Oral Discomfort: Causes and Solutions for Persistent Symptoms

Oral issues

Hello Doctor, I have previously inquired about my condition and have also visited a major hospital to see an oral and maxillofacial surgeon.
I detailed my issues to the doctor, who examined my mouth and said everything looked fine.
The doctor also reviewed my previous full-mouth X-rays and mentioned that the gums appeared normal and there were no tumors.
I asked the doctor if X-rays could detect tumors, and the doctor replied that if there were a tumor, the bone in the X-ray would show abnormalities, so I didn't pursue this further.
As for my symptoms, I have a burning and tingling sensation on the left side of my mouth, specifically in the cheek and posterior dental arch area.
Sometimes, I also experience a numb feeling, along with a slight sensation of blockage in my left ear, tinnitus, and some ear pain (I had my ears checked over a month ago with no issues found).
There is also pain in the outer cheek area, and I have a strange taste in my mouth that resembles a mix of salty and bloody flavors.
The doctor explained that this could be related to salivary gland issues due to insufficient water intake, leading to decreased saliva production and resulting in oral inflammation, which could explain the burning sensation.
Regarding other areas, the doctor said everything looked fine.
However, I have been experiencing a sore throat on the left side for the past few days, so I consulted an ENT specialist.
Upon entering, the doctor only subjectively addressed my previous concerns and mentioned that my extraction site had healed.
I told the doctor that my current symptoms involve discomfort in my mouth and an unusual taste in my saliva, but the doctor said they didn't understand what I was saying.
I struggled to articulate my feelings about the discomfort in my mouth.
The doctor noted some redness in the palatine tonsils and suggested it might be due to inflammation.
I mentioned that this has been ongoing for a month, and the doctor simply advised me to try medication, implying that I might be wasting resources by frequently visiting the hospital for my oral discomfort, and perhaps they thought I was being overly dramatic.
This discomfort has persisted for over a month, and it is quite distressing.
I have seen many doctors without improvement, and I am uncertain whether there is a significant issue or a tumor, which has led to feelings of depression and negative thoughts.
I truly don't know how to handle this situation.
I hope to receive assistance from here to analyze my condition.
What should I do, and what tests can clearly determine if there is something wrong in my gums or cheek area (I am willing to pay out of pocket)? I hope to resolve this quickly, as I do not want to continue feeling uncomfortable in my mouth and cheek every day.
Please help me, Doctor.
Thank you.

Ms. Chen, 40~49 year old female. Ask Date: 2019/03/16

Dr. Zeng Guanghui reply Dentistry

Discomfort in the oral cavity and cheeks, characterized by a burning and tingling sensation, was noted.
However, both the oral examination and X-rays showed no abnormalities.
Additionally, there is pain on the outer cheek near the ear, which may indicate a temporomandibular joint (TMJ) issue.
It is recommended to consult an oral surgeon to discuss the symptoms and undergo a thorough examination by a physician.

Reply Date: 2019/03/16

More Info

I'm sorry to hear about the persistent discomfort you're experiencing in your oral cavity. It sounds like you've been through a lot of consultations and examinations without finding a clear diagnosis or relief. Let's break down your symptoms and explore potential causes and solutions.

From what you've described, your symptoms include a burning sensation, tingling, and a strange taste in your mouth, particularly on the left side. You also mentioned experiencing ear discomfort and a feeling of fullness, which can sometimes be associated with issues in the jaw or throat. Given that you've already consulted with various specialists, including oral surgeons and ENT doctors, it's understandable to feel frustrated and concerned about the lack of answers.

Possible Causes
1. Salivary Gland Issues: Your doctor mentioned that the strange taste could be related to salivary gland function. Reduced saliva production can lead to dry mouth (xerostomia), which can cause discomfort and alter taste perception. This condition can be exacerbated by dehydration, certain medications, or underlying health issues.

2. Nerve Involvement: The tingling and burning sensations could indicate nerve irritation or dysfunction. Conditions like neuropathy or even issues related to the trigeminal nerve, which innervates the face, might be contributing to your symptoms.

3. Temporomandibular Joint (TMJ) Disorders: Given the connection between your jaw and ear discomfort, TMJ disorders might be a factor. These can cause pain in the jaw, face, and even lead to referred pain in the ear.

4. Oral Mucosal Conditions: Conditions such as oral lichen planus, geographic tongue, or other inflammatory conditions can cause burning sensations and changes in taste. These often require a biopsy for diagnosis.

5. Psychological Factors: Chronic pain and discomfort can lead to anxiety and depression, which may exacerbate your perception of pain and discomfort. It's important to address these feelings with a healthcare professional.

Recommended Steps
1. Consult a Specialist: Since you've seen multiple specialists without a clear diagnosis, consider seeking a consultation with an oral medicine specialist or a neurologist who has experience with oral and facial pain. They may provide a fresh perspective on your symptoms.

2. Salivary Gland Evaluation: A thorough evaluation of your salivary glands, possibly including imaging studies like a sialography or ultrasound, can help determine if there's an obstruction or dysfunction.

3. Nerve Studies: Electromyography (EMG) or nerve conduction studies may help assess if there's nerve damage contributing to your symptoms.

4. Psychological Support: Given the emotional toll this situation has taken on you, consider speaking with a mental health professional. They can help you develop coping strategies and address any anxiety or depression stemming from your chronic discomfort.

5. Lifestyle Adjustments: Ensure you're staying well-hydrated and consider using saliva substitutes or mouth rinses designed for dry mouth. Avoiding irritants like spicy or acidic foods may also help alleviate some discomfort.

6. Follow-Up: If you feel your concerns are not being taken seriously, don’t hesitate to seek a second opinion. It’s crucial to find a healthcare provider who listens to your concerns and works with you to find a solution.

Conclusion
Your symptoms are complex and multifaceted, and it’s understandable to feel overwhelmed. By seeking further evaluation and possibly a different specialist, you may find the answers you need. Remember, you deserve to have your concerns addressed, and it’s important to advocate for your health. Don't hesitate to reach out for support, both medically and emotionally, as you navigate this challenging situation.

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