Oral Mucosa Issues: Symptoms, Causes, and Next Steps

Oral issues

Hello Doctor, I would like to consult you.
I have been experiencing discomfort in my oral mucosa for a month and a half (since I had my upper left second molar extracted).
The symptoms are a burning and stabbing sensation, primarily on the left side of my cheek and the area behind my gums.
I also feel swelling and numbness, and I have observed that the color is redder compared to the right side.
Additionally, I have pain near the outer part of my ear, and I experience mild tinnitus and pain inside my ear.
I have already seen a dentist who said there was no significant issue and did not notice any swelling.
In my most recent visit, the doctor suggested that it might be due to decreased saliva secretion from the salivary glands, leading to bacterial growth in my mouth and subsequent inflammation of the oral mucosa.
I was advised to increase my fluid intake and take vitamin B complex and vitamin C, with the understanding that improvement would take some time.
I am unsure if this is the cause, as I have been to the doctor multiple times and have taken antibiotics and anti-inflammatory medications without improvement (I have seen doctors about ten times).
I can only trust the doctor's advice to drink more water and take vitamin supplements.

Today, I went to a dental clinic recommended by a friend for a thorough examination, where I had a full-mouth X-ray taken.
The dentist said there were no issues with my gums and that they did not feel swollen (although I feel they are).
The dentist also mentioned that my discomfort is not related to the extraction of my last remaining tooth.
They examined the area near my ear, and when I mentioned the pain in my ear, the dentist suggested it might be a temporomandibular joint (TMJ) issue.
However, I asked if the burning sensation in my mouth could also be related to this, and the dentist said it might be due to an immune system issue, or it could be a separate problem altogether.
They wrote a referral for me to see an oral surgeon or an oral diagnostic specialist at a larger hospital.
I have previously seen an oral surgeon, but they could not identify the cause.

Now, I am seeking your advice on what I should do and which specialty I should consult.
I am quite apprehensive about seeing another doctor, as I have already seen many, and they are not the same doctor.
Is it true that oral mucosal inflammation cannot recover solely through medication? If my oral mucosa appears red, does that mean it has been thoroughly examined by a doctor and is unlikely to be problematic? I read online that numbness, pain, and swelling in the mouth can be symptoms of precancerous lesions.
My symptoms have persisted for over a month and are quite similar, with no improvement.
I often feel very uncomfortable and am worried that this could indicate something serious.
Until I find out what the issue is, I cannot feel at ease, and my emotions are becoming unstable.
I apologize for troubling you with my questions, but I really need your help.
Thank you very much.
About a week ago, I visited a doctor for a sore throat, and the doctor noted that my tonsils were slightly red.
When I asked if it was inflamed, the doctor said it might be and suggested I take medication to see if it helps.
Today, I checked my tonsils and noticed a small white spot that looks like an ulcer, but I am unsure if it is.
I am very concerned that it could be something serious.
Approximately half a month ago, I had an endoscopy, which showed no abnormalities.
Is there a possibility that something serious could develop now? What tests can be done to further investigate and ensure there are no issues in areas that cannot be seen with the naked eye, such as inside the mouth or bones (I am willing to pay out of pocket)? Would a CT scan or MRI be appropriate?

Miss Lin, 40~49 year old female. Ask Date: 2019/03/21

Dr. Zheng Jueyi reply Otolaryngology

Hello, based on the current symptoms and examinations by multiple physicians, oral cancer can be ruled out, so you can feel reassured.
As for the persistent pain, it seems more like a symptom of chronic inflammation.
It is recommended to adjust your routine, avoid irritating foods, drink plenty of water, and improve your sleep.
If there is still no improvement, you may consult with a dentist, an otolaryngologist, or a neurologist for pharmacological assistance in treatment.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2019/03/21

More Info

It sounds like you are experiencing a complex and distressing set of oral symptoms that have persisted for over a month and a half. Your symptoms, including burning sensations, swelling, and discomfort in the oral mucosa, as well as pain near your ear and throat, warrant a thorough evaluation. Here’s a structured approach to understanding your situation and the next steps you can take.

Understanding Your Symptoms
1. Oral Mucosa Issues: The burning sensation and swelling in your oral mucosa could be due to several factors, including:
- Post-Operative Changes: After the extraction of a tooth, the surrounding tissues can take time to heal. Sometimes, the healing process can lead to inflammation or irritation of the oral mucosa.

- Dry Mouth (Xerostomia): As your dentist suggested, reduced saliva production can lead to an increase in bacteria, resulting in inflammation. This can be exacerbated by medications, dehydration, or certain medical conditions.

- Allergic Reactions or Irritants: Sometimes, food, dental products, or other irritants can cause localized reactions in the mouth.

- Infections: Oral infections, including viral or fungal infections, can also lead to similar symptoms.

2. Ear and Throat Discomfort: The pain near your ear and throat could be related to:
- Referred Pain: Issues in the jaw or oral cavity can sometimes cause pain that radiates to the ear or throat.

- Eustachian Tube Dysfunction: This can occur if there is inflammation in the throat or nasal passages, leading to ear discomfort.

- Tonsillitis or Pharyngitis: The redness and potential ulceration you observed in your tonsils could indicate an infection that may need further evaluation.

Next Steps
1. Consult a Specialist: Since you have already seen multiple healthcare providers, it may be beneficial to consult with an oral and maxillofacial specialist or an ENT (Ear, Nose, and Throat) specialist. They can provide a more focused examination of your symptoms and may recommend imaging studies if necessary.

2. Imaging Studies: If your symptoms persist without a clear diagnosis, imaging studies such as a CT scan or MRI could be useful. These can help visualize the structures of the jaw, sinuses, and surrounding tissues to identify any underlying issues that may not be visible during a physical examination.

3. Further Testing: If there is a concern about autoimmune conditions or other systemic issues, blood tests may be warranted to evaluate your immune system and overall health.

4. Oral Hygiene and Care: Continue to maintain good oral hygiene, as this can help reduce inflammation and discomfort. Using a saline rinse or an alcohol-free mouthwash may provide some relief.

5. Diet and Hydration: Staying well-hydrated and avoiding irritants (like spicy or acidic foods) can help manage your symptoms. Incorporating vitamin B and C-rich foods may also support oral health.

6. Mental Health Support: Given the emotional toll that chronic symptoms can take, consider seeking support from a mental health professional. Stress and anxiety can exacerbate physical symptoms, and addressing these aspects can be beneficial for your overall well-being.

Conclusion
While your symptoms are concerning, it’s important to approach them systematically. Continue to advocate for your health by seeking specialists who can provide a comprehensive evaluation. Remember that healing can take time, and it’s essential to address both the physical and emotional aspects of your health. If you have further questions or need clarification on any points, don’t hesitate to reach out to your healthcare providers. Your well-being is paramount, and persistent symptoms deserve thorough investigation and care.

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