Oral injury from Calotropis procera: A case report on inadvertent gingival damage.

Abstract

Background: Chemical burns of the oral cavity and esophagus are frequently reported in southeast Europe, often resulting from the improper use of pharmaceutical or non-pharmaceutical substances. Calotropis procera (Apple of Sodom, Giant milkweed), a plant known for its toxic latex, has been associated with various dermatological and mucosal injuries. The objective of this case report is to describe a rare instance of gingival chemical burn caused by direct application of C. procera latex and to raise awareness about the potential risks of plant-based self-treatment.

Methods: A 49-year-old female presented with a painful lesion in the mandibular vestibule following direct application of C. procera latex. Clinical examination revealed a white, scrapable patch with irregular borders localized to the lower right alveolar mucosa and gingival region, extending from tooth #29 to tooth #31. The diagnosis was made based on history, clinical presentation, and exclusion of other potential etiologies. The patient was prescribed Curnext oral gel 2%, primarily composed of curcumin, the active polyphenol derived from Curcuma longa (turmeric), to be applied thrice daily for 1 week to 10 days. Supportive oral prophylaxis was provided, and the patient was educated on appropriate oral hygiene measures RESULTS: The patient demonstrated 94% adherence based on self-reported feedback and a log diary, with no adverse effects noted from Curnext oral gel 2%. By day 7, symptoms had resolved significantly, and a 3-month follow-up confirmed complete recovery without recurrence.

Conclusions: This case illustrates the risk of chemical burns associated with exposure to C. procera latex and the essential role of patient education in mitigating the dangers of unverified traditional remedies. Timely diagnosis, appropriate management, and comprehensive preventive counselling are critical in promoting healing and preventing long-term complications, thereby enhancing patient outcomes and contributing to public health efforts aimed at reducing preventable oral injuries.

Key points: Why is this case new information? Despite the fact that Calotropis is one of the most widely utilized plants in India, there have never been any case reports of chemical burns to our knowledge. What are the keys to successful management of this case? The chemical burn was promptly diagnosed, herbal gel was applied, and full recovery was seen. What are the primary limitations to success in this case? Only 3 months of follow-up was conducted; any additional follow-up should be reviewed.

Plain language summary: This case report describes a woman who accidentally injured the soft tissues inside her mouth after applying the sap of a plant called Calotropis procera-commonly known as Apple of Sodom or Giant Milkweed-to her gums in an attempt to relieve pain. While this plant is widely used in traditional remedies, its milky sap is actually toxic and can cause chemical burns. The patient developed a painful, white patch in her lower gums and sought treatment. She was diagnosed with a chemical burn caused by the plant's latex and was treated using an herbal gel containing curcumin, the healing compound found in turmeric. Alongside this, she received gentle dental cleaning and advice on how to take care of her oral health. Her condition improved quickly, and by the end of one week, most of her symptoms had resolved. A follow-up after 3 months confirmed full recovery with no lingering effects. This case is important because it highlights the hidden dangers of using natural substances without medical supervision. It also shows how early diagnosis and simple, effective care can lead to a full recovery. Public awareness and education are key to preventing similar injuries in the future.