Prolonged Oral Discomfort: Causes and Solutions

Oral issues

Hello Doctor, I appreciate your patience in reading this lengthy message.
I have been experiencing discomfort in my oral cavity for the past five months.
Let me detail my symptoms: all issues are on the left side of my mouth.
I feel a mild burning pain and swelling in the oral mucosa.
The gums near the upper second molar are uncomfortable and slightly painful to the touch (this tooth was extracted in mid-January).
The back and middle of my tongue have an unusual taste when I'm not eating, which is salty with a hint of sourness, and sometimes I perceive a metallic taste.
The area around my left jaw joint feels swollen and painful.
Initially, I thought it was related to my teeth, particularly the last remaining molar, which I believed was causing discomfort by rubbing against the cheek mucosa.
In May, I decided to extract it to see if it would help, but there was no improvement.

I wonder if the issue started after the extraction in January when I noticed an ulcer on my gums.
I have been worried and frequently check my mouth, but the ulcer has not healed for a long time.
I have visited various clinics and hospitals, and I recall that my symptoms began to appear around that time.
I even had a biopsy done abroad, which showed no abnormal viruses.
The ulcer still has a small white area.
I have consulted with oral and maxillofacial surgeons, dentists, ENT specialists, and neurologists.
So far, I have undergone a full mouth X-ray, mucosal examination, and a CT scan with contrast of the head and neck (which revealed a lymph node that the doctor said is within acceptable size limits).
However, I have been experiencing persistent dull pain on the left side of my neck, and I am unsure if it is related to the lymph node.
Additionally, there is a bone tumor in my frontal sinus measuring about 1.6 cm, but no other significant abnormalities were found in my oral cavity.

I suspect that this bone tumor might be pressing on a nerve, causing my oral symptoms, but this tumor has been present for three years.
When I inquired at the previous hospital, the doctor said it is unlikely to be the cause of my symptoms, and its size has remained relatively unchanged.
The only way to determine if it is related to my oral symptoms would be to remove it, but the location makes it a risky major surgery.
I still feel that the likelihood of it being the cause is low, especially since the symptoms did not appear until recently.

An MRI of my brain showed no significant structural abnormalities, but I still have some neurological tests pending.
I recently gave birth to my second child over seven months ago and have not breastfed for a long time.
My menstrual cycle has also been irregular for the past three months, and I have started taking hormone-regulating medication.
One oral specialist suggested I have temporomandibular joint (TMJ) issues, which may be contributing to my oral sensory abnormalities.
Another doctor mentioned that I have both deep and superficial TMJ problems, leading to muscle issues in my mouth and discomfort.
Despite taking various medications over this long period, I still cannot pinpoint the problem, and I worry that some issues may have been overlooked during examinations.
I would like to ask if the CT scan of my head and neck with contrast can clearly assess the underlying structures of my oral cavity, jawbone, TMJ, and oral mucosa for any growths or problems.
If I want to further investigate the oral cavity, jawbone, and TMJ, what additional tests can be performed? Could the salty, sour, and metallic taste in my mouth indicate an issue with some internal organ? However, I had a health check-up about a month before the symptoms appeared, and there were no significant issues with my internal organs.
I am concerned that the oral symptoms may stem from a deeper issue that has not been detected.

Five months of discomfort has been incredibly frustrating and distressing, as the symptoms persist outside of eating.
My stress levels are high, and at times I feel overwhelmed, but I have two children whom I cannot bear to leave.
I genuinely do not know which specialist to consult or what tests to undergo.
Could you please help analyze whether I might be experiencing autonomic nervous system dysfunction, hormonal imbalance, endocrine disorders, or stress-related symptoms? My primary concern is whether there is something harmful in my body causing these symptoms, so I hope to find more precise tests or blood tests that could be helpful.
I sincerely appreciate your assistance.
Thank you.

Miss Lin, 40~49 year old female. Ask Date: 2019/06/12

Dr. Liao Yaopan reply Family Medicine

Hello, regarding your concerns, oral issues should be thoroughly evaluated by an oral and maxillofacial specialist.
If further follow-up is needed to rule out possible factors, you may consult a rheumatologist to check for any autoimmune diseases.
Of course, physiological discomfort caused by mental stress could also be one of the reasons, but this would be considered last in the differential diagnosis.
Please note that online consultations are not equivalent to in-person medical visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2019/06/12

More Info

Dear Patient,
Thank you for sharing your detailed symptoms and concerns regarding your prolonged oral discomfort. It sounds like you have been through a significant amount of testing and have seen various specialists without finding a definitive cause for your discomfort. I understand how frustrating and distressing this situation can be, especially when it affects your daily life and well-being.

Based on your description, it seems that you are experiencing a combination of oral mucosal irritation, potential temporomandibular joint (TMJ) dysfunction, and possibly some underlying systemic issues. The symptoms you describe, such as the burning sensation in the oral mucosa, discomfort in the gums, and altered taste sensations, can be indicative of several conditions.

1. Oral Mucosal Conditions: The presence of a persistent ulcer or white lesion in the mouth could suggest a condition such as oral lichen planus or a chronic inflammatory process. These conditions can cause discomfort and may require a biopsy for a definitive diagnosis. If you haven't already, consider consulting an oral medicine specialist who can provide a more focused evaluation of your oral mucosa.

2. TMJ Dysfunction: Given your history of jaw discomfort and the mention of grinding your teeth, TMJ dysfunction could indeed be a contributing factor. This condition can lead to muscle tension, pain, and altered sensations in the oral cavity. Treatment options may include physical therapy, the use of a night guard to prevent grinding, and possibly medications to manage pain and inflammation.

3. Systemic Factors: You mentioned hormonal changes following childbirth and irregular menstrual cycles. Hormonal fluctuations can impact oral health, leading to increased sensitivity and discomfort. Additionally, stress and anxiety can exacerbate these symptoms. It may be beneficial to explore stress management techniques, such as mindfulness or counseling, to help alleviate some of the psychological burden you are experiencing.

4. Investigating Underlying Conditions: If you are concerned about systemic issues, further blood tests could be helpful. Tests for autoimmune conditions, vitamin deficiencies (such as B12 or folate), and thyroid function could provide insight into any underlying health issues that may be contributing to your symptoms.

5. Imaging and Further Evaluation: A CT scan with contrast can provide detailed images of the jaw and surrounding structures, but it may not always reveal soft tissue issues. If you suspect there may be something deeper, an MRI could be more beneficial as it provides better visualization of soft tissues, including muscles and nerves. Discuss with your healthcare provider the possibility of obtaining an MRI of the jaw and surrounding areas.

6. Referral to Specialists: Given the complexity of your symptoms, it may be worthwhile to seek a multidisciplinary approach. A team that includes an oral surgeon, a neurologist, and possibly an endocrinologist could provide a comprehensive evaluation and treatment plan tailored to your needs.

In summary, while your symptoms are multifaceted and may stem from various sources, a thorough and coordinated approach to diagnosis and treatment is essential. I encourage you to continue advocating for your health and seeking out specialists who can help you navigate this challenging situation. Remember, you are not alone in this, and there are professionals who can assist you in finding relief.

Take care, and I wish you the best in your journey toward better health.

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