I understand that you are uncomfortable and that you have not been given a diagnosis just a bunch of things you do not have. If you want a diagnosis don't waste your time or money going to doctors, getting blood tests, and trying treatments that do not work. If you need a definitive diagnosis you must get a biopsy and the biopsy must go to an oral pathologist. General pathologists see very few oral biopsies and are not as familiar with oral conditions. Until you know what you have you cannot begin to treat it and all of the tests you have had have not done the only thing that will give you a diagnosis. Get a biopsy and find a doctor who has an advanced degree in oral pathology or oral medicine. If you don't you will continue to be given diagnosed of exclusion, it's not HIV, it's not STD. This is nice to know but it hasn't told you what it is. If they will not biopsy the tongue leave the office and find a board certified oral surgeon who should be able to help.
For the record geographic tongue is a genetic condition which tends to become worse during stress and often follows a sexual encounter. People think that they caught something performing oral sex, usually with a stranger. In all of my cases oral sex was not a contributory factor. I have had hundreds of patients with geographic tongue, many of whom related the changes on their tongue to the prior evenings activities. Stress and to some degree guilt can make the symptoms of geographic tongue flair.
Without seeing you face to face I cannot confirm that you have the same thing. I would suggest that you ask your dentist or physician to look at your tongue at your next visit and perhaps show them the link to this posting.
Dr. Gwen Cohen BrownView Thread
I hope that you are feeling better and the boards were successful. More than likely you will feel better with lower stress. Remember that it can't be cured and most miracle mouthwash do not treat the condition they only suppress the symptoms.
Dr. Gwen Cohen BrownView Thread
Sorry to hear that you have been concerned. Although incannot diagnose on line it looks within normal limits to me.
You have tiny little hairlike papilla on the top of your tongue. They are normal and are composed of keratin like your hair, skin and nails. Under a microscope these papilla look like little kids party hats, stacked up on each other. They have "leaves" like hair. Because they have space under these leaves on the papilla they become great places for things to ferment.
So I often see discolored tongues, yellow and brown with patients smoking and drinking tea or coffee, red with throat lozenges, blue with blue raspberry ices. The color tends to reflect whatever the patient has had in their mouth.
If you are smoking or drinking caffeine, coffee or tea, and are on any medication it is likely that your mouth is dry. If your mouth is dry these discolorants will stay in your mouth longer because of lack of salivary clearance - a dry mouth. Drinking alcohol and/ or using an alcohol based out rinse may also increase the dryness.
Do not scrub it do not use a tongue scraper aggressively, believe it or not it will actually make the papilla on the tongue get longer and the longer they become the more likely they will discolor.
I suggest that you see a dentist to confirm this clinical impression, they will have seen this more often and will be able to provide an accurate diagnosis. There are also over the counter oral lubricants that may help as well. Check with your pharmacist for good options.
Although I cannot diagnose on line the attached photo looks like a totally benign clinical condition known as Geographic Tongue. The red areas tend to look flat without the little hairlike papilla (the normal white hairlike projections kniwn as filliform papilla)and often have a slightly raised white border.
The reason it is called Geographic Tongue - or benign migratory glossitis - is that 90% of the time it occurs only on the tongue, usually the lateral (side) borders and the top of the tongue. It tends to be seen on the anterior third of the tongue (tip) but can occur anywhere.
This is a well known condition and is often hereditary and seen with another condition known as fissured tongue. So the next time you see your parents, siblings or children look in their mout and more likely than not someone else will have a similar looking tongue.
This is a variation of normal. It is not spreading on your tongue it is getting better in one place and developing in another. It is not contagious you did not get it from anyone and you cannot give it to anyone. It is not caused by a virus. It is not a canker sore, cold sore or yeast infection.
The reason it can be painful is that the little white hairlike papilla are composed of keratin like your skin hair and nails. We do not know why these papilla fall off with geographic tongue however we know that they do. Without this protection the papilla provide your tongue is naked in these areas and therefore may be uncomfortable with hot, spicy or acidic foods. The papilla will gow back, give it some time.
On a purely anecdotal level, and I have seen hundreds of patients with Geographic Tongue it does seem to become more active with stress. I suggest that you see your dentist to confirm the diagnosis. It is a clinical diagnosis and neither lab tests or biopsy is required. In general I do not treat geographic tongue unless it has become secondarily infected with yeast or bacteria however in my entire career as an oral pathologist I have probably only teated a handful of patients.
It is often misdiagnosed as an oral yeast infection. The anti fungal medication may provide some relief but it is really only treating a secondary yeast infection and the effect is mostly placebo. Yeast is a normal part of your oral flora and keeps your mouth balanced and healthy. If anyone tries to culture your tongue or do a scraping run for the door. if you need a diagnostic procedure you should have a biopsy. and for the record it is not suggestive of a systemic yeast infection, and it is not due to eating bread. If this is geographic tongue antibiotics are never an appropriate treatment, in fact antibiotics will probably make your tongue feel worse. It is not bacterial.
I have found that most people, once they have a diagnosis, are much less stressed about their tongue (with a diagnosis) which will actually make it hurt less. Stop looking at it, playing with it and worrying about it. If it continues to bother you I suggest seeing either a specialist in oral medicine or oral pathology.
If you are using a alcohol based mouth rinse stop it will give you a chemical burn on the unprotected areas of the tongue. In fact stop all mouth rinses and use the most bland old fashioned tooth paste you can find, stay away from the whitening products and look for a toothpaste without SLS. Your pharmacist can help you find one. Do not use hydrogen peroxide as that may also cause a chemical burn. Do not use "organic" toothpaste, many have volatile oils which can also cause a superficial chemical burn. I know it seems like it would be a good idea but in many cases it will make the burning feeling much worse.
Basically once you have confirmed the diagnosis it will be less of a concern, less stress and faster resolution.
Hi dmogar, I believe that you should go directly and deal with the most likely cause of your bad breath and see if cutting back or stopping your alcohol and cigarette intake decreases the smell.
I am not quite sure what your dentist means when he said that you may have a lack of oxygen to your mouth. If you can provide more information it may be helpful as you dentist saw you clinically and I did not.
Changing toothpaste may help temporarily but this is not a long term solution and the stronger the mint/peppermint is in the toothpaste the more irritating it can be to the oral mucosa and can potentially also change the balance of the normal oral flora in your mouth.
To this end I strongly recommend that you do not use an "organic" toothpaste as they use volatile oils as flavorings and these oils will be painful if your tissue is irritated.
I believe that you should have a scrupulously clean oral cavity, brush and floss twice a day (gently), use a non alcohol based mouthwash or better yet no mouth rinse at all, and only use a tongue scraper gently and infrequently. Vigorously scraping your tongue could further alter the delicate balance of the oral flora in your mouth and make the smell worse.
If you have gum disease/bone loss you should see a dentist twice a year for routine check-ups and a dental hygienist 3 or 4 times a year.
Please write back if you have additional questions.
Both alcohol and tobacco are extremely drying to the oral mucosa. Alcohol desiccates (dries out) the tissue and breaks the cement that holds the epithelial cells together which may result in local irritation, mild sloughing and superficial dryness.Tobacco is also extremely drying and irritating and leaves a residue in the mouth.
When the oral cavity is extremely dry the salivary output is not enough to provide adequate salivary clearance and therefore the normal oral flora - microbial, bacterial and fungal organisms - become denser and more irritating to the oral mucosa. There are not more organisms but they are not diluted by saliva and therefore are a sludge. The organisms are both aerobic and anaerobic and as such can also "ferment".
So you are correct that dryness can cause bad breath, however your alcohol and cigarette use are most likely the culprit here. I strongly suggest that you try to decrease your alcohol and cigarette intake. In addition to making your mouth feel better you will find that your breath is fresher.
If this does not improve your breath you should see an Ear Nose and Throat doctor as post nasal drip and sinus infection can also cause a bad smell. If that is not the source of the smell you should see a Gastro-Intestinal doctor as reflux can cause bad taste as well.