Oral Mucosa and Tongue Issues: Symptoms and Solutions

Oral mucosa and tongue issues?

Over the past year, episodes have occurred every two to three months, typically before and during menstruation, lasting about two weeks each time.
The symptoms are localized to the tongue and the lower part of the oral cavity, as follows: there is a pulling sensation under the tongue when moving it, accompanied by inflammatory pain; there are a few small white lesions around the lingual frenulum, but they are not painful; the lateral edges of the tongue often have indentations from teeth and also exhibit inflammatory pain; the tongue feels more swollen than usual; the mucosa beneath the tongue feels rough and has a loss of sensation; upon waking and stretching the tongue, there is bleeding from the sublingual area.
These conditions alternate over the course of two weeks.
I kindly request your insights, thank you.

TAKI, 30~39 year old female. Ask Date: 2022/08/16

Dr. Li Jiaxuan reply Otolaryngology

Do you have a habit of grinding your teeth while sleeping? It may be necessary to visit the clinic to assess the extent of any mucosal lesions and sublingual hematomas.
If needed, a biopsy may be performed.
Wishing you well.

Reply Date: 2022/08/16

More Info

Understanding oral mucosa and tongue issues can be quite complex, especially when symptoms are recurrent and can be linked to hormonal changes, such as those experienced during the menstrual cycle. Based on the symptoms you've described, it appears that you may be dealing with a combination of oral mucosal irritation, possible inflammation, and perhaps some underlying hormonal influences.

Symptoms Breakdown
1. Tongue Movement and Discomfort: The pulling sensation and pain during tongue movement could indicate inflammation of the sublingual area or the lingual frenulum. This could be due to irritation from food, dental appliances, or even a reaction to certain medications.

2. White Lesions: The presence of small white spots on the tongue or surrounding areas could be indicative of a few conditions, such as oral thrush (a fungal infection), leukoplakia, or even canker sores. While these lesions are not painful, their presence suggests that there may be an underlying issue with the mucosal health.

3. Teeth Impressions on the Tongue: The presence of indentations along the sides of your tongue (known as scalloped tongue) can be a sign of bruxism (teeth grinding), which may be exacerbated by stress or anxiety, or it could be related to the size of your tongue in relation to your oral cavity.

4. Mucosal Texture Changes: The rough texture of the oral mucosa could be a sign of keratosis or inflammation. This could be due to chronic irritation from food, tobacco use, or even a reaction to dental materials.

5. Bleeding: The bleeding you experience upon stretching your tongue in the morning could be due to fragile mucosal tissues, which may be exacerbated by dryness during sleep or inflammation.

Potential Causes
- Hormonal Fluctuations: Given that your symptoms coincide with your menstrual cycle, hormonal changes could be influencing your oral health. Estrogen and progesterone can affect mucosal health and may lead to increased sensitivity or inflammation.

- Oral Hygiene: Poor oral hygiene can lead to a buildup of bacteria and plaque, which can irritate the mucosal surfaces and lead to inflammation.

- Dietary Factors: Certain foods, especially acidic or spicy ones, can exacerbate mucosal irritation and lead to discomfort.

- Stress and Anxiety: These factors can lead to bruxism and changes in oral habits, which can further irritate the mucosa.

Recommendations
1. Consult a Specialist: It would be beneficial to see an oral pathologist or an oral medicine specialist who can perform a thorough examination and possibly a biopsy if lesions persist. They can help rule out any serious conditions.

2. Maintain Oral Hygiene: Ensure that you are practicing good oral hygiene. Brush your teeth at least twice a day and floss daily. Consider using a gentle mouthwash that does not contain alcohol, as it can dry out the mucosa.

3. Dietary Adjustments: Pay attention to your diet. Try to avoid overly spicy, acidic, or abrasive foods that could irritate your oral mucosa. Staying hydrated is also crucial.

4. Manage Stress: If stress is a contributing factor, consider stress management techniques such as mindfulness, yoga, or counseling.

5. Hormonal Evaluation: Since your symptoms correlate with your menstrual cycle, it may be worth discussing with your healthcare provider whether hormonal evaluations or adjustments could be beneficial.

6. Regular Check-ups: Regular dental check-ups can help monitor your oral health and catch any issues early.

Conclusion
Your symptoms suggest a multifactorial issue involving hormonal influences, potential oral hygiene concerns, and possibly stress-related factors. A comprehensive approach involving medical evaluation, lifestyle adjustments, and possibly dietary changes may help alleviate your symptoms. Always consult with a healthcare professional for personalized advice and treatment options.

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