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Julian Chen
Julian Chen, Dentist
Category: Dental
Satisfied Customers: 568
Experience:  Practicing General Dentist since 2002
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Ive been having pain/ more of an irritation under my tongue

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I've been having pain/ more of an irritation under my tongue so after months I looked in the mirror and noticed a bean size lump intwined with my Lingua Frenulum. I've seen pics of what it's suppose to look like and I know that it's not normal. Do you think it's just an ulcer or do you think it could be something more? It gets irritated when I drink sodas and what not. And I've been smoking a pak a day for about three years. In case that might be relevant. Thanks for the help

Unfortunately, it is very difficult to diagnose soft tissue growths/lesions over the internet. You describe noticing a "bean size lump" on your lingual frenulum. However, the morphology of the frenulum can vary. I can easily testify that many of my patients present with similar bean-sized lumps, while others do not.

The more pressing matter is that you are having pain/sensitivity and by you mentioning lingual frenulum, I'm assuming specifically on that lump when you drink sodas. That is certainly not normal and warrants a closer look by your dentist.

Ulcers typically will have some redness in the middle surrounded by slightly raised tissue and are fairly well circumscribed. They are usually rather painful when touched. Again, without the opportunity to see it clinically, it is impossible for me to formulate a diagnosis.

You smoking a pack of cigarettes a day does put you at a much higher risk for developing oral cancer. And as such, I would strongly advise you to schedule an appointment with the dentist or oral surgeon for a comprehensive evaluation. In the event that what you describe is cancerous, the sooner you address it, the better off your prognosis will be. Oral cancers are quite manageable when caught early. They become deadly when patients continue to ignore them.

I had a patient 5 years ago that came into my office. He had been smoking since he was 17 (he was in his 50s). He presented with a golf ball-sized growth underneath his tongue and I asked why it took him this long to come see a dentist. His explanation was that he wasn't having any pain so he just ignored it. And the reason he even bothered coming in was because the floor of the mouth had ripped open and is finally causing him pain/irritation. The oral surgeons ended up removing 2/3 of his tongue, pulled out all his remaining teeth in anticipation of radiation therapy. But unfortunately, he loss his battle to cancer shortly.

I applaud you for having the awareness that your smoking habit gives us cause for concern. I hope that the irritation is nothing serious but I would also hope that you may consider quitting smoking after this experience.

Please see your dentist or oral surgeon ASAP for a comprehensive evaluation.


Dr. Chen
Customer: replied 8 years ago.

I just want to thank you so much Julian... Honestly under any other circumstance I would of been checked out months ago (due to the fact I'm quite the worrier when it comes to my health/ And yeah I know I smoke. haha) but I've been in Iraq living out in sector thus not having the time or the opportunity to really seek medical attention. And I guess the stress of combat was my excuse for smoking, not saying it was a good one. So yeah would it be possible for me to take a pic of it and send it to you? Or doesn't this program work like that? I'm going to get checked out but we just got back and things are chaotic and we're stationed at a new location so I don't know how to go about getting checked out. But I will head your voice and go in to the dentist/ doctor whenever I get the chance. But a little assurance would go a long ways for me. So if you would be willing to take a look at a pic that would be great. Otherwise thanks for your advice so far. Jordan

Hi Jordan,

Unfortunately, a photo won't help me too much as I won't have the opportunity to palpate the lump and see how you react. One important question that you may not even know the answer to is whether you've only noticed the lump due to the irritation under the tongue, and prior to that, you never really knew how your lingual frenulum looked like.

Is it possible that when you hold the cigarette in your mouth, you're holding it in a way where the filter end is located underneath the tongue? If that is the case, then all the chemicals are directed at that region and can cause the tissue to become irritated. Nicotine is known to be a vaso-constrictor, meaning its presence can cause the blood vessels that come in contact with it to shrink. The other carcinogens can cause mutations to the cells in the area. Prolonged exposure can actually result in the loss of blood supply to that small area, causing slight tissue necrosis and hardening of the skin. Also, if any of the carcinogens successfully alter some of the soft tissue cells, it can cause the cells to become dysplastic. It is certainly possible that the irritation you're feeling is simply just the early stages of epithelial dysplasia, which is precancerous. But the emphasis is on the "PRE". So if you stop smoking, your body should be able to recover shortly and normal, healthy tissue should be able to repopulate in time.

The only way to determine if something has gone awry is through a biopsy (incisional or excisional) and have an oral pathologist study the sample under a microscope.

I certainly do not intend on painting a bleak picture for you. However, if it is something of concern, you want to address it asap. I am under the impression that there might be a dentist or dental services provided on the base where you're stationed at. If so, perhaps you can schedule a check-up. In the meantime, if you can, stop smoking altogether and swap the habit for something a little less risky, gum chewing perhaps.

And lastly, I thank you for your service and sacrifice.


Dr. Chen
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