Oral Discomfort: Possible Causes and Concerns

Oral issues

Hello Doctor, I would like to consult you.
I have been experiencing discomfort in my oral cavity for almost two months.
The symptoms include a mild burning sensation on the left side of my oral mucosa and the soft palate joint area, sometimes accompanied by a sour, tingling pain and slight swelling.
There is also an unusual taste, reminiscent of a metallic or bloody flavor, but there is no blood when I spit.
I have seen a dentist who found no issues, and I also consulted an oral surgeon abroad who casually examined me with a wooden stick and stated that there was no oral cancer, but this did not address the cause of my discomfort.

I read online that pain or discomfort in the oral mucosa could be a precursor to oral cancer, which has made me very anxious about potential lesions.
I am particularly worried about missing the opportunity for early treatment.
In mid-January, I had my upper left second molar extracted, and since then, I have felt discomfort in my mouth.
There was also an ulcer near the extraction site that has not completely healed for over a month.
A biopsy performed abroad did not reveal any malignant virus, but the ulcer still has a small white area.

I am concerned that I might be missing something, especially since the area behind my last upper tooth feels burning and painful, and appears slightly swollen.
The dentist said that X-rays showed no abnormalities, only bone, which raises the question of whether early-stage lesions or tumors might not be visible on X-rays.
The discomfort on the left side of my cheek is causing me significant anxiety, especially with the burning sensation and unusual taste.
Despite multiple visits to the dentist, the cause remains undetermined.
I have also undergone a nasopharyngoscopy, which showed no issues except for mild redness and swelling of the palatine tonsils.

I would appreciate your analysis on whether this could be related to ENT issues.
Thank you very much.

Ms. Chen, 40~49 year old female. Ask Date: 2019/03/08

Dr. Li Jiaxuan reply Otolaryngology

Your condition appears to involve inflammation between the gums and the temporomandibular joint, which may be a precursor to a malignant tumor or chronic inflammatory dental wounds.
It is recommended to maintain proper oral hygiene.
Regarding your concern about the growth, a more cautious approach would be to suggest a head and neck CT scan.
Dentists typically examine areas below the hard palate, but certain deep triangular regions above the hard palate, especially submucosal areas, may not be visible.
Therefore, a head and neck CT scan would provide a more comprehensive assessment.
Wishing you well.

Reply Date: 2019/03/08

More Info

Hello, thank you for reaching out with your concerns regarding your oral discomfort. Based on the symptoms you've described, it seems that you are experiencing a complex set of issues that may involve multiple factors, including dental health, potential nerve involvement, and possibly systemic conditions.

Firstly, the sensations of burning, tingling, and unusual tastes in your mouth can be indicative of several conditions. One possibility is a condition known as burning mouth syndrome (BMS), which is characterized by a burning sensation in the tongue, lips, gums, and other areas of the mouth without an obvious cause. This condition can be associated with various factors, including hormonal changes, nutritional deficiencies (such as vitamin B12, iron, or folate), and even psychological factors such as anxiety or depression.

The presence of a persistent ulcer near the extraction site of your second molar, which has not healed completely, raises concerns. While you mentioned that a biopsy did not reveal any malignancy, the ongoing symptoms, including the white area you observe, warrant further investigation. Chronic ulcers can sometimes be a sign of underlying conditions, including autoimmune disorders or infections that may not have been initially identified.

Given that you have already undergone multiple evaluations, including X-rays and a biopsy, it may be beneficial to consider a multidisciplinary approach. Consulting with an oral and maxillofacial surgeon could provide a more in-depth evaluation of the structural aspects of your oral cavity. They may recommend advanced imaging techniques, such as a cone beam computed tomography (CBCT) scan, which can provide a more detailed view of the jawbone and surrounding structures than standard X-rays.

Additionally, the unusual taste and burning sensation could also be linked to issues with the salivary glands or even a condition affecting the nerves that supply sensation to the mouth. Since you have mentioned that you have undergone an endoscopy with no significant findings, it might be worthwhile to explore the possibility of a neurological evaluation. A neurologist can assess for any nerve-related issues that could be contributing to your symptoms.

In terms of your dental health, if you have not already done so, consider visiting a periodontist to evaluate the health of your gums and the underlying bone structure. They can assess for any signs of periodontal disease, which could explain some of the discomfort you are experiencing.

Lastly, managing anxiety and stress is crucial, as these factors can exacerbate oral discomfort. Engaging in relaxation techniques, cognitive behavioral therapy, or mindfulness practices may help alleviate some of the psychological burden associated with your symptoms.

In summary, while your symptoms are concerning and warrant thorough investigation, there are multiple avenues to explore. A collaborative approach involving dental specialists, oral surgeons, and neurologists may provide you with a clearer understanding of your condition and lead to effective management strategies. Please continue to advocate for your health and seek out the necessary specialists to ensure that all potential causes are thoroughly evaluated.

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