The Case of Palate Ulcer

A 24-year-old patient came to the department with the complaint of pain in the roof of his mouth. While taking history, I discovered that his pain started a few days after the extraction of the tooth at the site where local anesthesia was administered. Oral examination revealed a well-circumscribed ulcer, about 10 x 5 mm in size, and reddish-yellow in color on the hard palate.

My differential diagnosis included anesthetic necrosis and necrotizing sialometaplasia. The clinical findings, with support from history helped confirm my diagnosis of anesthetic necrosis.                                                                

Notes from Dr. K

Anesthetic Necrosis:

Anesthetic necrosis is usually a result of excess pressure application during local anesthesia administration in attempts to deposit an increased amount of anesthetic solution. Localized ischemia results that presents as a well-circumscribed, deep ulcer. The ulcer heals over a period of time. In persistent lesions a small degree of intervention can encourage healing. As Dr. M says, the history and clinical presentation were highly suggestive of this diagnosis.  

Necrotizing sialometaplasia was easy to rule out in this scenario, the ulcer was on the hard palate (no salivary glands there), there was absence of the classic history of "palate falling off", and the condition usually takes a couple of weeks to evolve from a swelling to a crater (our case was only a few days old judging from the condition of the healing socket).