Oral Discomfort: Is It Neurological or Hormonal?

Oral issues

Hello Doctor, I have already inquired about the report, and it has come out.
The MRI with contrast shows no tumors in the brain, and some blood test issues seem to be minor.
However, the doctor suspects it might be an ovarian issue.
I told the doctor that I had visited a gynecologist in early June due to abnormal menstruation, and an ultrasound of the pelvic area showed no abnormalities in the ovaries.
I have started hormone therapy for three months, and I have completed two treatment cycles.
I will return to the gynecologist and the metabolic specialist in September.
The doctor suspects ovarian degeneration and advised me to continue the medication and observe, with a follow-up blood test in six months.
Now, I would like to ask the doctor if my oral discomfort symptoms are truly caused by nerve issues? Do I need to consult an oral surgeon for a re-examination? I have already undergone a CT scan of the head and neck with contrast, which showed no abnormalities, and the neck ultrasound also showed no issues.
Additionally, I had a complete MRI of the head, and the doctor stated that no tumors were found, and nothing was visible in the jaw area.
However, the discomfort in my mouth persists.
Given all these examinations, can we rule out the possibility of a tumor in the oral cavity? Or do I need to undergo another CT scan or MRI of the mouth?
The neurologist suspects that my oral and tongue discomfort is nerve-related and mentioned that it would take time to heal.
I am currently taking Vitamin B12, Rifampicin (three times a day), and one tablet each of Rifampicin and Xanax before bed.
I have also consulted a rheumatologist based on the doctor's suggestion, but there were no issues found.
My oral symptoms continue to worry me about any undetected lesions.
My brainstem examination results were right at the borderline of 42, which affects the control of cranial nerves IX, XI, and XII, potentially causing my oral symptoms.

I have been seeing doctors for six months and have consulted many specialties.
The ENT specialist found no significant problems, and the oral surgeon also said everything was fine.
Could there be an issue within the muscles that is not visible? Therefore, I kindly ask the doctor to analyze my situation.
Do I need to see another specialist for further examination, or is it truly a neurological issue, or could it be related to hormonal imbalance? It is all very complicated, and I am unsure how to proceed with treatment.
I apologize for the trouble and sincerely appreciate your help.
Thank you.

Miss Lin, 40~49 year old female. Ask Date: 2019/07/29

Dr. Jiang Junyi reply Neurology

Hello, regarding the issues you mentioned, I have some suggestions.
The endocrinologist suspects ovarian degeneration and advised me to continue medication and observe for six months before returning for blood tests.
Now, I would like to ask the doctor if my oral discomfort symptoms are truly caused by nerve issues.
Do I need to consult an oral surgeon for a re-evaluation?
A: It is advisable to check the salivary gland secretion to see if there are signs of dry mouth syndrome.
I have already undergone a CT scan of the head and neck with contrast, which did not reveal any abnormalities.
The neck ultrasound also showed no issues, and I had a complete MRI of the head, where the doctor found no tumors.
There was nothing visible in the gum area, yet my oral discomfort persists.
Given that I have undergone so many tests, can I rule out the possibility of tumors in the oral cavity? Or do I need to have another CT scan or MRI specifically for the oral area? The neurologist suspects that my nerve issues are causing discomfort in my mouth and tongue, stating that recovery will take time.
I am currently taking vitamin B12, Rifampin (three times a day), and one tablet each of Rifampin and Xanax before bed.
I have also consulted a rheumatologist based on the doctor's recommendation, but there were no issues found.
My oral symptoms still cause me concern about any undetected lesions.
My brainstem examination results were right at the borderline of 42, which is concerning regarding the control of cranial nerves IX, XI, and XII, potentially causing my oral symptoms.
A: Regarding oral tumors, if there are no habits such as drinking alcohol or smoking, the likelihood of tumor development is low.
Imaging diagnostics should be complemented by a physical examination from an oral surgeon.
It is recommended to consult an oral surgeon first.
I have been seeing doctors for six months and have consulted many specialties.
The ENT specialist indicated no significant problems, and the oral surgeon also found nothing concerning.
Could there be an issue within the muscles that is not visible? Therefore, I ask the doctor to help analyze whether I need to seek further evaluations from other specialists, or if this is truly a neurological issue, or perhaps related to hormonal imbalances.
It is all too complex, and I am unsure how to proceed for effective treatment.
My suggestion: Your symptoms may be related to sympathetic nervous system overactivity.
Sympathetic nervous system excitation can inhibit gland secretion, cause contraction of arrector pili muscles, dilate pupils, relax ciliary muscles (flattening the lens for distance vision), stimulate the sinoatrial node (increasing heart rate), enhance cardiac contractility, cause contraction of most arterial smooth muscles, relax smooth muscles in skeletal muscle arteries, dilate bronchi (bronchodilation), inhibit bronchial gland secretion, decrease gastrointestinal motility, and inhibit gastrointestinal gland secretion, among others.
It is recommended to first regulate the sympathetic nervous system and train parasympathetic nervous system function to at least reduce bodily discomfort.
I suggest discussing the evaluation of sympathetic nervous system function with a neurologist.
Wishing you health, peace, and happiness.
Dr.
Jiang from Taoyuan Medical Center cares about you.

Reply Date: 2019/07/29

More Info

It sounds like you are experiencing a complex set of symptoms that have persisted for an extended period, and I understand how distressing this can be. Based on your description, you have undergone a thorough evaluation, including MRI and CT scans, which have not revealed any tumors or significant abnormalities in your brain or neck. Additionally, you have consulted various specialists, including neurologists, dentists, and gynecologists, without a definitive diagnosis.

Given the symptoms you are experiencing—oral discomfort, abnormal sensations in your tongue, and the potential hormonal issues related to your menstrual cycle—it is essential to consider both neurological and hormonal factors. The fact that your MRI and CT scans were clear is reassuring, as it suggests that there are no significant structural abnormalities in your brain or neck that could be causing your symptoms. However, the persistent discomfort in your oral cavity may still have a neurological component, especially if your neurologist has indicated that there may be nerve involvement.

The cranial nerves, particularly the trigeminal nerve (cranial nerve V), are responsible for sensation in the face and oral cavity. If there is any irritation or dysfunction of these nerves, it could lead to sensations such as burning, tingling, or discomfort in the mouth and tongue. Additionally, the involvement of cranial nerves IX, XI, and XII, as mentioned by your neurologist, could also contribute to your symptoms, particularly if there is any degeneration or dysfunction.

Hormonal fluctuations can also play a significant role in oral health. Hormonal imbalances, particularly those related to estrogen and progesterone, can affect the mucosal lining of the mouth, leading to symptoms such as dryness, discomfort, and changes in taste sensation. Since you are currently undergoing hormone therapy and have experienced menstrual irregularities, it is plausible that your oral symptoms could be linked to these hormonal changes.

Considering the complexity of your situation, here are some recommendations:
1. Follow Up with Your Gynecologist: Since you are already on hormone therapy, it is crucial to continue monitoring your hormonal levels and menstrual cycle. Discuss any changes in your oral symptoms with your gynecologist, as they may need to adjust your treatment plan based on your ongoing symptoms.

2. Neurological Evaluation: If you have not already done so, consider seeking a second opinion from a neurologist who specializes in craniofacial pain or neuropathic pain. They may be able to provide further insights into whether your symptoms could be related to nerve dysfunction.

3. Oral and Maxillofacial Specialist: Given your ongoing oral discomfort, it may be beneficial to consult an oral and maxillofacial specialist. They can conduct a thorough examination of your oral cavity and assess for any subtle issues that may not have been detected in previous imaging studies.

4. Consider a Multidisciplinary Approach: Since your symptoms may involve multiple systems (neurological, hormonal, and possibly autoimmune), a multidisciplinary approach involving a rheumatologist or immunologist may be beneficial. They can evaluate for any underlying autoimmune conditions that could be contributing to your symptoms.

5. Symptom Management: In the meantime, continue with the vitamin B12 supplementation, as it is essential for nerve health. Discuss with your healthcare provider about other potential treatments for managing your oral discomfort, such as topical anesthetics or medications that target nerve pain.

6. Mental Health Support: Given the stress and anxiety that can accompany chronic health issues, consider seeking support from a mental health professional. They can help you develop coping strategies to manage the emotional impact of your symptoms.

In conclusion, while your imaging studies have ruled out significant structural issues, your symptoms may still be influenced by a combination of neurological and hormonal factors. Continued collaboration with your healthcare providers and a multidisciplinary approach may help you find relief and a clearer understanding of your condition.

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