DEAR DR. GOTT: I have had what I will call a sore on the right side of my tongue. It’s about the size of a pencil eraser. It’s white and hurts. I’ve had it for a few months and it hasn’t gotten any larger. I’m wondering what it could be and if I can’t care for it myself, do I go to a dentist or do I see my DO?
DEAR READER: This simple question may be difficult to answer because I am unsure just what the lesion looks like and there are a number of different possible conditions; however, my initial reaction is to diagnose you with repeat canker sores. However, keep in mind you may have candidiasis, lichen planus, recurrent herpes, and more so an examination of the lesion is necessary prior to making the proper diagnosis.
Recurrent aphthous stomatitis, otherwise known as a canker sore, appears as an oral ulcer and is characterized by recurring, painful single lesions that are typically white or yellowish in color, on or under the tongue, inside the cheeks or lips, at the base of the gums, or on the soft palate. They may be painful but are not contagious. There are three clinical forms – minor, major, and herpetiform, with the minor form being most common. Most patients with minor canker sores will not require medical assistance. Those that do may be treated with periodic topical therapy such as corticosteroids, fluocinonide gel and other medications; however, their effectiveness is uncertain. Major sores are larger, deeper, may scar, and take up to six weeks to heal. Herpetiform canker sores have irregular edges, heal without scarring, and are pinpoint in size with up to 100 lesions in each cluster.
Causes for canker sores include stress, H-pylori, cheek biting, sensitivity to specific foods such as eggs, coffee, cheese, nuts, pineapple, or toothpaste and mouth rinses that contain sodium lauryl sulfate and a deficiency of vitamin B12, zinc, folic acid or iron. Some medical conditions such as celiac disease and HIV/AIDS can also cause canker sores to appear.
It would be in your best interests to either see your primary care physician or dentist for a specific diagnosis. Either might recommend an over-the-counter such as Anbesol, Aphthasol and others that should reduce the pain you experience and hasten the healing process. Or, prescription oral medications taken for heartburn and gout may even help. Be sure to visit the medical professional of your choice only when you have an active lesion. If you haven’t had recent lab work, ask your doctor’s opinion on ordering a vitamin B panel and zinc and folic acid levels so you can determine if there is a deficiency there worth pursuing. While you are waiting for your appointment, make a paste of baking soda and water to dab on the lesion, or dab milk of magnesia on it. Purchase a new tube of toothpaste without sodium lauryl sulfate. These simple remedies, or a combination thereof, might provide relief from the pain and irritation of the lesion.
Readers who would like related information can order my Health Report “Vitamins & Minerals” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
