Oral Mucosa Shedding: Causes and Solutions - Otolaryngology

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Oral mucosa shedding, or desquamation, can be a concerning symptom that may arise from various factors, including changes in oral hygiene products, medications, dietary habits, and underlying health conditions. In your case, the recent onset of oral mucosa shedding coincides with several changes in your routine, which may provide clues to the underlying cause.

1. Toothpaste Change: You mentioned starting to use a whitening toothpaste (舒酸定美白牙膏) about two months ago. Whitening toothpastes often contain abrasive agents and chemicals that can irritate the oral mucosa, leading to sensitivity and shedding. If you suspect this is the cause, consider switching back to a gentler, non-whitening toothpaste that is free from harsh abrasives and chemicals.

2. Herbal Medicine: The introduction of traditional Chinese medicine (中藥) could also be a factor. Some herbal ingredients may cause allergic reactions or sensitivities in certain individuals, potentially leading to mucosal irritation. It would be wise to consult with the practitioner who prescribed the herbal medicine to discuss your symptoms and consider alternative remedies if necessary.

3. Medication Changes: Changes in psychiatric medications can also lead to side effects that affect the oral cavity. Some medications may cause dry mouth (xerostomia), which can contribute to mucosal irritation and shedding. If you have recently changed your medication, it is important to discuss these symptoms with your psychiatrist, as they may need to adjust your treatment plan.

4. Mouthwash Use: The use of mouthwash, especially those containing alcohol or strong antiseptic agents, can disrupt the natural balance of oral flora and lead to mucosal irritation. If you have started using a new mouthwash, consider discontinuing it to see if your symptoms improve.


Recommendations for Management:
- Discontinue Potential Irritants: Stop using the whitening toothpaste and any new mouthwash for a few weeks to see if your symptoms improve. Opt for a mild, fluoride toothpaste and a non-alcoholic mouthwash designed for sensitive mouths.

- Stay Hydrated: Ensure you are drinking plenty of water to keep your mouth moist. This can help alleviate dryness and irritation.

- Consult Healthcare Providers: Since your symptoms have persisted for two months, it is advisable to consult with a dentist or an oral specialist. They can perform a thorough examination to rule out any underlying conditions such as oral lichen planus, candidiasis, or other mucosal disorders.

- Monitor Dietary Changes: Pay attention to your diet. Spicy, acidic, or very hot foods can exacerbate mucosal irritation. Keeping a food diary may help identify any triggers.

- Consider Allergy Testing: If the shedding continues, you might want to discuss the possibility of allergy testing with your healthcare provider to determine if you have developed sensitivities to any substances in your oral care products or diet.

- Follow-Up on Mental Health Medications: Since you are under psychiatric care, it is crucial to keep your psychiatrist informed about any side effects you experience from medication changes. They may need to adjust your prescriptions or suggest alternatives.

In summary, oral mucosa shedding can be multifactorial, and identifying the specific cause in your case will require careful consideration of the changes you've made recently. By discontinuing potential irritants and consulting with healthcare professionals, you can work towards finding a solution that alleviates your symptoms and restores your oral health.