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Mark Bornfeld, DDS
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 5757
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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Canker sore began 13 days ago on lower left tori. On 4th, April

Customer Question

Canker sore began 13 days ago on lower left tori. On 4th, April 6 day I called dentist who prescribed a paste Triamcinolone Acetonide which did a little good. Sore ulcerated & lost crater part that revealed the bone of the tori days 4th or 5th. Bone revealed for about 1 week or more. I have taken acetaminaphen throughout first week. Pain spread to left jaw & neck. Went to dentist unscheduled on 8th day, April 11 & he prescribed 16 hydroco/apap 5-5000MG every 4 to 6 hours for pain, & Lidocain 2% visc sol. I hardly ever use the lidocaine as it doesn't get to the whole pain which is all in my left jaw & left neck since April 10th. Dentist told me he has had a canker sore so knows how painful they can be & agreed they can last up to about 2 weeks. He added, "If I had not had one, I would have blown you off." April 13 I called dentist stating I am not any better & don't I need an antibiotic. Staff called in 30 Clindamycin 300MG which I have been taking about 4 times/day, to be taken every 6 hours until finished.

I called dentist Friday, April 15 & said pain is not any better. Dentist's partner said antibiotics have not had enough time to kick in so wait until April 18 or 19.

I think the tori has gum growing over it now in place of the crater of the sore. My left jaw on inside & outside still aches all the time. For about 4-5 days there is a lump that one can feel on the outside of my left jaw that especially hurts. Today the lump feels less big, still there. When pushed around I can feel something in it, maybe a cyst? It hurts but may be not as bad as yesterday.

My plan is to take acetaminophen today. I have 2 of the hydroco/apap pills left. I have never completed a whole prescription of pain pills but most likely will this time.

I am distressed about not really knowing what the cause of the pain & lump is & therefore dentist does not really know what to do about it. I think the whole thing began when I went to dentist March 23 to get tooth filling redone with tooth enamel looking material fill in. They had to have me do an xray which I could not do the first time due to the film (right name?) they insert for me to bite on made me gag (a usual problem of mine at dentist) & the contraption was too hard pushing down on the tori. I think that caused an abrasion because that's where the canker sore is.

Should it take this long for canker sores to heal?
Is the problem likely something else along with it since all of this jaw & neck pain & lump?
What are the wildest things that you think could be going on?
Dentist said if it is not better by tomorrow, April 18 or April 19 they think it is something viral. Then what?
I've never had this bad of a pain & never this long & never went to dentist for canker sore. I've never completed a whole prescription of pain meds for one event. All of these facts are disturbing to me.
Would you be satisfied if all went away with the antibiotics I'm now on but never find out what all really happened?
Thanks for thoughts/advice.
XXXXX XXXXX
Submitted: 3 years ago.
Category: Dental
Expert:  replied 3 years ago.
Welcome to JustAnswer, and thank you for putting your trust in me!

The presence of mandibular (lower jaw) tori unavoidably predisposes to injury of the fragile gum tissues covering these bony prominences. They are in an area that receive substantial contact and functional friction during chewing.

It is uncertain whether your lesion represents a true apthous ulcer (canker sore), or whether it is some other ulcerative disorder-- oral ulcers mostly take on an appearance that is not particularly different, regardless of the cause. A canker sore can look a great deal like a traumatic ulcer, which can look much like a viral lesion, such as one due to Coxsackie virus. Given the location of the ulcer, I would give more weight to a presumptive diagnosis of traumatic ulcer rather than a canker sore, although I doubt that making that distinction is particularly important or useful going forward. Thew swelling on the outside of the jaw is almost certainly just an inflamed lymph node, and would be expected in the presence of any inflammatory lesion that persisted more than a few days; this in itself has little diagnostic significance, and is innocent in nature.

If you wanted some speculative, more exotic diagnoses, I would include auto-immune disease (lichen planus, pemphigoid, lupus, sarcoidosis), bacterial infection (including actinomycosis, tuberculosis, or other chlamydial or spirochetal disease), osteonecrosis of the jaw (especially considering the bone exposure, and if you are on bisphosphonate medications for treatment of osteoporosis), or even a stomatitis secondary to blood dyscrasia or malignancy.

However, these guesses are unlikely diagnoses. The most important part of your narrative is that the symptoms are waning, although I concede that it is not happening as quickly as you might like. The resolution of the pain, however slow it may be, is strong evidence that whatever it is, your ulcer is healing, and you shouldn't do anything to stand in the way of that improving trend.

Usually, tori are not treated. However, if you experience repeated injury to these areas, you might want to consider whether removal of these bony prominences would be beneficial. For this purpose, you should consult with an oral surgeon. Your dentist can provide you with a referral, or you may consult the online directory of the American Association of Oral and Maxillofacial Surgeons for contact information for an oral surgeon in your community.

Hope this helps...
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 5757
Experience: Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
Mark Bornfeld, DDS and other Dental Specialists are ready to help you
Customer: replied 3 years ago.
I am satisfied but need to know what to do next time before it gets this bad for this long. Thanks.
Expert:  Mark Bornfeld, DDS replied 3 years ago.
Symptomatic treatment is best. There is nothing in your description that suggests that this ulcer represents an infection, and I don't think that using an antibiotic is supported by the facts unless it has been conclusively determined that you have a bacterial infection. I also don't agree with the use of topical corticosteroids as a first-line therapy unless it has been determined that this represents an auto-immune disorder, such as those noted above. Prevention is key, and if you experience repeated ulcers in the same place, you should consider surgical removal of your torus.

But before a specific therapeutic approach can be recommended, you will need to corroborate the diagnosis. Your description is suggestive of something that may be more than just a traumatic or aphthous ulcer, and it would be best if an oral surgeon or oral pathologist can directly assess the lesion at a time when it is manifest. In this way, a more direct management of the underlying causes can be implemented, rather than simply responding to symptoms as they occur.

Good luck!

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