Oral Infections: Tonsillitis, Gum Swelling, and Lip Ulcers

Purulent tonsillitis in the oral cavity, gingival swelling, and purulent lips?

Hello Doctor, since I took my sister to the hospital on January 4th and stayed there from 9 AM to 10 PM, I have not slept for eighteen hours.
It was the most irregular day for my schedule in over a year and I was exposed to the most viruses and bacteria.
Starting the next day, I began to feel pain in my left lower jaw and had a headache, and my lips developed what appeared to be canker sores (white lesions) for no apparent reason.
The symptoms persisted until the morning of January 6th when I visited a clinic.
The doctor said that aside from not having a fever, my symptoms resembled those of the flu (the doctor did not notice the lesions on my lips, which had already formed scabs by that time) and mentioned that my tonsils were slightly swollen.
He prescribed some medication and advised me to take a rapid test if I developed a fever later.
After taking the medication that day, my headache was gone, but by the evening, I started to experience a sore throat and fever.
The next day (January 7th), I went to the emergency room, still having a fever (38 degrees Celsius), and aside from the fever, my throat was extremely painful (the gums above my wisdom tooth also started to swell and hurt).
The emergency doctor examined my mouth and diagnosed me with tonsillar abscess, administered an intramuscular injection, and prescribed medication (including antibiotics, anti-inflammatory, pain relief, and cough suppressants) before I went home.
However, the doctor also did not notice my mouth and gums (at this point, I realized that after the lesions scabbed over, new pus formed, and the lesions were getting larger, now almost covering my entire lower lip).
On January 9th in the afternoon, I went to see a dermatologist primarily to check my lips.
Before seeing the doctor, I thought the lesions were herpes, but after examining my mouth, the doctor first asked if the lesions were painful or itchy (they were not).
He then noticed the swelling of my gums (at this point, not only was the gum below my left wisdom tooth swollen, but the gums on the upper left side were also swollen).
Knowing that I currently had a tonsillar abscess, he suggested that my lip condition was not a single skin disease but appeared to be a viral infection, and that the current condition of my lips was one of the manifestations of this infection.
He prescribed antibiotics (to continue from what the emergency doctor had prescribed) and an ointment for my lips.
Today is the third and final day of taking the medication prescribed by the emergency doctor, but my throat still hurts, and the swelling of my gums seems to be increasing.
This morning, when I opened my mouth, the gums near my front teeth bled, and the lesions on my lips still appear to be purulent and unpleasant.
Currently, only the dermatologist has seen all my symptoms and provided a diagnosis of viral infection.
Should I see a doctor again?

Rou, 20~29 year old female. Ask Date: 2018/01/09

Dr. Hong Yuanbin reply Internal Medicine

Hello, based on your description, your oral ulceration does seem severe.
It may not be possible to determine the true cause based solely on your description.
I recommend visiting a major hospital's dental department for relevant examinations, including viral testing.
If there is no improvement, a biopsy may be necessary.
Thank you for your inquiry.

Reply Date: 2018/01/09

More Info

Based on your detailed description, it seems that you are experiencing a complex interplay of oral infections, including tonsillitis, gum swelling, and lip ulcers. Your symptoms began after a long day of exposure to potential pathogens, which likely contributed to your current condition. The timeline of your symptoms, starting with pain in the left lower jaw and the appearance of white sores on your lips, suggests a viral or bacterial infection that has progressed over time.

Initially, you were diagnosed with tonsillitis, which is an inflammation of the tonsils that can be caused by viral or bacterial infections. The fact that you experienced fever and severe throat pain indicates that your body is fighting off an infection. The swelling of your gums, particularly around the area of your wisdom teeth, suggests that you may also be dealing with gingivitis or periodontitis, which can occur when bacteria accumulate in the mouth, especially if oral hygiene is compromised.

The appearance of ulcers on your lips and the increasing size of the sores could indicate a secondary infection or a viral infection, such as herpes simplex virus, which can cause cold sores. However, since your symptoms have not improved with the antibiotics prescribed, it is essential to consider that the underlying cause may not be bacterial but rather viral, which antibiotics would not effectively treat.

Given that your symptoms have persisted and even worsened, it is advisable to seek further medical attention. Here are some recommendations:
1. Consult an Oral Surgeon or Dentist: Since you have significant gum swelling and pain, a dental professional can assess the health of your gums and teeth, particularly around the wisdom teeth area. They may recommend imaging studies, such as X-rays, to evaluate for any underlying dental issues, such as impacted wisdom teeth or abscesses.

2. Visit an Ear, Nose, and Throat (ENT) Specialist: An ENT specialist can provide a thorough examination of your throat and tonsils. They can also perform tests to determine if there is a viral infection that requires different treatment, such as antiviral medications.

3. Consider a Viral Culture or Blood Tests: If a viral infection is suspected, your doctor may recommend tests to identify the specific virus. This can help tailor your treatment plan more effectively.

4. Pain Management: In the meantime, you can manage pain and discomfort with over-the-counter pain relievers such as ibuprofen or acetaminophen. Additionally, using topical anesthetics or mouth rinses designed for oral ulcers may provide temporary relief.

5. Maintain Oral Hygiene: Continue to practice good oral hygiene, but be gentle around the affected areas. Rinsing with warm salt water can help soothe inflammation and promote healing.

6. Monitor Symptoms: Keep track of any changes in your symptoms, such as increased swelling, fever, or the appearance of new sores. If you notice any concerning changes, seek medical attention promptly.

7. Avoid Sharing Utensils: Since there is a possibility of a viral infection, it is wise to avoid sharing utensils or engaging in close contact with others to prevent potential transmission.

In conclusion, your symptoms warrant further evaluation by dental and medical professionals to determine the exact cause and appropriate treatment. Early intervention can help prevent complications and promote faster recovery. Don't hesitate to seek care, especially if your symptoms continue to worsen or if you develop new symptoms.

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