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Sores, Lumps and Bumps 1

 

 

 

Sores, Bumps, Lumps and abnormalities in the mouth that are commonly mistaken for cancer but are NOT

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The following is a list of everything you wanted to know about the sores and bumps that occur in the mouth.  Some of these are considered normal oral anatomy.  Others are abnormal but not treated since they heal by themselves or are harmless, while still others are considered pathological (sickness) but are generally ignored since treatment is not available. Click on the associated thumbnail to enlarge the picture.

Hard bony bumps under the gums (tori)

"Torus" is Latin for "a smooth rounded anatomical protuberance".   these bumps are naturally occurring, benign protuberances of bone covered by attached mucosa (gum tissue).

Torus PalitinusTorus palatinus

These are simply hard, bony growths covered by firm, pink gum tissue on the hard palate.  They are solidly bound down to the underlying bone and cannot be moved around with finger pressure.  These start out as small hard bumps in the center of the palate in younger persons, but they tend to enlarge as the patient gets older. They develop very slowly and do not appear suddenly over the course of a few weeks or months.  They are considered normal anatomtorus Palitinusy unless they become too large or they interfere with the construction of an upper denture, in which case they are removed by an oral surgeon.  Sometimes, patients will have a large torus for years, but not realize that it was there all along until, one day, quite suddenly, they notice it for the first time.  At that point, they think they have developed oral cancer, but find, after considerable worry that it is really just their normal anatomy.

Torus MandibularisTorus Mandibularis

These are the same type of Toris Mandibularis growths as the Torus Palatinus except that they grow on the inside of the lower jaw.  Again, they can grow quite large, or they may remain as small bumps.  They are also bound to the underlying bone and cannot be moved around with finger pressure.  These are also quite often mistaken by patients for oral cancer.  Very large mandibular torii can become a nuisance since they are covered with easily abraded soft tissue and can become quite sore when eating hard or irritating foods. In situations like this, it is advisable to visit an oral surgeon and have them removed.  The operation is not especially difficult, and aside from transient post operative discomfort, the effects are immediate and quite positive.

Exostoses

Bony exostosisExostoses are simply hard bumps that occur on the bone on the outside of the top or bottom teeth.  Like tori, they are solidly bound down to the underlying bone and are not movable.  They can be quite tiny, feeling like a large, immovable grain of sand under the gums, or they can be quite large as in the image to the right.  In general, they are considered normal anatomy and are left alone unless they interfere with the construction of a denture, in which case they are removed by an oral surgeon.

Tongue abnormalities

Burning mouth syndrome (BMS) (also known as burning tongue syndrome)

Hitchiker's guide logoA small percentage of older men and women (mostly women), generally at, or around the age of menopause develop a problem with chronic burning pain and phantom tastes in their mouths.  It can occur on the palate, but most often centers on the tongue. The tongue itself looks perfectly normal.  It just develops a burning sensation that progresses throughout the day, disappears overnight, and reappears the next day after eating.  These patients may have seen numerous doctors to try to rid themselves of the annoying, and sometimes painful symptoms, but generally to no avail.  The problem has been ignored for centuries because there seemed to be no physical reason for the symptoms, and because it was believed that it was a hysterical symptom brought on by emotional distress.  In fact, the problem sometimes does respond to antidepressant drugs like Elavil.

There are two types of burning mouth syndrome.

Primary, or idiopathic burning mouth syndrome is the most common type.  Idiopathic means that the cause is unknown, and this appears to be the most common type.

Primary burning mouth syndrome

A theory to explain some cases of  idiopathic BMS

Recent research (Google  Dr. Linda Bartoshuk)  has revealed a hypothesis (not proven) which might explain BMS (Burning Mouth Syndrome).  It involves actual damage to the seventh cranial nerve which supplies the taste buds in the anterior 2/3 of the tongue. This may be caused by the change in hormonal balance due to menopause and/or a viral infection.  The theory is that these persons have lost much of their ability to taste, even though many do not realize their loss since the brain is good at amplifying small signals.  This loss of the function in a branch of the 7th nerve (the corda tympani) leaves the trigeminal nerve in a position of dominance.   (The trigeminal is the nerve responsible for transmitting the sensations of touch and pain from the face and mouth to the brain.)  This theory assumes a sort of balance between the two nerves, and if a patient suffers a loss of ability to taste because of damage to the 7th cranial nerve, then the brain compensates for the loss of taste by amplifying the signals from both the corda tympani and the trigeminal nerve in the tongue and palate.  The increase in sensitivity in the trigeminal causes phantom pain in the structures of the mouth, sort of like turning up the volume on a weak radio station also increases the background hiss.  In addition, as a result of the exaggeration of the taste impulses from the 7th cranial nerve, the brain begins to generate phantom taste sensations.  This sort of taste hallucination is similar to the tactile "fat lip" sensation that a patient feels when the conduction of the trigeminal nerve is blocked by a shot of a local anesthetic to numb the lower teeth.  It's not really a fat lip, but the brain interprets it that way.  Same thing with phantom taste sensations.

Secondary burning mouth syndrome is caused by an underlying medical condition.  The most common conditions associated with BMS are as follows:

Nutritional deficiencies, especially deficiencies in vitamins B12, B1, B9, B2, B6, Iron or zinc.

Yeast (candida) infections,

Liken Planus

Geographic Tongue

Nerve damage

Allergies (especially to mouthwashes or toothpastes)

Acid reflux (GERD or ARD)

Certain Blood pressure meds such as ACE inhibitors

Endocrine disorders or hormonal imbalance (such as those associated with menopause)

Mouth irritation from habits like rubbing the tongue on teeth or dentures, overbrushing the tongue, overuse of acidic drinks, overuse of mouthwash

Ways to treat BMS

Sometimes people develop this problem due to a hypersensitivity to some toothpaste or oral rinse that they have recently begun using. The first line of defense is to change your toothpaste to a type with only fluoride (Tom's of Maine is a reasonable choice) and cut out mouth rinses.  The type of toothpaste most often involved with this type of hypersensitivity are those containing triclosan, or  pyrophosphates which are added to reduce the buildup of calculus (like Crest Complete or Colgate Total) Also try to determine if you have recently been taking a new medication who's introduction coincided with the onset of the symptoms.  A simple change of medication could make the difference. 

See a physician to see if you are suffering from a dietary deficiency.  Alternatively, you might try (temporarily) taking vitamin B supplements, especially vitamin B12 and folic acid.

It was discovered, quite by accident, that patients suffering from epilepsy who also suffered idiopathic BMS experienced relief from the symptoms of both of these ailments by the administration of the epilepsy drugs clonazepam (Klonopin) and gabapentin (Neurontin). Thus a small, once or twice a day oral dose of of one of these drugs has been found to relieve the symptoms of BMS in most patients.  Alternatively, clonazepam may be dissolved in the mouth using 1/2 of a .5 mg tablet twice a day.  Another drug which has been found to be useful in treating BMS is Chlordiazepoxide (Librium) not to exceed 10 mg three times per day. 

Another treatment that may work (or at least reduce the symptoms) in about 1/2 of sufferers is capsaicin desensitization.  Capsaicin is the ingredient in hot peppers that makes them hot.  The regimen is dilution of one part Tabasco sauce in two or three parts water with the patient rinsing and expectorating (spitting out).  This is done every 2-3 hours at first, and tapering off over a day or two to once or twice a day.  Be careful.  Some people are hypersensitive to capsaicin, so if the burning is too severe, stop immediately!

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