27. soreness in the floor of the mouth

A 25-year-old woman complained of severe pain in the floor of her mouth for 3 days following toothache from a lower anterior tooth. This lesion was not associated with fever, malaise or cervical lymphadenopathy and appeared one day after an episode of toothache from a necrotic central right lower incisor. That pain was relieved by an aspirin put directly by the patient lingual to the responsible incisor. No other similar lesions were seen on the day of the examination or from the past and the patient had no serious diseases and was not on any other medication.

Clinical examination revealed a white slough which could be easily removed leaving an haemorrhagic, painful ulceration unfixed to the surrounding tissues, with a diffuse erythema in the floor of her mouth.

The history and clinical information suggest a chemical burn is most likely. Direct application of aspirin to the mucosa can cause severe local necrosis seen as a large ulceration covered with white exudate.