Persistent Oral Discomfort: Causes and Solutions

Oral issues

Hello Dr.
Tseng, I apologize for the lengthy message, but I recently underwent some examinations and would appreciate your patience in reading through my concerns.
Thank you.

I have been experiencing discomfort in my oral cavity for the past five months.
Let me detail my current symptoms, which are all located 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 part of my tongue has an abnormal taste when I am not eating, described as salty with a hint of sour, and at times, it tastes like blood.
The area around the left posterior mandible feels swollen and painful, and I feel like my upper and lower teeth are biting into the soft tissue inside my mouth.
Initially, I thought the discomfort was due to the extraction of the last molar, which was irritating the buccal mucosa, but after deciding to extract it in May, there was no improvement.

I have been concerned since mid-January when I noticed an ulcer on my gums after the extraction.
I have been frequently checking my mouth and worrying about it, as it has not healed for a long time.
I have visited various hospitals and clinics, and reflecting on my symptoms, I realize they began to appear around that time.
I even had a biopsy done abroad, which showed no abnormal viruses, but the ulcer still has a slight white appearance.

I have already consulted with oral and maxillofacial surgeons, dentists, ENT specialists, and neurologists.
So far, I have undergone a full mouth X-ray, oral mucosa examination, and a CT scan of the head and neck with contrast (which revealed a lymph node that the doctor said is within acceptable size limits).
However, I have been experiencing persistent 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 there are no other obvious pathological changes in the oral cavity.
It is suspected that this bone tumor may be compressing a nerve, causing my oral symptoms, but this tumor has been present for three years.
I inquired at the previous hospital, and the doctor said it is unlikely to be the cause, as 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 high-risk major surgery.
I still feel that the likelihood of it being related to this tumor is low, as symptoms would have appeared three years ago.
An MRI of the brain showed no significant structural abnormalities, and some neurological tests are still pending.
I recently gave birth over seven months ago and have not breastfed for a while.
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 could be contributing to my oral sensory abnormalities.
Another doctor indicated that I have both deep and superficial TMJ problems, leading to muscular issues in the oral cavity and resulting discomfort.
I am uncertain if TMJ is indeed the problem, as I have been on various medications for a long time without any improvement.
I am still unable to pinpoint the source of the issue and worry that there may be undetected problems.
I would like to ask if the CT scan of the head and neck with contrast can clearly examine the base of the oral cavity, the mandible, the TMJ, and the underlying oral mucosa for any growths or issues.
If I want to further confirm the conditions of the oral cavity, mandible, and TMJ, what additional tests can be performed? Would it be necessary to conduct a biopsy of the oral mucosa or gums?
The salty, sour, and bloody taste in my mouth—could it indicate bleeding from a specific area in the oral cavity? Is it possible that there is an issue with an internal organ? However, I had a health check-up about a month before the symptoms appeared, and there were no significant problems with my internal organs.
I am concerned that the oral symptoms may stem from a deeper issue that has not been detected.

These symptoms have persisted for over five months, causing me great frustration and discomfort, as they are constant except when eating.
My stress levels are very high, and I am struggling to cope, especially since I have two children who depend on me.
I genuinely do not know which specialist to consult next or what tests to pursue.

Could you please help analyze whether I might be experiencing autonomic nervous system dysregulation, 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.
Is there a need for a biopsy of the uncomfortable areas in my mouth?
I sincerely appreciate your help and guidance.
Thank you.

Miss Lin, 40~49 year old female. Ask Date: 2019/06/13

Dr. Zeng Guanghui reply Dentistry

It is recommended that if there is a suspicion of temporomandibular joint (TMJ) issues, one should consult an oral and maxillofacial surgeon for a TMJ imaging examination, and also to assess whether there is an issue with occlusal instability.

Reply Date: 2019/06/13

More Info

Hello, thank you for sharing your detailed concerns regarding your persistent oral discomfort. It sounds like you have been through a lot in trying to find the root cause of your symptoms, and I can understand how frustrating and distressing this experience must be for you. Based on the information you've provided, let's break down your situation and explore potential avenues for further investigation and management.

Understanding Your Symptoms
Your symptoms, which include burning sensations, discomfort in the gums, abnormal taste sensations, and pain in the jaw area, can indeed be complex. The fact that these symptoms are localized to the left side of your mouth and have persisted for several months suggests that there may be multiple factors at play.

1. Temporomandibular Joint (TMJ) Disorders: Given that some healthcare providers have suggested TMJ issues, it is worth considering this as a significant factor. TMJ disorders can lead to pain in the jaw, discomfort in the surrounding muscles, and even referred pain that might feel like it’s coming from the teeth or gums. Symptoms can also include clicking or popping sounds when moving the jaw, which may explain some of the discomfort you are experiencing.

2. Oral Mucosal Conditions: The presence of a white area in your mouth could indicate a few different conditions, including leukoplakia, lichen planus, or even a chronic ulcer. These conditions can sometimes be associated with discomfort and abnormal taste sensations. A biopsy may be warranted if the area does not improve or if there are concerns about malignancy.

3. Nerve Involvement: The burning sensation and altered taste could also suggest a neuropathic component, possibly related to nerve compression or irritation. This could be due to TMJ issues or other structural problems in the jaw or neck area.

4. Hormonal and Stress Factors: Given your recent pregnancy and hormonal changes, it’s possible that hormonal fluctuations could be contributing to your symptoms. Stress and anxiety can also manifest physically, leading to muscle tension and exacerbating TMJ disorders or other oral discomforts.

Diagnostic Approaches
To address your concerns about potential underlying issues, here are some recommendations for further evaluation:
1. Advanced Imaging: While a CT scan can provide detailed images of the bone structures, it may not always capture soft tissue details effectively. An MRI of the jaw and surrounding areas could be beneficial to assess the soft tissues, including the muscles and ligaments associated with the TMJ, as well as any potential nerve involvement.

2. Oral Examination and Biopsy: If there are persistent lesions or areas of concern in the oral mucosa, a biopsy may be necessary to rule out any pathological conditions. This can provide clarity on whether there are any underlying issues that require treatment.

3. Blood Tests: Comprehensive blood work could help assess for systemic issues, including autoimmune conditions, hormonal imbalances, or signs of infection or inflammation that could be contributing to your symptoms.

4. Referral to Specialists: Given the complexity of your symptoms, it may be beneficial to consult with a multidisciplinary team, including an oral and maxillofacial surgeon, a neurologist, and possibly an endocrinologist to evaluate for any hormonal or metabolic issues.

Management Strategies
While you are undergoing further evaluations, consider the following management strategies:
- Pain Management: Over-the-counter anti-inflammatory medications may help alleviate some discomfort. If pain persists, a healthcare provider may prescribe muscle relaxants or other medications.

- Physical Therapy: A physical therapist specializing in TMJ disorders can provide exercises and techniques to help relieve muscle tension and improve jaw function.

- Stress Management: Techniques such as mindfulness, meditation, or counseling may help manage stress, which could be contributing to your symptoms.

- Dietary Adjustments: Avoiding foods that exacerbate your symptoms, such as hard or chewy foods, may provide temporary relief.

Conclusion
Your situation is undoubtedly challenging, and it’s crucial to continue advocating for your health. Persistent oral discomfort can stem from various sources, and a thorough investigation is essential to identify the underlying cause. I encourage you to pursue further evaluations and consider the recommendations provided. Remember, you are not alone in this journey, and seeking support from healthcare professionals who listen and understand your concerns is vital. Please take care of yourself, and I hope you find relief soon.

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