Open Wide: An Overview of Some Common Ailments of the Mouth and Tongue
Written by: Harvard Vanguard Oral and Maxillofacial Department
Many people develop ulcers in their mouth from time to time - in most cases these heal up in a few days. Sometimes growths or lesions develop in the lining mucous membranes of the mouth due to trauma, however, and on occasion they can be more serious. If you have such a condition you should check with your dentist or primary care physician who may refer you to an oral and maxillofacial surgeon* for further evaluation and possible biopsy.
Ulcers in the Mouth
- Canker sores - These are the most common ulcers in the mouth and are called Aphthous Ulcers. They can develop in the mucous membrane lining of the mouth, inside the cheeks, on the floor of the mouth or tongue. They can be quite painful but only last for a few days and then heal entirely. They are frequently caused by trauma or develop after routine dental care. There is no way to prevent them, but over the counter medications can ease the discomfort. There are no long term consequences. If they last more than a few days, or if you get them on a frequent basis, check with your dentist or primary care physician.
- Oral Lichen Planus - This is a skin condition, but can occur in the mouth without any signs on the skin. Frequently, patients are unaware that they have this or they may notice a roughness inside their cheeks or some stinging or burning with hot, salty or spicy foods. The areas look like white lace and may have some red areas. They frequently get worse with stress and are sometimes the result of a drug reaction. There is no cure, but medications can help to control the discomfort.
Lesions and Growths
- Trauma - If you bite your lip or cheeks you may develop some swelling in the area which will continue to get irritated. This is a Bite Fibroma and is entirely benign. It can be removed by an oral surgeon under local anesthesia.
- Cheek biting - Many people catch their cheeks between their teeth when they grind their teeth or inadvertently during chewing. Over time this can cause an irritated area in the cheeks in a line corresponding to where the cheeks meet. Your dentist may be able to smooth off rough edges of your teeth or construct a night guard to keep your cheeks away from where your teeth meet at night.
- Infections - Viral infections can cause blisters and ulcers in the mouth and these may interfere with eating and swallowing. You will have discomfort, the glands under your jaw will be swollen and sore, and you will have a fever. Consult with your primary care physician.
- Yeast infections – Yeast Infections can cause a white film to form over your tongue, gums or inside your cheeks. These infections frequently occur if you are run down or are taking antibiotics. Consult your primary care physician.
- Cysts inside the lips - We all have many small pea sized saliva glands inside our lips. If these are traumatized they can enlarge into a bluish swelling or cyst. Sometimes these burst, shrink down but then came back. They can be removed under local anesthesia by your oral surgeon. Sometimes it is better to remove them with a laser to prevent recurrence.
- Varicosities - With age our veins become more prominent – i.e. varicose veins in the legs. In the mouth this can happen in the lips or floor of the mouth. If they bleed or become unsightly your oral surgeon can remove them under local anesthesia sometimes with a laser.
- Amalgam Tattoo - If pieces of an old metal filling or the debris from a filling or crown preparation becomes lodged in the mucous membranes of your mouth they will stain the tissue black - this is called an Amalgam Tattoo and is not at all dangerous.
- Bony Lumps - Smooth, hard bony swellings are a part of many people’s normal anatomy in the mouth. They are located in the middle of the roof of the mouth or under the tongue behind and below your lower teeth. Usually there is no reason to remove them but if they grow so big that they catch food, interfere with chewing or speaking, or if your dentist cannot make a satisfactory denture, your oral surgeon may advise you to have them removed.
The Tongue
Your tongue can be a good indicator of your general health. For example if you are anemic or run down your tongue can feel sore and look red and shiny. Here are some of the common conditions that manifest themselves on the tongue.
- Geographic tongue - This is an irregular area on one or both sides of your tongue which can be present for many years and is not usually painful unless irritated. The shape can change and looks like the edge of a map-hence its name!
- Black hairy tongue - If you smoke, drink a lot of coffee or take certain medications the tongue may become coated with a thick brown or black coating which may cause bad breath and look unpleasant. You should check with your dentist or primary care physician. The best way to deal with this is to use a tongue brush or scraper.
- Cracks in the tongue - This is called fissured tongue and is normal anatomy. They may be sore especially when irritated.
- Cancer of the mouth - You can develop a cancer in the mouth which if it is diagnosed early can be cured. Painful ulcers on the tongue, floor of the mouth or under dentures should be checked by your oral surgeon and biopsied if necessary. Although cancer occurs most commonly in older patients especially those who smoke and drink it can also be seen in younger patients especially those with a family history of cancer. If you are at all concerned ask your dentist or hygienist to do a mouth cancer screening and have your dentist check any ulcer or lesion that does not heal after a few days.
What is a Biopsy?
Your oral surgeon may suggest that the lesion or ulcer be biopsied to confirm the diagnosis under the microscope. A small piece of tissue or the entire area (if it is small enough) is removed under local anesthesia and the tissue sent to the pathology department for examination under the microscope. Dissolving stitches may be placed and you will be given post operative instructions and prescriptions as necessary. The report will be available within a week, longer if bone is involved and your oral surgeon will either call you with the results or see you in follow-up. You should always speak with your oral surgeon if you have any questions or concerns. The results will be available to your physician and can be sent to your dentist if you wish.
*Harvard Vanguard Oral and Maxillofacial Surgeons: Leslie Halpern, MD, DDS; David Keith, DMD; Edward Lahey, MD, DMD; Carol Lorente, DMD; and Joseph Wilkes, DMD