Clinical Management of a Persistent Retromolar Ulcer with Traumatic Etiology in Pediatric Patient: A Case Report

Abstract

Background: Traumatic oral ulcers usually resolve after removal of the causative factor; however, persistent lesions in the retromolar region may require combined mechanical and behavioural management. Case Presentation: An 11-year-old boy presented with bilateral non-healing retromolar ulcers of two months’ duration, associated with habitual cheek biting and burning on consumption of hot and spicy foods. Previous selective grinding and topical medication had provided only mild symptomatic relief without reduction in lesion size. Clinical examination showed bilateral ulcers adjacent to teeth 17 and 27, with irregular margins, peripheral mucosal overgrowth, and yellowish slough. A provisional diagnosis of chronic traumatic ulcer secondary to habitual cheek biting was made. Management: Initial treatment comprised enameloplasty, topical corticosteroid and antiseptic therapy, and multivitamin supplementation. Although early healing was observed, the biting habit persisted. A custom cheek plumper was therefore delivered as a protective barrier, but compliance was poor and biting recurred when the appliance was removed. A full-coverage occlusal splint was subsequently fabricated, together with counselling for the patient and parents. Outcome: At the three-month review, symptoms had resolved completely. The right ulcer had healed fully, and only a small residual depression remained on the left. Conclusion: Persistent traumatic retromolar ulcers in children may require sequential appliance therapy and behavioural support when elimination of local irritants alone is insufficient.