Chronic Mouth Sores and Painful Tongue: Seeking Dental Solutions

Chronic chapped lips, a smooth tongue with pain and a burning sensation?

Hello Doctor: I have a history of iron deficiency anemia and partial gastric resection.
Over the past 2 to 3 years, I have occasionally experienced redness and cracking at the corners of my mouth, which heals after applying an oral ointment for a few days.
However, in the past year, the cracking at both corners of my mouth and dry lips has not improved; I experience this almost daily, making it difficult to open my mouth wide or smile.
My tongue has also been sensitive since three years ago, starting with mild numbness and pain, but in the past year, my entire oral cavity has become very sensitive.
I cannot eat anything slightly hot, spicy, or coarse, such as toast, whole grain bread, or fried foods.
My tongue appears smooth, without coating, and looks somewhat red, but the tip and surface of my tongue feel numb and swollen when not eating, and painful when I do eat.
Additionally, my overall saliva production has decreased.
Blood tests show no deficiency in vitamin B12 or folate.
I have seen an ENT specialist who provided me with oral ointment and multivitamins, but there has been no improvement, and my symptoms have even worsened recently.
I am also taking iron supplements to address my anemia.
I am unsure which specialty to consult, and the doctors I have seen have provided similar treatments without any improvement.
Eating has become a painful experience for me, and I often prefer not to eat or only consume cold liquid foods, such as milk, soy milk, or pudding.
I would appreciate your assessment and recommendations.
Thank you!

Kristy, 40~49 year old female. Ask Date: 2021/09/05

Dr. Zeng Guanghui reply Dentistry

Iron deficiency anemia can cause dryness and cracking of the oral mucosa and tongue, leading to sensitivity to irritating foods.
If symptoms are severe and affect eating, it is advisable to consult a family medicine physician for evaluation and treatment.
Good oral hygiene should be maintained, and spicy foods and alcohol-containing mouthwashes should be avoided.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2021/09/05

More Info

Chronic mouth sores and a painful tongue can significantly impact your quality of life, especially when they interfere with eating and speaking. Given your medical history of iron deficiency anemia and partial gastric resection, it's essential to consider how these conditions might contribute to your oral symptoms.
From your description, it seems you are experiencing angular cheilitis (cracked corners of the mouth), glossitis (inflammation of the tongue), and possibly oral mucositis. These conditions can be exacerbated by nutritional deficiencies, particularly in vitamins such as B12, folate, and iron, which are crucial for maintaining healthy mucosal tissues. Although you mentioned that your blood tests showed no deficiencies in these vitamins, it’s worth noting that absorption issues could arise from your gastric surgery, leading to functional deficiencies even when serum levels appear normal.

The symptoms you describe—cracked lips, a sensitive and painful tongue, and a decrease in saliva production—could also indicate a condition known as burning mouth syndrome (BMS). BMS is characterized by a burning sensation in the tongue or other areas of the mouth without an obvious cause. It can be associated with various factors, including hormonal changes, anxiety, and certain medications.
Here are some recommendations to help manage your symptoms:
1. Hydration and Saliva Production: Since you mentioned a decrease in saliva, it’s crucial to stay hydrated. Consider using saliva substitutes or mouthwashes designed to alleviate dry mouth. Chewing sugar-free gum or sucking on sugar-free candies can stimulate saliva production.

2. Dietary Adjustments: Avoid spicy, acidic, or rough-textured foods that can irritate your mouth. Instead, focus on soft, bland foods that are easier to eat. Foods like yogurt, smoothies, and soups can provide nutrition without causing pain.

3. Topical Treatments: While you have been using oral ointments, consider asking your healthcare provider about topical corticosteroids or other medications that can reduce inflammation and pain in the mouth.
4. Nutritional Support: Even if your blood tests are normal, consider consulting a nutritionist who can help you devise a diet plan that ensures you’re getting adequate nutrients, particularly if your eating habits have changed due to pain.

5. Consultation with Specialists: Since your symptoms have persisted despite treatment, it may be beneficial to consult with a specialist in oral medicine or a dentist with experience in managing complex oral conditions. They can provide a more thorough examination and possibly recommend treatments that have not yet been considered.

6. Pain Management: Over-the-counter pain relievers like acetaminophen or ibuprofen may help manage discomfort. However, consult your healthcare provider before starting any new medication, especially if you are taking other medications for your anemia or any other condition.

7. Stress Management: Since stress can exacerbate oral pain, consider incorporating stress-reduction techniques such as mindfulness, meditation, or gentle exercise into your routine.

8. Follow-Up: Regular follow-ups with your healthcare provider are essential to monitor your symptoms and adjust your treatment plan as necessary. If your symptoms worsen or new symptoms arise, seek medical attention promptly.

In conclusion, while chronic mouth sores and tongue pain can be challenging to manage, a comprehensive approach that includes dietary changes, proper hydration, topical treatments, and specialist consultations can help alleviate your symptoms and improve your quality of life. Don’t hesitate to advocate for yourself and seek further evaluations if your current treatment plan is not providing relief.

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