. Therefore, we added a local corticosteroid (betamethasone) and am oral antiseptic (chlorhexidine digluconate) applied three times a day. After 3 weeks the lesion healed. A list of possible causative factors regarding gingival ulcers is included.

INTRODUCTION

It is well known that gingival ulceration might develop in patients suffering from acute ulcerative gingivitis and as a result of immunodeficiency, especially in leukemic, neutropenic patients and human immunodeficiency virus (HIV) infection. Quite often gingival ulcers may develop due to the viral infections such as herpes simplex, herpes zoster, hand, foot and mouth disease, cytomegalovirus infection, etc. Some medications such as cytotoxics, antihypertensives, non-steroidal anti-inflammatory analgesics, antidepressants, etc., might also cause ulcers in the oral cavity (1). In some patients the lesions may be self-inflicted (2). However, most often, gingival ulcers result from mechanical, chemical and thermal trauma. In this case we report on a mechanically induced gingival necrosis with bone exposure due to the ill-fitting denture.

CASE REPORT

An eighty-year-old male patient presented with exposed bone in the area 46 on the toothless alveolar ridge of 0.8 cm in diameter and it was of yellowish colour and painful (Figure 1). Radiological findings failed to show any sign of bone pathology. Apart from that, the patient was taking doxazosin due to urinary problems and ipatropium bromide due to respiratory problems. He wore a 6 years old faulty partial lower denture (Figure 2). The patient was a doctor of veterinary medicine and denied local trauma, dental treatments in the past three months or self-inflicted cause of the lesion. He was initially treated with a periodontal bandage (Resopack, HagenWerken, Germany) for the first three days and was instructed not to wear the denture; however no benefit could be seen. Therefore, we added a local corticosteroid (betamethasone) and oral antiseptic (chlorhexidine digluconate) applied three times a day. After 3 weeks the lesion healed (Figure 3).

Figure 1.

Gingival necrosis in mandibular right molar.

Figure 2.

Ill-fitting partial lower denture.

Figure 3.

Healed area after three weeks.

DISCUSSION

Gingival ulcers are most often the result of mechanical, chemical and thermal trauma. Various case reports on chemically induced oral ulcerations have been published, most frequently associated with irregular use of chemicals in dentistry such as 3% hydrogen peroxide, paraformaldehyde, formalin, calcium hydroxide, formocresol, ferric sulphate, hypochlorate, tetracycline hydrochloride, etc. (2-8). Some of the chemical burns might be associated with improper use of analgesics placed in the decayed tooth as well as garlic (9, 10). However, our patient did not visit his dentist for a few months.

It is known that thermal injuries in the oral cavity might be a result of electrosurgery, heat plugger and sometimes due to the improper use of impression materials by dentists (11, 12). Thermal injuries in the oral cavity are usually seen after eating pizza or microwave-heated food (13, 14).

Regarding mechanical injuries, there have been case reports on orthodontic appliances which have caused various injuries to the oral mucosa (10). A case report on severe periodontal damage induced by an ultrasonic endodontic device was also described and it resulted in the necrosis of gingival and nasal mucosa (15). Also, prosthetic appliances such as dentures especially faulty ones might induce gingival ulcers as it was seen in our case. As with all injuries due to the mechanical, chemical or thermal trauma it is of utmost importance to exclude offending agents. Furthermore, the use of topical steroids and antiseptics is advised.

In our case, only local therapy was provided. Local corticosteroids together with chlorhexidine digluconate and not wearing the denture resulted in gingival ulcer healing.