Traumatic white lesions in the pediatric oral cavity are mucosal alterations caused by mechanical, thermal, or chemical trauma.
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✅ Introduction
White lesions in children may arise from physiological processes, benign injuries, or pathological conditions. Trauma-related white lesions are particularly common because children frequently bite, scrape, or irritate the oral mucosa during play, mastication, or parafunctional habits. Misdiagnosis may lead to unnecessary antimicrobial use or missed identification of systemic disease. This article presents an evidence-based diagnostic and therapeutic approach focused specifically on traumatic etiologies.
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➤ Etiology of Traumatic White Lesions
Traumatic white lesions in children typically arise from:
▪️ Accidental cheek or lip biting
▪️ Frictional keratosis from orthodontic appliances or fractured teeth
▪️ Thermal burns from hot food or beverages
▪️ Chemical injuries, commonly from aspirin or acidic agents
▪️ Iatrogenic trauma (dental procedures, suction injuries)
▪️ Self-inflicted habits (nail biting, bruxism-related cheek trauma)
These insults cause epithelial hyperkeratosis, necrosis, or fibrin deposition, producing a white appearance.
➤ Key Diagnostic Features
Clinically, traumatic white lesions typically show:
▪️ Well-defined or irregular white patches, sometimes with erythematous borders
▪️ History of repeated trauma
▪️ Non-scrapable surface, distinguishing them from candidiasis
▪️ Rapid onset, often within hours
▪️ Pain or sensitivity, although frictional keratosis is often asymptomatic
▪️ Resolution in 7–14 days once the irritant is removed
Laboratory tests or biopsies are rarely required unless lesions persist or atypical features appear.
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➤ First-line Management
▪️ Eliminate the source of trauma, such as sharp teeth, orthodontic appliances, or biting habits.
▪️ Advise soft diet and reduced irritants (acidic foods, strong spices).
▪️ Topical analgesics (benzocaine or lidocaine gel) for pain relief.
▪️ Barrier protectants, such as hyaluronic acid gels or Orabase.
▪️ Re-evaluation in 1–2 weeks to confirm healing.
➤ When to Consider Medications
▪️ Severe inflammation: short-term topical corticosteroids (e.g., 0.1% triamcinolone acetonide).
▪️ Secondary infection: antimicrobial mouth rinses (chlorhexidine 0.12%).
▪️ Persistent biting habits: behavioral therapy or orthodontic guards.
➤ When to Escalate
Lesions should be reassessed or referred if:
▪️ Persist beyond 3 weeks
▪️ Present with induration, ulceration, or unexplained bleeding
▪️ Mimic systemic pathologies (lichen planus, HSV, autoimmune disorders)
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▪️ Proper smoothing of sharp dental edges
▪️ Protection during orthodontic treatment
▪️ Counseling caregivers about parafunctional habits
▪️ Avoidance of chemical irritants in the mouth
▪️ Guidance on safe temperature of food and drinks
▪️ Encourage wearing mouthguards during sports activities
馃搳 Comparative Table: Trauma-Induced vs Infectious White Lesions
| Aspect | Advantages | Limitations |
|---|---|---|
| Trauma-Induced Lesions | Clear history of injury; rapid healing once irritant removed | May mimic other pathologies; recurrent in parafunctional habits |
| Infectious Lesions | Responsive to targeted antimicrobial therapy; distinctive scrapable features | Risk of misdiagnosis; may indicate systemic disease if recurrent |
馃挰 Discussion
Traumatic white lesions are typically benign but can resemble more serious conditions. A careful history is the most critical diagnostic tool. Distinguishing traumatic keratosis from infectious or systemic etiologies prevents overtreatment with antifungals or unnecessary biopsies. Evidence supports environmental modification and habit correction as effective first-line management. Pediatric dentists must remain alert to lesions that deviate from typical healing patterns, as these may signal underlying systemic issues requiring medical evaluation.
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Traumatic white lesions in children are common, benign, and generally self-limiting. Through a structured diagnostic process, clinicians can differentiate them from infectious and systemic pathologies. Early identification, elimination of irritants, and follow-up are essential to successful management. Prevention strategies involving appliance adjustment, habit counseling, and environmental modifications significantly reduce recurrence.
馃攷 Recommendations
▪️ Conduct a thorough history to identify traumatic etiology.
▪️ Prioritize removal of mechanical, chemical, or thermal irritants.
▪️ Use barrier and analgesic agents when needed.
▪️ Re-evaluate within 1–2 weeks to confirm resolution.
▪️ Refer if lesions persist beyond 3 weeks or show atypical features.
▪️ Educate caregivers and children to reduce risky habits and oral trauma.
馃摎 References
✔ American Academy of Pediatric Dentistry. (2022). Policy on management of dental patients with oral lesions. AAPD Reference Manual. https://www.aapd.org
✔ Chiang, M. L., & Ng, S. K. (2021). Traumatic oral lesions in children: A clinical review. Pediatric Dentistry Journal, 31(2), 45–52. https://doi.org/10.1016/j.pdj.2021.03.004
✔ Odell, E. W. (2020). Clinical problem solving in oral medicine. Elsevier.
✔ Regezi, J. A., Sciubba, J. J., & Jordan, R. C. (2022). Oral pathology: Clinical pathologic correlations (8th ed.). Elsevier.
✔ Villa, A., & Abati, S. (2019). Oral white lesions: An updated clinical diagnostic decision tree. Journal of Dentistry, 84, 103–110. https://doi.org/10.1016/j.jdent.2019.03.011
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