Unusual Oral Symptoms: Seeking Answers for Persistent Discomfort - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Based on your description, it seems like you have oral ulcers.
This condition can only be treated symptomatically.
Here is an article for your reference:
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"Mouth Ulcers" - A Common Concern
In the ENT clinic, we often encounter patients of all ages suffering from this issue.
Although they are just small mouth ulcers, they can cause significant discomfort for patients.
It's important not to underestimate these seemingly harmless ulcers, as there are several diseases that require careful differential diagnosis.
Below are some common conditions associated with mouth ulcers:
1.
Chickenpox: The causative agent is the varicella-zoster virus.
Diagnosing chickenpox is not particularly challenging, as it has a characteristic feature where different types of skin rashes (macules, papules, vesicles, pustules) can be seen simultaneously on the same area.
Patients often report itching but not pain, with rashes primarily concentrated on the trunk, shoulders, face, and limbs.
2.
Hand, Foot, and Mouth Disease: The causative agents are typically coxsackieviruses from the enterovirus group (A4, A5, A9, A10, A16; B2, B5), while the more notorious enterovirus 71 is less common.
As the name suggests, the rashes are found on the oral mucosa and the extremities of the hands and feet, causing mild itching or pain, and often leading to difficulty in eating due to oral ulcers.
3.
Herpetic Gingivostomatitis: The causative agent is the herpes simplex virus.
Ulcers are usually found in the anterior part of the oral cavity, with swollen gums that bleed easily upon touch, and a characteristic foul odor in the mouth.
If a child has atopic dermatitis, there is a risk of developing "herpetic eczema," which can lead to bacterial infections, with reported mortality rates of 1-9%.
4.
Herpangina: Despite its name, herpangina is not caused by the herpes virus.
The causative agents are coxsackieviruses from the enterovirus group (types 1-10, 16, 22).
Ulcers are typically located in the posterior part of the oral cavity, without the swollen gums and foul odor characteristic of herpetic gingivostomatitis, making it easier to differentiate between the two.
5.
Recurrent Aphthous Stomatitis: This condition does not have a specific causative agent.
This is the true subject of this article, as it represents what is commonly referred to as "mouth ulcers." Many people have experienced yellowish-white, painful depressions of varying sizes on the oral mucosa, soft and hard palates, or lips.
If left untreated, these can sometimes take up to two weeks to heal spontaneously.
This condition tends to recur periodically, initially presenting with mild pain or burning sensations, but not as severe as the systemic discomfort associated with herpes simplex.
Many patients become adept at predicting when they will experience lesions in specific areas.
The ulcers typically start as red papules, which then erode to form ulcers that gradually enlarge and become more painful, affecting eating, sleeping, mood, and speaking.
After 7-10 days, the ulcers heal without leaving any scars, and the damaged mucosa returns to normal.
The onset of this condition is often observed in students during exams, business people under financial stress, or elderly individuals with anxious personalities, indicating that stress, pressure, or anxiety can trigger outbreaks.
There is often a familial tendency, with multiple family members seeking treatment together, and female patients may notice a correlation with their menstrual cycle.

As for the common patient inquiry regarding vitamin deficiencies, in today's affluent society, people often experience nutritional excess rather than deficiency, making it difficult to support the notion of vitamin deficiency as a cause.
It is generally accepted that psychological stress and other factors lead to changes in immune function, resulting in autoimmune lesions.
The table below summarizes the classification and treatment options for recurrent aphthous stomatitis:
| Severity | Mild | Severe |
|----------------|-----------------------|-----------------------|
| Number of Ulcers | 1-5 | 1-10 or >50 |
| Size | <1 cm | 1-3 cm |
| Location | Non-keratinized oral mucosa | Non-keratinized oral mucosa and soft palate, throat |
| Duration | 4-14 days | <6 weeks |
| Scarring | No | May occur |
| Incidence | Highest | Second highest |
| Treatment | Topical corticosteroid ointment, possibly with oral corticosteroids | Mandatory use of oral corticosteroids |
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Reply Date: 2006/04/13