Oral Discomfort: Causes and Treatment Options

Oral issues

Hello Dr.
Tseng,
I have previously detailed my symptoms and consulted with you about my ongoing oral discomfort, which has persisted for four months.
During this time, I have seen several dentists, oral surgeons, and ENT specialists.
My last visit was over a month ago, where a dentist from a clinic referred me to a major hospital's oral medicine department.
The doctor stated that there were no obvious issues with my oral mucosa, and there were no signs of growth in my gums; only an X-ray was performed.
However, the doctor acknowledged that my discomfort is real and suggested it might be related to a temporomandibular joint (TMJ) issue combined with abnormal oral sensations.
Although my TMJ discomfort has lessened, I still experience discomfort in my gums and jaw, including mild pain and heat.
The mucosa in my mouth is painful, and the back of my left tongue and surrounding area has a strange salty and sour taste.
All these symptoms are confined to the left side of my mouth.
The doctor mentioned that the abnormal sensations could be due to a brain issue, similar to a computer error, which is why I continuously feel discomfort in the left side of my oral mucosa and gums, along with strange taste sensations at the back of my tongue.
I also visited an ENT specialist, who examined my tongue and said it felt normal, but I still have this uncomfortable feeling and strange taste.
Currently, the oral medicine doctor has prescribed medication to help alleviate my emotional distress, which I have been taking for about three weeks.
However, the abnormal oral sensations persist.
I asked the doctor if I would eventually get better, and he assured me that I would, as long as I manage my emotions and try not to focus on the discomfort, although it may take a long time to improve.
However, the abnormal sensations in my mouth are akin to someone experiencing a toothache; it is hard not to pay attention to it.
I wish I could ignore this feeling, as it would make things easier for me.

I am still very concerned about whether there is an underlying issue in my mouth, such as growths.
I once mentioned to the doctor that I wanted to pay for a CT scan, but he said it was unnecessary.
Yet, I continue to experience discomfort that affects my daily life and emotional well-being.
At times, the discomfort is so overwhelming that I contemplate doing something drastic, but I am also fearful.
I have a six-and-a-half-month-old and a six-year-old child, and I truly cannot bear the thought of leaving them.
So, I keep telling myself that it’s nothing serious and to just endure the discomfort.
However, these symptoms do not cease; I feel them every moment of the day.
The doctor also believes I may have some psychosomatic issues, as he inquired whether I felt postpartum depression, to which I replied that my depression stems from the prolonged oral discomfort.
I genuinely wish for a doctor who can treat me effectively.
He mentioned that I could also see a psychiatrist, as he specializes in psychosomatic issues related to oral health.
However, I feel that general psychiatric care may not address my specific concerns.
I am truly at a loss regarding which specialist to consult.
Please help me analyze my situation.
Do I need a CT scan or other examinations, or could you refer me to the appropriate specialty? My current symptoms include abnormal taste sensations in my mouth and tongue, even without eating, along with a strange taste and a tingling, swollen discomfort in my upper left gums.
However, upon examination, there are no obvious injuries or problems.

Because there are no clear symptoms, every time I visit a doctor, they conclude that there is no issue, yet I am undeniably experiencing discomfort.
I really don’t know how to proceed with treatment or which specialist to see for further evaluation.
Please assist me in analyzing my situation.
Thank you so much for your help!

Miss Chen, 40~49 year old female. Ask Date: 2019/05/06

Dr. Zeng Guanghui reply Dentistry

After an oral examination and X-rays, there were no abnormalities found in the oral mucosa and gums.
However, there are taste disturbances and a tingling, uncomfortable sensation in the tongue and oral mucosa, which may be more related to emotional and psychological stress.
It is recommended to consult a psychiatrist for further evaluation and diagnosis.

Reply Date: 2019/05/06

More Info

Understanding oral discomfort can be a complex issue, especially when symptoms persist despite multiple consultations and examinations. Based on the symptoms you've described, it appears that you are experiencing a combination of oral discomfort, altered taste sensations, and possibly psychosomatic symptoms. Here’s a comprehensive approach to understanding and addressing your concerns.

Possible Causes of Your Symptoms
1. Temporomandibular Joint Disorder (TMJ): Given that your symptoms are localized to one side of your mouth and you have a history of jaw discomfort, TMJ dysfunction could be a significant factor. TMJ disorders can lead to pain and discomfort in the jaw, which may radiate to the teeth and gums, causing a sensation of discomfort in the oral cavity.

2. Neuropathic Pain: Your description of a persistent abnormal taste and discomfort could suggest a neuropathic component, where the nerves in the oral cavity are sending incorrect signals to the brain. This can occur after dental procedures or due to underlying stress and anxiety.

3. Oral Mucosal Conditions: Although previous examinations did not reveal any significant issues, conditions like oral lichen planus or geographic tongue can cause discomfort and altered sensations. These conditions may not always be visible during a routine examination.

4. Psychosomatic Factors: Stress and anxiety can manifest physically, leading to symptoms like oral discomfort. Your mention of postpartum depression is particularly relevant, as hormonal changes and emotional stress can exacerbate physical symptoms.

Recommended Steps for Diagnosis and Treatment
1. Consult a Specialist: Since your symptoms are persistent and multifaceted, it may be beneficial to consult with a specialist in orofacial pain or a TMJ specialist. They can provide a more focused evaluation of your jaw and oral structures.

2. Imaging Studies: While your doctor mentioned that a CT scan may not be necessary, if your symptoms continue without improvement, it might be worth discussing again. A CT scan can provide detailed images of the jaw joint and surrounding structures, helping to identify any underlying issues that may not be visible on X-rays.

3. Psychological Support: Given the emotional toll that your symptoms are taking, it may be helpful to seek support from a mental health professional. Cognitive-behavioral therapy (CBT) can be particularly effective in managing chronic pain and anxiety.

4. Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage discomfort. Additionally, muscle relaxants or topical analgesics may be prescribed by your doctor to alleviate symptoms.

5. Lifestyle Modifications: Stress management techniques such as mindfulness, yoga, or meditation can help reduce anxiety and improve your overall well-being. Additionally, ensuring you have a balanced diet and staying hydrated can support oral health.

6. Follow-Up Care: Regular follow-ups with your healthcare providers are essential. Keeping a symptom diary can help track your discomfort and any potential triggers, which can be valuable information for your healthcare team.

Conclusion
Your ongoing oral discomfort is undoubtedly distressing, and it’s important to approach this issue holistically. By consulting with specialists, considering psychological support, and exploring various treatment options, you can work towards finding relief. Remember, you are not alone in this journey, and seeking help is a vital step toward recovery. Your health and well-being are paramount, especially as you care for your young children. Please continue to advocate for yourself and seek the support you need.

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