Oral Lesions: Causes, Symptoms, and Treatment Options

A few weeks ago, I had a hole in my upper gum. On December 18, I developed a hole on the tip of my tongue, and then on the 20th, I had another hole in the tissue inside my lower jaw?

Recently, a sore on my tongue healed in about 7 days, but on December 18, I suddenly developed a painful ulcer on the tip of my tongue.
It hurt a lot whenever I touched it, and it wasn't until the 21st or 22nd that the pain lessened, although the wound still appeared white and has now turned a bit gray.
The redness around the tip of my tongue has decreased, and the pain level is now about 1 to 2 out of 10.
I only feel a slight sting when brushing my teeth or if I accidentally touch it with my teeth, but I can still sense that the ulcer is there.
However, the sore on the inner part of my chin is quite painful.
Initially, on the 20th, after brushing my teeth, I felt a sharp pain underneath, around 2 to 3 out of 10.
I thought it was due to not brushing well, but even after brushing, it still hurt, so I ignored it.
The next morning, the pain intensified.
I initially thought it was gum pain, but when I pulled down my lower lip, I saw a white ulcer with redness around it, suggesting inflammation.
Touching that area, or even the skin on my upper lip and outer chin, causes significant pain, reaching about 5 to 6 out of 10.
As of today, the 23rd, the pain has decreased to about 4 out of 10, which is a slight improvement.

Doctor, could this sensitivity be due to the proximity to nerves, causing abnormal nerve sensitivity? Otherwise, why does touching my chin or even opening my mouth to eat cause such pain? I recall that the last time I had mouth ulcers was quite a while ago, at least 3 to 4 years back.
Does this mean I am experiencing recurrent episodes?

Mr. Chen, 30~39 year old female. Ask Date: 2023/12/23

Dr. Zheng Jueyi reply Otolaryngology

The sensations around the oral cavity are primarily mediated by the trigeminal nerve, and pain may be triggered by touching the area, opening the mouth, or chewing.
If the oral ulcers are not persistent and occur with long intervals, they are unlikely to be classified as recurrent.

Reply Date: 2023/12/23

More Info

Understanding oral lesions can be quite complex, as they can arise from various causes and present with a range of symptoms. Based on your description, it appears you are experiencing painful lesions on your tongue and inner cheek, which have been persistent and recurrent. Let's break down the potential causes, symptoms, and treatment options for oral lesions.

Causes of Oral Lesions
1. Trauma or Injury: Oral lesions can often result from physical trauma, such as biting the inside of the cheek or tongue, or from aggressive brushing. This seems to be a possibility in your case, especially if you have experienced pain after brushing your teeth.

2. Aphthous Stomatitis (Canker Sores): These are small, painful ulcers that can occur on the tongue, inside the cheeks, or on the gums. They are often triggered by stress, hormonal changes, or certain food sensitivities.

3. Infections: Viral infections, such as herpes simplex virus, can lead to painful lesions in the mouth. Fungal infections, like oral thrush, can also cause white patches and discomfort.

4. Allergic Reactions: Sometimes, reactions to certain foods, dental products, or medications can cause lesions in the mouth.

5. Systemic Conditions: Conditions such as autoimmune diseases (like lupus or Behçet's disease), vitamin deficiencies (especially B vitamins), or even gastrointestinal issues can manifest as oral lesions.

Symptoms
From your description, the symptoms include:
- Painful lesions on the tongue and inner cheek.

- Redness and inflammation around the lesions.

- Sensitivity to touch, which may indicate nerve involvement or heightened sensitivity due to inflammation.

- The presence of a white or grayish coating on the lesions, which can suggest a healing process or a fungal infection.

Treatment Options
1. Topical Treatments: Over-the-counter topical anesthetics (like benzocaine) can help numb the area and provide temporary relief from pain. Additionally, corticosteroid ointments prescribed by a dentist can reduce inflammation and promote healing.

2. Oral Rinses: Antiseptic mouthwashes or saltwater rinses can help keep the area clean and reduce the risk of secondary infections. Some may also recommend rinsing with a baking soda solution to neutralize acidity and soothe irritation.

3. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and reduce inflammation. Acetaminophen can also be used for pain relief.

4. Dietary Adjustments: Avoiding spicy, acidic, or abrasive foods can help minimize irritation to the lesions. Soft foods may be easier to consume while healing.

5. Consultation with Specialists: If the lesions persist or worsen, it may be beneficial to consult with an oral surgeon or a dermatologist specializing in oral health. They may recommend further diagnostic tests, such as a biopsy, to rule out more serious conditions.

6. Addressing Underlying Conditions: If there are indications of systemic issues (like autoimmune disorders or nutritional deficiencies), addressing these with appropriate medical treatment is crucial.

Conclusion
The pain you are experiencing could indeed be related to nerve sensitivity due to inflammation or trauma. Given the recurrent nature of your lesions, it is advisable to keep a close watch on any patterns or triggers that may exacerbate your symptoms. If the lesions do not improve with home care or if they recur frequently, seeking further evaluation from a healthcare professional is essential. They can provide a more tailored approach to your treatment and help identify any underlying conditions that may be contributing to your oral health issues.

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