Mouth, Tongue, and Teeth;The Dermatology Perspective of Care.

The oral mucous membranes are an extension of our skin, albeit unique in composition and appearance. This tissue obviously is different than our outward body skin and filled with lubricating and salivary glands. Nonetheless, a little peek into the oral cavity is not only in the realm of your dentist, but also for your dermatology provider.

There are many specific diseases beyond Herpes Simplex (written in the last blog) that can affect the oral mucosal skin. Some are autoimmune while others may be a cause of dental trauma. Let’s review a few of the most common here.

Apthous Ulcers aka “Canker Sores”

These are often mistaken for herpes simplex by the untrained eye. However, they are not caused by a virus or bacteria, but rather, thought to have an autoimmune component and familial connection. Induction can occur from stress, trauma, smoking cessation, hormone fluctuations, food allergies, and Sodium Lauryl Sulfate in various oral care products. They present as 2 mm-1 cm round ulcers with a red halo and can be painful. Often it takes 7-10 days for healing to occur.

OTC Treatment

In general, to decrease further irritation from these sore, avoid spicy or acidic foods. Try remedies like wet tea bag soaks, which contains tannic acid, a natural pain reducer.

Folate, B6, B12 and Zinc are great as preventative measures in people who may be deficient in such. As canker sores are self-healing, many OTC treatments aim to reduce pain and inflammation. Orajel antiseptic mouth sore rinse, or a mixture of half hydrogen peroxide/half water are great antibacterial solutions to utilize. Kanka is a helpful product to coat lesions and protect them from further irritation and pain.

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Topical steroids like fluocinonide or triamcinolone paste are prescribed to help with inflammation of lesions.

Oral steroids or Carafate (an ulcer medication) may also be used to calm irritated lesions as last resort.

Oral Candidiasis aka “Thrush”

This may show up as cottage cheese like white plaques on the tongue or inside of the mouth caused by an overgrowth of a natural yeast called candida. During illness or due to certain medications, the normal balance of this yeast can overgrow causing an oral film.

Although this condition must be treated with an anti-yeast prescription, there are OTC preventative measures available to combat thrush occurrence. Practice good oral hygiene, get regular dental checks, avoid foods high in yeast or sugar (bread, beer, wine), and don’t overkill on your mouthwash as it will disturb the natural environment inside your mouth (one-two times a day is sufficient to gargle).

Mucocele

Mucocele’s are clear, dome shaped bumps filled with salivary fluid. They appear after trauma like biting, which will cause the salivary releasing fluid duct to plug up. Mucocele’s are benign lesions which show up on lips, gums, under tongue, or the roof of the mouth.

In Office Treatment

These lesions often disappear on their own, but if you find them irritating, your clinician can inject them with a steroid to shrink them, burn them off with a cautery, or even remove some of the skin and tie off the duct with a suture.

Actinic Chelitis

Actinic Chelitis is a pre-cancerous epidermal change, typically on the lower lip. It shows up as thinning, scale, white patchy discoloration, redness, peeling, crust, and bumps. These changes are induced by chronic sun exposure, which in the long run may mutate into squamous cell skin cancer.

OTC

Once these changes occur it is quite difficult to revert the skin back to normal. Aquaphor is a great emollient agent to sooth and smooth lips. However, much of the treatment required would be preventative of further damage, such as using an SPF 30 lip balm, hats, and glasses outdoors.

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Off-label prescribing of creams like retinoids, fluorouracil, or imiquimod may be used to slough off lip layers and help the body heal in more normal skin. Procedures such tissue freezing with liquid nitrogen, burning with a cautery, or using photo or laser therapy may also be enlisted.

Lip and Oral Cancers

Cancers of the lip or oral mucosa may be caused by sun exposure in the former or the use of tobacco products. An outward appearance of such would be bumps, sores, or scaly patches that do not heal, bleed easily, or are growing over time. Inside the mouth, cancerous lesions may also appear as bumps, sores, or white patches. A biopsy will be required to determine the nature of lesions, followed by surgical removal if positive.

Furry and Black Hairy Tongue

Furry Tongue, which assumes its name from the white carpet like film that accumulates, is due to smoking, mouth breathing, low fiber diet, and poor oral hygiene. Its onyx counterpart, Black Hairy Tongue owes its coloration to byproducts of bacteria, also induced by smoking, antibiotic use, oral yeast infection, and poor oral hygiene.

The treatment is to remove any causes, use a firm bristled toothbrush to fight off the coating, and 50-50 hydrogen peroxide mixture to brush and bleach tongue.

Geographic Tongue

Geographic tongue is a benign variation which causes missing “papillae” (small pink bumps) in an irregular pattern, surrounded by white borders on the tongue. These patches may rotate around the tongue or even disappear at times. It affects up to 3% of the population, but is a harmless concern.

OTC Treatment

You cannot rid yourself of this condition. However, if the patches are sore or painful, OTC pain relievers, mouth rinses, or zinc supplements may be used. To prevent such symptoms, avoid hot/spicy/acidic or salty foods. Additionally, toothpastes with whitening components or robust flavor may irritate such a condition, thus sensitive toothpaste is recommended.

Teeth

Although in a different realm of care, patients do ask about having an award winning smile under a healthy pout. Of course concerns of this variety is best discussed with your dentist. Nonetheless, many dermatology offices also offer teeth whitening products to support the healthy lip and skin products available. For those who want a mega-watt smile but have sensitive teeth, geographic tongue, cold sore history, or some of the other above conditions, a milder whitening toothpaste may be necessary. A unique blend without the irritating hydrogen peroxide is available as AP24 Whitening Fluoride Toothpaste.

Tom’s of Maine and Sensodyne are also top rated products that include a whitening line, as an OTC option.

Noted as a new social media selfie rage, are the photos of people foaming black bubbles from the mouth! If you’re wondering about this craze, it’s a cavity full of charcoal. According to the manufacturer for one brand, “The Tuxedo all-natural charcoal teeth whitening tooth and gum powder is unlike other toothpastes on the market in that it does not bleach your teeth but rather gently lifts stain from your enamel. It is made with organic charcoal that acts as a detoxifier in your mouth. It gently removes stains caused by smoking, drinking tea and coffee, and other lifestyle and dietary habits.”

Two other well reviewed whitening items, less the black foamy mess, are mainstays on store shelves. Crest 3-D White Strips are an easy to use and affordable whitening alternative. Yet, Smile Brighter Teeth Whitening Gel Pens, provide greater convenience, as they which don’t require trays or strips.

Despite what your lip, tongue, or tooth condition may be, it’s best to be proactive with your oral health through regular skin checks with your dermatologist (including oral-visual inspection) and bi-yearly cleanings with your dentist.

*The information provided above or in any blogs on this site is for educational purposes only. I does not replace advice or necessary examination and diagnosis from your healthcare clinician. Please see your healthcare provider for any and all concerns with changes in your health or treatment of disease.*

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