Oral Mucosa Issues: Could It Be Autonomic Nervous System Dysfunction?

Q: Oral Mucosa Issues: Could It Be Autonomic Nervous System Dysfunction?

Hello： In addition to considering diseases of the immune system, your symptoms may also suggest trigeminal neuralgia, particularly given your neuropathic pain symptoms that may involve the mandibular branch. <br>According to the International Classification of Headache Disorders,

Autonomic Nervous System Dysregulation

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 localized to the left side of my cheek and the area of the gums towards the back.
I also feel swelling and numbness, and I have observed that the color in that area is redder than on the right side.
Additionally, I have pain near the outside of my ear, and I experience mild tinnitus and pain inside my ear (the pain near my ear varies in intensity, sometimes stronger and sometimes lighter).
I have already seen a dentist who said there was no major issue; the oral mucosa is slightly red.
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 the mouth and subsequent inflammation of the oral mucosa.
I was advised to increase my fluid intake and take vitamin B complex and vitamin C, and that improvement would take some time.
I am unsure if this is the cause, as I have been to the doctor and taken antibiotics and anti-inflammatory medications without improvement.
Today, I visited a dental clinic recommended by a friend for a thorough check-up, where I had a full-mouth X-ray taken.
They said there were no issues with the gums and that they felt no swelling (although I feel there is some).
They also mentioned that my discomfort is not related to the extraction of the last remaining tooth.
The dentist examined the area near my ear, and when I mentioned the pain in my ear, they 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 an issue with my immune system, or it could be a separate problem.
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 consulting you on what I should do.
I have also seen an otolaryngologist, who said they did not know the reason and suggested I see a neurologist.
Could the redness, swelling, and pain of the oral mucosa be related to a neurological issue? Is it true that oral mucosa inflammation cannot recover solely with medication? If the oral mucosa appears red, does that mean it has been thoroughly examined by a doctor and there should be no issues? I read online that numbness, pain, and swelling in the mouth could be symptoms of precancerous lesions.
My symptoms have persisted for over a month and are quite similar, with no improvement, and I often feel very uncomfortable.
I am worried that something serious might be wrong.
What tests can be done to ensure that there are no issues in areas that cannot be seen by the eyes? Until my symptoms improve or I can confirm that everything is fine, I will not be at ease.
I am unsure which specialty to consult.
Can a CT scan reveal if there is anything abnormal in my mouth or inside my cheeks? I apologize for the trouble and appreciate your help.
Thank you.
Could this be related to autonomic nervous system dysregulation or an immune system issue?

Ms. Chen, 40~49 year old female. Ask Date: 2019/03/22

Dr. Jiang Junyi reply Neurology

Hello: In addition to considering diseases of the immune system, your symptoms may also suggest trigeminal neuralgia, particularly given your neuropathic pain symptoms that may involve the mandibular branch.
According to the International Classification of Headache Disorders, Third Edition (ICHD-3), the diagnostic criteria for trigeminal neuralgia are as follows:
- At least three attacks
- Pain occurring in one or more divisions of the trigeminal nerve
- At least three of the following pain characteristics must be met:
o Lasting from a fraction of a second to two minutes, with periodic, paroxysmal attacks
o Severe pain intensity
o Electric shock-like, burning, or sharp pain
o More than three trigger points in the face
- No other obvious neurological deficits.

The course of trigeminal neuralgia varies from person to person.
Attacks can last from a few days to several weeks or months, followed by periods of remission.
Symptoms tend to recur, but medication treatment is usually effective in controlling them.
It is recommended that you consult a neurologist for discussion and treatment.
Wishing you good health, peace, and joy.
Dr.
Jiang, Neurology Department, cares about you.

Reply Date: 2019/03/22

More Info

It sounds like you are experiencing a complex set of symptoms related to your oral mucosa and possibly involving the autonomic nervous system. Given the duration and nature of your symptoms, it is understandable that you are feeling concerned and seeking clarity on what might be happening.

From your description, you have been experiencing discomfort in your oral mucosa, particularly after the extraction of your upper left second molar. Symptoms such as burning, tingling, swelling, and redness in the left cheek and jaw area, along with ear pain and tinnitus, can indeed be indicative of several underlying issues.

1. Oral Mucosa Inflammation: The inflammation of the oral mucosa could be due to a variety of factors, including post-surgical healing, reduced saliva production, or even an allergic reaction. The fact that your dentist noted a possible decrease in saliva production suggests that xerostomia (dry mouth) could be contributing to your symptoms. Saliva plays a crucial role in maintaining oral health by neutralizing acids, providing antimicrobial action, and aiding in digestion. When saliva is insufficient, it can lead to an overgrowth of bacteria, resulting in inflammation and discomfort.

2. Autonomic Nervous System Dysfunction: The autonomic nervous system (ANS) regulates involuntary bodily functions, including salivation. If there is dysfunction in the ANS, it could potentially lead to symptoms such as dry mouth and altered sensation in the oral cavity. Stress and anxiety can exacerbate these symptoms, leading to a cycle of discomfort.
3. Temporomandibular Joint (TMJ) Issues: Your dentist suggested that your symptoms might be related to TMJ dysfunction. This condition can cause pain in the jaw, face, and even the ear, as well as referred pain that might mimic other issues. TMJ disorders can also lead to muscle tension and discomfort in the surrounding areas, which could explain the pain you are experiencing.

4. Immune System Considerations: If there is an underlying autoimmune condition, it could manifest as oral mucosal lesions or discomfort. Conditions such as Sjögren's syndrome, which affects saliva production, could lead to similar symptoms.
5. Cancer Concerns: While it is natural to worry about serious conditions such as oral cancer, it is important to note that many of the symptoms you describe can be attributed to less severe conditions. However, if your symptoms persist without improvement, further investigation may be warranted.

Recommendations:
- Follow-Up with Specialists: Since you have already seen several specialists, it may be beneficial to follow up with an oral pathologist or an oral medicine specialist who can provide a more in-depth evaluation of your oral mucosa. They may consider a biopsy if there are suspicious lesions.

- Consider Imaging: A CT scan or MRI can provide detailed images of the soft tissues in your mouth and jaw. This could help identify any underlying issues that may not be visible during a standard examination.

- Evaluate for TMJ Dysfunction: If you suspect TMJ issues, consider seeing a dentist who specializes in this area. They may recommend treatments such as physical therapy, dental splints, or other interventions.

- Manage Stress and Anxiety: Since stress can exacerbate symptoms, consider stress management techniques such as mindfulness, yoga, or counseling.

- Hydration and Nutrition: Continue to stay hydrated and consider dietary adjustments that may help with your symptoms. Vitamin B and C supplementation, as suggested by your dentist, can support mucosal health.

- Regular Monitoring: Keep a symptom diary to track any changes or patterns in your symptoms. This can be helpful for your healthcare providers in determining the best course of action.

In conclusion, while your symptoms are concerning, they may not necessarily indicate a severe underlying condition. A thorough evaluation by the appropriate specialists, along with imaging if necessary, can help clarify the situation. It’s important to advocate for your health and seek further evaluations until you feel satisfied with the answers you receive.

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