DEAR DR. GOTT: Please tell me about lumps in the mucosa (inside cheeks) in the mouth. My adult son has suffered from these for about 10 years. They are many and are filled with white squishy stuff that can be expressed through squeezing. They can be painful. He has been to many doctors and dentists for treatment but nothing works. Please, do you have any suggestions?
DEAR READER: You son likely has mucous cysts which are quite common. They are thought to be the result of sucking the lip membranes between the teeth or from biting the cheek lining itself. Generally speaking they are harmless and painless but can be extremely bothersome.
Symptoms include a fluid-filled sac that appears on the inside of the lip, tongue, palate, inside the cheeks, around the tongue, near lip piercings, or on the floor of the mouth. Mucous cysts will often rupture spontaneously without being expressed or prodded. When cysts return – as appears to be the case with your son – they may require removal by a health care provider, a procedure that should not be attempted at home because of the potential for infection and tissue damage.
Management includes brushing the teeth and rinsing with mouth wash at least twice each day to discourage the buildup of bacteria and discontinuing smoking if appropriate. If your son has any piercings around his mouth, he might fare better if he were to remove them for a period of time to see if the cysts dissipate, suggesting a possible allergy. I must say, however, that diligently adhering to this maintenance will not necessarily prevent the cysts from forming. When the cysts disappear in a week or two, he may be doing enough on his own. However, if they re-appear frequently, he should make an appointment for excision of the cysts. There are some dentists who can perform the procedure in an office atmosphere with a sterile needle; however, 10 years is extremely long. Therefore, I recommend he shift gears, ask for a referral to a ear-nose-and-throat specialist or oral surgeon, perhaps one at a top-notch teaching hospital, and get the assistance he needs that is long overdue.
I do not usually hear of mucous cysts that present with white material again and again over such an extended period of time and while I do not want to alarm anyone, your son might ask if a biopsy might be appropriate to make sure there is nothing else going on. Perhaps he is suffering from an unusual presentation of pemphigoid (an autoimmune disorder known to cause blistering) for which a dermatologist would be his best option for diagnosis and treatment. It’s always better to cover the bases than to receive an unfavorable diagnosis years after a situation occurs.
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