Oral Wounds: Is That White Spot with a Black Dot Normal?

My question?

A week ago, I developed a sore in the upper right part of my mouth.
After a week of using medication, the wound is healing, but there is a white area in the center with a black dot.
Is this normal? Additionally, I frequently get sores; is this also normal, or could it indicate a deficiency of some substance?

Feng zhi ren, 10~19 year old female. Ask Date: 2004/11/04

Dr. Zeng Guanghui reply Dentistry

If wounds frequently appear on the oral mucosa, it may be commonly referred to as "mouth sores," which are also known as recurrent aphthous ulcers.
The frequency of these outbreaks varies from person to person, occurring every few weeks or months, and can affect any area of the oral mucosa, including the tongue.
Triggers include excessive emotional or psychological stress and disruptions in daily routines, which can interfere with the autoimmune system, causing the body’s antibodies to attack its own oral mucosal cells.
During an outbreak, there are usually prodromal symptoms such as a burning sensation in the oral mucosa, followed by the formation of a white pseudomembrane covered by a ring of red inflamed tissue.
At this stage, the rough surface of the mucosa can easily trap food debris or external pigments.
Once an oral ulcer occurs, it is advisable to avoid irritating foods and excessively hot meals, while maintaining good oral hygiene to prevent secondary infections.
Maintaining a healthy lifestyle and managing work-related or psychological stress can help reduce the frequency of oral ulcer outbreaks.

Reply Date: 2004/11/04

More Info

When it comes to oral wounds, particularly those that appear white with a black dot in the center, there are several factors to consider. The presence of a white spot in the healing process of an oral wound can often be attributed to the natural healing mechanisms of the body. As wounds heal, they may form a layer of new tissue, which can appear white due to the presence of fibrin, a protein involved in blood clotting and tissue repair. The black dot you mentioned could be a scab or a small area of necrotic tissue, which is not uncommon in the healing process.

However, it is essential to monitor the wound closely. If the black dot is not improving or if it begins to change in appearance, size, or color, it could indicate an underlying issue that requires further evaluation. Persistent or recurrent wounds in the mouth may suggest several potential problems, including:
1. Oral Candidiasis: This fungal infection can cause white patches in the mouth, and if there is an underlying issue such as a weakened immune system, it can lead to recurrent lesions.

2. Aphthous Ulcers: These are common, painful sores that can appear in the mouth and may recur frequently. They are often triggered by stress, certain foods, or deficiencies in vitamins such as B12, folate, or iron.

3. Trauma or Irritation: If you frequently experience oral wounds, consider whether there are any habits or factors contributing to this, such as aggressive brushing, dental appliances, or certain foods that may irritate the mucosa.

4. Systemic Conditions: Conditions such as autoimmune diseases or vitamin deficiencies can lead to recurrent oral ulcers. If you suspect this might be the case, it would be prudent to consult with a healthcare provider for a comprehensive evaluation.

5. Oral Cancer: While less common, persistent sores that do not heal or change in appearance can be a sign of oral cancer. This is particularly concerning if you have risk factors such as tobacco use or a history of sun exposure to the lips.

Given your description of the wound healing with a white area and a black dot, it is advisable to consult with a dentist or an oral specialist. They can perform a thorough examination and may recommend a biopsy if there are any concerns about the nature of the lesion. Additionally, they can provide guidance on proper oral hygiene practices and dietary recommendations to help prevent future occurrences.

In summary, while the appearance of a white spot with a black dot in the center of a healing oral wound can be part of the normal healing process, it is crucial to remain vigilant. If you experience recurrent wounds or any changes in your oral health, seeking professional advice is essential to rule out any serious underlying conditions and to ensure appropriate treatment.

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