Oral Discomfort: Symptoms and Specialist Guidance

Oral issues

Hello Doctor, I apologize for the lengthy message.
For about the past two months, I have been experiencing discomfort in the left side of my oral cavity, specifically in the cheek and soft palate area.
There is a burning and stabbing sensation, accompanied by a sour taste that resembles the taste of blood (I can't distinguish between the two).
I also feel a slight tingling sensation at the tip of my tongue, which sometimes extends to my cheek.
Additionally, I experience aching discomfort in the area just below my left ear.
The discomfort in my mouth is somewhat alleviated when eating, but I still feel it at night while trying to sleep, where the mucosa feels either burning or cold, sometimes hard to differentiate.
Currently, there are no obvious ulcers in my mouth.

On January 18, I had the second molar on the left side extracted, and at that time, there was an ulcer in the adjacent gum.
It has not completely healed after more than a month, but several doctors have examined it and said it does not appear to be anything serious.
However, due to my concerns, I had a biopsy done abroad, which indicated it was a benign ulcer with no signs of malignancy.
The extraction site now appears slightly white.

Regarding the discomfort in my mouth, I have undergone a nasopharyngoscopy, which did not reveal any issues.
I have visited several dental clinics abroad, and they have all stated that the extraction site is healing well and that there are no problems with my other teeth.
They also mentioned that the mucosa looks fine.
I am unsure if oral examinations are less common abroad.
During a full-mouth X-ray, the dentist noted that the area around the gums is all bone and that there are no growths, but I wonder if tumors might not be visible on X-rays.
Could early-stage lesions or abnormalities go undetected? This has made me quite anxious, as I am worried about the possibility of oral cancer, gum cancer, or tongue cancer.

I plan to return to Taiwan for further examination at a major hospital.
Which specialty should I consult for my current symptoms? Should I see a dentist, an oral and maxillofacial surgeon, an oral medicine specialist, or an ENT specialist? I would appreciate your analysis and guidance.
Thank you very much.

Miss Chen, 40~49 year old female. Ask Date: 2019/03/10

Dr. Xiao Yongxun reply Family Medicine

Dear Ms.
Chen,
1.
Thank you for your detailed description.
I am not a specialist in this field and have not conducted research on it; I can only provide references based on my limited knowledge.
2.
The physicians you have encountered are very thorough.
In addition to routine examinations, they have performed a nasopharyngoscopy, biopsy, and full-mouth X-rays.
Their aim is likely to rule out malignant conditions such as nasopharyngeal cancer, oral cancer, gingival cancer, or tongue cancer.
If all results are normal, it may indicate that there is currently no cancer, or there may be cancer that is too early to detect.
Personally, I believe that it is possible that there is currently no cancer.
3.
Please prepare complete information and first consult with your primary care physician for discussion and understanding, then seek care at an ENT or dental clinic at a hospital.
(This is merely a personal suggestion and may not be accurate.)

Reply Date: 2019/03/10

More Info

Hello,
Thank you for sharing your concerns regarding your oral discomfort. Based on the symptoms you've described, it seems that you are experiencing a complex interplay of issues that could involve multiple areas of expertise in the medical field. Let’s break down your symptoms and the appropriate specialists you might consider consulting.

Symptoms Overview
1. Burning and Stinging Sensation: The burning sensation in your oral cavity, particularly on the left side, could indicate several potential issues, including inflammation, nerve irritation, or even a reaction to certain foods or medications.

2. Taste Alterations: The strange taste you describe, which you liken to blood, could be related to several factors, including oral infections, gum disease, or even systemic conditions affecting taste perception.

3. Numbness: The tingling sensation at the tip of your tongue could suggest nerve involvement, possibly due to irritation or damage to the nerves that supply sensation to the tongue and surrounding areas.

4. Ear Discomfort: The pain you feel near your left ear could be related to temporomandibular joint (TMJ) issues, which can cause referred pain to the ear and surrounding structures.

5. Post-Extraction Concerns: Since you had a tooth extraction recently, it’s important to consider that the healing process can sometimes lead to complications such as dry socket or lingering inflammation, which might explain some of your discomfort.

Recommended Specialists
Given the complexity of your symptoms, here are the specialists you might consider consulting:
1. Oral and Maxillofacial Surgeon: Since you have had a tooth extraction and are experiencing ongoing discomfort, an oral surgeon can evaluate the extraction site and assess for any complications that may have arisen post-surgery.

2. Oral Medicine Specialist: This specialist focuses on the diagnosis and management of oral mucosal diseases and can help evaluate the burning sensation and any lesions or abnormalities in your oral cavity.

3. Otolaryngologist (ENT): Given your ear discomfort and the potential overlap with oral symptoms, an ENT specialist can assess any related issues in the throat, ears, and nasal passages that might be contributing to your symptoms.

4. Neurologist: If the numbness and tingling persist, a neurologist can evaluate for any nerve-related issues that might be causing these sensations.

5. Dentist: A general dentist can perform a thorough examination of your teeth and gums, ensuring that there are no underlying dental issues contributing to your discomfort.

Diagnostic Considerations
- Imaging: While X-rays can reveal certain abnormalities, they may not always detect early-stage tumors or lesions. If there is a concern for oral cancer, a more comprehensive imaging study, such as a CT scan or MRI, may be warranted.

- Biopsy: Since you mentioned having a biopsy that returned benign results, it’s crucial to follow up on any persistent symptoms. If new lesions appear or if your symptoms worsen, further biopsies may be necessary.

Conclusion
It’s understandable to feel anxious about your symptoms, especially with concerns about serious conditions like oral cancer. However, the fact that previous examinations have not revealed any malignancies is reassuring. I recommend that you keep a detailed record of your symptoms and any changes you notice, as this information will be invaluable to the specialists you consult.

When you return to Taiwan, consider scheduling appointments with the specialists mentioned above to ensure a comprehensive evaluation of your symptoms. It’s important to advocate for your health and seek the care you need to address your concerns effectively.

Wishing you the best in your journey towards relief and recovery.

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