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Mark Bornfeld, DDS
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 5989
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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I have swollen lips on the inside, my gums and mouth feel

Customer Question

I have swollen lips on the inside, my gums and mouth feel swollen too, my lips hurt if I smile, My MD says they are not swollen, whatever, it is not his mouth that hurts. Started by having me take Vitamin B complex helps a little, Lisenopril and Diovan were blamed, stopped Diovan over two weeks and my lips are worse
Submitted: 2 months ago.
Category: Dental
Expert:  Mark Bornfeld, DDS replied 2 months ago.

Would you be able to upload photographs of the involved areas of your mouth? Also, please specify how long your symptoms have lasted.

Customer: replied 2 months ago.
Almost four years I have been having swelling of lips mouth and face, feels like I have had way too much salt in mouth, lips are swollen and strutted hurts to smile, one Dr. said not to put medicated lip balm on lips so just use lip gloss, or some blistex when hurt at night. Began around the time I started Lisenopril and Chlortrimeton, Dr. stopped Lisenopril and started Diovan, it also causes lip swelling, stopped it 3 weeds ago and lips are worse. Started Coreg and HydroDiuril 3 weeks ago. My face is swollen too
Expert:  Mark Bornfeld, DDS replied 2 months ago.

Although your photographs are not sufficiently clear to render fine surface detail, they show enough to indicate that you have developed more than simple swelling; it appears to be ulceration of the mucous membranes of the mouth. The difficulty with identifying the underlying cause of oral ulcerations is that a wide variety of different mucous membrane ulcerative disorders look superficially quite similar to each other; that makes it difficult to distinguish between them by appearance alone. And distinguishing them is important, because the management of each of these conditions is different.

It is tempting to blame the medications on your oral conditions, because a variety of drugs do have the potential for leading to oral ulcers. This is particularly the case with hydrochlorothiazide (Hydrodiuril), which has been implicated in rare reports of Stevens Johnson syndrome, and is chemically related to a wide variety of known allergens (e.g., sulfonamides, ester-class local anesthetics, and all derivatives of PABA). However, all the medications you list are in completely different drug classes from each other, and the failure to effect a favorable response despite changes in your medication regimen suggests that your chief complaint is not a drug reaction, and the onset of symptoms just when you began taking lisinopril may well be simple coincidence.

For this reason, I would suspect an unrelated condition-- perhaps an independent ulcerative disorder, and there are several of them-- e.g., oral lichen planus, mucous membrane pemphigoid, and others. The diagnosis of these conditions falls within the scope of practice of an oral pathologist or a specialist in oral medicine, and I would encourage you to arrange for a consultation with one of these types of clinicians. Your primary care general dentist or physician may be able to provide you with a referral, or you may find local practitioners by consulting the online directories of either the American Academy of Oral & Maxillofacial Pathology or the American Academy of Oral Medicine.

Hope this helps...

Customer: replied 2 months ago.
I saw an Oral & Maxillofacial Dentist today, he thinks it is a yeast infection, so will be starting a topical steroid first
Expert:  Mark Bornfeld, DDS replied 2 months ago.

Are you sure you heard correctly? Topical steroids are absolutely inappropriate for yeast infections; in fact, it is well known that patients who use steroid inhalers (e.g., asthmatics) are actually at increased risk for oral yeast infection. On the other hand, topical steroids are often used for short-term or intermittent treatment of inflammatory or autoimmune disorders of the oral mucous membranes. So, based on your doctor's selection of topical steroids as therapeutic management, it is more likely that you don't have a yeast infection (if he thought that, he would not have prescribed a topical steroid, but rather an antifungal like fluconazole or miconazole). On the other hand, even if your condition responds to steroid, it does not diagnostically narrow down the rather broad range of conditions that are responsive to steroid, and a diagnosis is sometimes useful, if not vital, to long-term management.

Hope this helps...

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