Common Mouth Problems

Mouth problems are a broad group and mixture of oral disorders, diseases, and other oral issues. We can list the common mouth problems as follows.

Canker Sores

Canker sores (recurrent aphthosis stomatitis) are one of the most common mouth problems. They are recurrent oral ulcers as we can see from the name. These aphthae are painful, round, creamy white lesions surrounded by red lines. Recurrent aphthae can be small, large, or grouped. However, they are mostly small. In these cases, ADA approved pain relievers (eg, KANK-A Mouth Pain Liquid or Benzodent Dental Pain Relieving Cream) will be especially helpful in relieving pain.

 

Aphthae usually heal within 7-10 days without scarring. But, aphthae tend to recur for indefinite periods. We can observe an increase in the frequency of aphthae in case of stress. For example, before the exam, we can see this. We can also observe an increase in aphthae after quitting smoking. Smoking also increases oral keratinization. 

The level of the factors that increase susceptibility to oral aphthae, is important. That is why, the patient’s complete blood count, serum iron, Vitamin B12, and folic acid levels should be checked.

As a treatment, the doctors or dentists usually recommend topical steroids, antiseptics (eg, ADA approved; Listerine Ultraclean Antiseptic Mouthwash series (Arctic Mint, Cool Mint, Freshburst) etc.), benzydamine, and chlorhexidine. They reduce pain and complications.

Moreover, the treatment may include administration of tetracycline in the form of a topical solution or systemically. In the case of more than 3 aphthae in the mouth, we call it complex aphthosis. In these cases, the doctors or dentists may recommend switching to colchicine, thalidomide, and dapsone.

Oral Thrush

Oral thrush (oral candidiasis) is also one of the common mouth problems. A type of fungus – candida causes oral thrush. In most people, candida lives on the back of the tongue without symptoms. In particular, the susceptibility to candida infection increases in cases where immunity is suppressed and body resistance decreases. For example, these usually occur, especially after antibiotic use. In addition, in cases of dry mouth and in diseases such as diabetes and anemia we can also observe such pictures.

Candida manifests itself in the form of white plaques. In particular, candida can develop on the palate in those who use dentures. Since the immune system is still not developed in newborns, we can see oral thrush frequently.

In the treatment of oral thrush, mouthwash containing nystatin, amphotericin B, and azole group can be preferred. If candida (especially on the tongue) is in the form of a thick plaque, the doctor or dentist removes this excess by wiping it with gauze.

Smoker’s Palate

Smoker’s palate (Nicotine stomatitis) is also one of the common mouth problems. It is gray-white formations on the palate in the form of raised bumps. It is a condition that we can observe in smokers. In other words, the heat of cigarette smoke causes this disorder, and treatment is usually not necessary. Because this disorder resolves spontaneously within a week or two upon cessation of smoking.

Geographic and Fissured Tongue

Geographic tongue is well-circumscribed red patches on the tongue. They are surrounded by thin, white borders. The tongue looks like a map. Therefore, the people mostly call it “mapped tongue”. The geographic tongue is usually asymptomatic. Because rarely pain and burning may develop. Treatment is not necessary for the mapped tongue. If pain and burning occur, the doctor or dentist may recomend  topical steroids.

In the fissured tongue, we can observe grooves and clefts in the tongue. As with the geographic tongue, the treatment is not necessary for the fissured tongue also. Fissured tongue is a common finding in Dawn syndrome.

Chronic Cheek Biting and Chewing

This disorder results from chronic cheek biting and chewing (Morsicatio Buccarum). It manifests itself as white, raised, lumpy formations that develop on the cheek mucosa after chronic cheek chewing. We usually observe morsicatio buccarum in irritable and neurotic individuals. In addition, tooth deformities can also cause this condition. Medical or dental interventions to reduce trauma are the main treatment modalities.

Mucocele

Mucocele is a common condition resulting in leakage of mucus into the underlying tissue. It forms usually due to damage to the minor salivary gland ducts. We usually see this condition in the lower lip mucosa.

Superficial mucoceles are in the form of bubbles, while deep mucoceles are in the form of blue-colored nodules. While superficial mucoceles open into the mouth, the treatment of deep mucoceles needs surgical intervention.

Necrotizing Ulcerative Gingivitis

Necrotizing ulcerative gingivitis (Vincent infection) is a type of gum infection. This disorder is multiple bacterial infections of the gum that presents with pain, bleeding, edema, and cell death. Conditions such as poor oral hygiene, malnutrition, smoking, stress, and immunosuppression increase susceptibility to Vincent infection.

The treatment of this gum infection is with broad-spectrum antibiotics, antiseptic mouthwashes, and debridement of dead tissue. Gargling with warm, salty water may provide partial relief to the patient.

Pemphigus

Pemphigus is an autoimmune bullous disease. In the case of this disease, autoantibodies forms against the body’s own antigens. Intraoral involvement often develops in pemphigus vulgaris (a form of pemphigus). This is usually the initial symptom of the disease.

In pemphigus, first, fluid-filled bullae, which we call bubbles, develop in the mouth. These bullae open rapidly and turn into large, painful, red erosions, that is, bullae that open to the surface.

The treatment of pemphigus is with antiseptic mouthwashes, immunosuppressant corticosteroids, and systemic medications such as tetracycline and niacinamide.

Lichen Planus

Lichen planus is more common in the mouth than on the skin and is more difficult to treat. We usually see these lesions on the inner cheek mucosa, less frequently on the gingiva and ridge of the tongue. It is white, reddened, or opened to the surface. Some dental treatment materials and pain relievers can cause the development of lichen planus in the mouth. Besides, the association of lichen planus with hepatitis B is common.

In the treatment of lichen planus, the doctor or dentist can prefer immunosuppressive agents such as corticosteroids and azathioprine, and acitretin and isothyretin or oral cyclosporine as systemic treatment. In local treatment, the treatment is with corticosteroids. As local treatment injection into the area can also be a choice. Patients can use topical anesthetic agents before a meal to facilitate food intake.

Leukoplakia and Erythroplakia

Leukoplakia manifests itself in the form of white patches and plaques on the oral mucosa that is unremovable by rubbing. It is the most common premalignant disease of the mouth that can become cancerous (precancerous).

Leukoplakia is closely related to smoking, alcohol, and trauma. Furthermore, this lesion is most common between the ages of 50-70.

Different from leukoplakia, erythroplakia is in the form of red, velvety, very sharply circumscribed plaques in the mouth. Although erythroplakia is less common than leukoplakia, it is more cancerous.

In both cases, the removal of lesions needs surgical procedures. In terms of both erythroplakia and leukoplakia, the person needs to avoid smoking, alcohol, and trauma.