A common cause of oral burns is electrical trauma occurring most frequently in children between 6 months and 3 ,when the child places the female end of a live extension cord into the mouth, or the child sucks or chews an exposed or properly insulated live wires. This type of oral burn characteristically involves intense heat, causing coagulation tissue necrosis. The oral burn wound may be superficial, involving only the vermilion border of one or both lips, or it may be very destructive, a full thickness, third degree burn. It may extend interiorly to the tongue, the labial vestibule, the floor of the mouth, or the buccal mucosa, rarely it may involve a hard tissue, such as the mandible and the primary and permanent teeth.
The oral burn patient will probably have parasthesia or anesthesia; pain is generally not a significant problem in these oral burns. Hemorrhage may occur anytime during the first 3 weeks of healing of oral burn. Within a few hours after the oral burn injury there may be a great increase in edema. The patient may drool uncontrollably after these oral burns. During the first few days after the accident involving oral burn, the center of the lesions which is generally composed of a grayish or yellowish tissue, may be depressed relative to a slightly elevated, narrow, erythematous margin, of the tissue that surrounds it. The necrotic tissue, known as "eschar", becomes charred or crusty in appearance and begins to separate from the surrounding viable tissue and sloughs off 1 to 3 weeks after the oral burn. Healing occurs by secondary intention.
Two or three month after the oral burn accident, the wound becomes indurated. For an additional 6 months, there is a propensity for the immature scar tissue to bind the lips, alveolar ridges, and other involved structures. If not treated during this time, contraction from the fibrotic scar tissue results in unaesthetic and functionally debilitating microstomia. The scar tissue softens as it matures, and by 9 months to 1 year after the injury the potential for tissue contraction is greatly decreased.
Treatment of Oral Burns- For oral burns, the patient is treated for other manifestations of electric shock first. The wound is then treated. The parents of the oral burn patient should be made aware of the possibility of a spontaneous arterial hemorrhage during the first 3 weeks (place firm pressure with a gauze, to the bleeding area for 10 minutes). Persistent bleeding due to these oral burns should be treated in a hospital. In these oral burns no initial surgical intervention is needed.
For oral burn an acrylic prosthetic appliance is used to prevent contracture of the healing tissue and to serve as a framework on which a more normal appearing commissure may be created and preserved after completion of the healing process after oral burns. This oral burn treatment, the patient is allowed to remove this oral burn appliance while eating, cleaning of teeth and appliance, or when modifications of the wings are necessary in the treatment of oral burns. When in place, the oral burn appliance is a static base from which wings extend laterally to provide contact with both commissures. To maintain symmetry relative to the midline during the oral burn healing process, the wings should make contact with the commissures equidistant from the midline and with equal pressure being exerted at these points. The wing is contoured so that it is the thickest in the occlusoccrvical dimension on the labial aspect. It is tapered to a nearly knife-edge at the point of contact with the commissure. In a cross sectional view, the wings should be large enough only to maintain the correct shape of the commissure.
The dentist delivers this oral burn treatment appliance in ten to fourteenth days after the oral burn injury. Once the oral burn appliance is properly modified and the patients wearing the appliance is instructed, the appointments can be spaced out over 4 to 6 weeks interval. The oral burn appliance should be worn 24 hours a day for speedy healing in these oral burn cases, except for eating and cleaning. The oral burn appliance may not eliminate the need for minor surgical revisions. The appliance can prevent asymmetry of the commissures, resulting from tissue cohesion and scar contracture. It can provide a more normal appearing commissures after healing of oral burn.
For treating oral burns in infants or toddlers, a "headgear" type of extra oral anchorage apparatus is used which is made of durable cloth, such as denim lined with gingham, which provides a static case from which elastic material extends to the wings of the burn appliance. The use of the oral burn appliance after a commissurotomy differs from its utilization after a oral burn injury in that the appliance must be delivered by the time the sutures are removed, since by the second week after oral burn surgery there may already be a decrease in the lateral extension of the primary incision as a result of wound healing and the total time that the patient needs to wear the appliance may be less than 1 year.