A three-year-old girl came to a dental clinic with a serious condition: a motorcycle accident had resulted in the loss of her two upper primary front teeth, teeth 51 and 61, while also leaving a large open wound in the anterior maxillary gingival region. The alveolar bone was exposed. The child refused to eat and drink because of the pain. Her family declined hospitalization. This was where a simple therapeutic option—a topical hyaluronic acid gel—was put to the test.
The case report, published in the Jurnal Kesehatan Gigi, was written by Citra Saka Gama Diarum, Shoimah Alfa Makmur, and drg. Putri Kusuma Wardani Mahendra, M.Kes., Sp.KGA., from the Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Gadjah Mada. The findings offer new insights into the management of extensive traumatic ulcers in pediatric patients.
A Wound That Is More Than Just a Scratch
A traumatic ulcer is not an ordinary wound. When trauma damages the oral mucosa through the basement membrane and into the underlying connective tissue, nerve endings become exposed. Every touch can feel like a sharp sting. In children, this condition can have consequences that extend far beyond physical pain: eating may become difficult, speech may be affected, and school attendance may even be disrupted.
The prevalence of oral ulcers in children is approximately 9% of all cases of oral ulceration. Specifically for traumatic ulcers, the prevalence ranges from 1.33% to 8.53%, with a similar distribution between boys and girls. The conventional first-line treatment is topical corticosteroids. However, their use in infants and young children must be considered carefully because of the risk of systemic effects. Long-term use may also contribute to drug resistance or secondary fungal infections.
In this case, the clinical team chose a different approach.
Two Months, Five Visits, One Clear Change
Initial treatment began with saline irrigation to remove debris, followed by pressure with sterile gauze to control bleeding. Panoramic radiography was performed to rule out bone fractures, and the results were negative. The patient received antibiotics and analgesics and was then discharged with instructions for daily wound care using sterile gauze and warm water.
One week later, the upper lip laceration had begun to heal, but the sockets of teeth 51 and 61 remained open and were covered by a pseudomembrane layer. This was when hyaluronic acid gel was introduced, applied twice daily after meals.
The results were documented progressively. At the second visit, two weeks after the trauma, gingival tissue had begun to cover the alveolar bone. The pain score on the Visual Analogue Scale (VAS) had decreased from 10 at the initial visit to 5. At the third visit, one month later, the gingival tissue had completely covered the sockets and had a color consistent with the surrounding mucosa. The child had begun eating and drinking without pain. Two months after the accident, the wound had healed completely. The VAS score was 0, with no remaining signs of inflammation.
“The clinical outcome in this case suggests that hyaluronic acid gel contributed to the healing of a large traumatic ulcer, while also providing comfort to the pediatric patient. No adverse effects or complications were noted during the treatment period.”
A Multilayered Mechanism of Action
Hyaluronic acid is not foreign to the human body. It is a linear polysaccharide that naturally occurs in the extracellular matrix of connective tissue, skin, and epithelium, as well as within the oral cavity itself, including the gingiva, periodontal ligament, alveolar bone, and cementum.
During wound healing, hyaluronic acid acts during the third and fourth phases, namely fibroblast migration and tissue remodeling. It maintains tissue hydration, stimulates the production of growth factors, supports collagen biosynthesis, and facilitates keratinocyte re-epithelialization. Low-molecular-weight forms penetrate deeper tissue layers, while high-molecular-weight forms act on the wound surface.
The gel used in this case contained 0.2% hyaluronic acid combined with 7.5% xylitol. Xylitol, a five-carbon sugar alcohol, is known to inhibit bacterial adhesion and biofilm formation while increasing oral pH, thereby creating an environment that is unfavorable to pathogenic bacteria.
Although hyaluronic acid does not have direct antibacterial properties like chlorhexidine, its high viscosity forms a physical barrier that minimizes microbial penetration into the wound. The combination of these two ingredients makes the gel both effective and safe, even for a three-year-old patient.
Pediatric Tolerance: An Often-Overlooked Factor
Successful treatment in children is not solely a matter of clinical efficacy. Patient compliance—and in this case, parental compliance—is a key determinant of the final outcome. Hyaluronic acid gel produces a cooling sensation when applied, is tasteless, and does not cause irritation. This profile makes it much easier for children to tolerate than many other topical agents.
Previous studies have confirmed the low cytotoxicity of hyaluronic acid, further supporting its safety for pediatric populations. No risk of overdose has been reported with topical use. Spray preparations containing the same substance are also available for cases involving more extensive lesions or patients with burning mouth syndrome.
The case of a three-year-old child who lost her two front teeth in an accident may sound dramatic. Yet that is precisely where its relevance lies: even wounds that appear severe can heal with the right, careful, and measured approach. The once-exposed alveolar bone is now covered by healthy gingiva. The child can eat again.
Authors: Nanda Ayu, drg. Achmad Zam Zam Aghasy, M.Kes.
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