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Ask Dr. S. Attili Your Own Question

Dr. S. Attili
Dr. S. Attili, Dermatologist & Dermatopathologist
Category: Dermatology
Satisfied Customers: 4633
Experience:  MRCP (Dermatology), Int. Board Certification in Dermatopathology
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What type of doctor do I see for a sore mouth? Been to dentist

Customer Question

What type of doctor do I see for a sore mouth? Been to dentist and internal medicine doctor. Do not have an infection.
Submitted: 2 years ago.
Category: Dermatology
Expert:  Dr. S. Attili replied 2 years ago.

Dr.Sasi Attili : Hi. I will do my best to advise. However, please note that this does not substitute an in-person consultation with a doctor.
Expert:  Dr. S. Attili replied 2 years ago.
Hi. I will do my best to advise. However, please note that this does not substitute an in-person consultation with a doctor.

The best doctor to see is a oral medicine specialist. Dermatologists/ ENT specialists will also be able to help if you don't have a good oral medicine specialist in your area.
Customer: replied 2 years ago.
;Have seen dematogist and ent as well as dentist and internal medicine. What is an oral medicine doctor? The others brushed me off.
Expert:  replied 2 years ago.
Oral medicine doctor is the doctor that specialises in mouth problems. They are the best people to see for oral problems as the other specialists I have mentioned, do not specialize specifically in diseases of the mouth, while oral medicine specialist, do
Dr. S. Attili, Dermatologist & Dermatopathologist
Category: Dermatology
Satisfied Customers: 4633
Experience: MRCP (Dermatology), Int. Board Certification in Dermatopathology
Dr. S. Attili and other Dermatology Specialists are ready to help you
Customer: replied 2 years ago.
Relist: Incomplete answer.
I do not know what an oral doctor is. My mouth is painfully sore. Do not have an infection.
Expert:  dermdoc19 replied 2 years ago.
These answers are for informational purposes and do not replace a physician head-to-head visit. A patient-physician relationship is not established.
If you tell me what is the nearest city, I might be able to recommend a dermatologist who specializes in these problems.
Expert:  Dr. S. Attili replied 2 years ago.
Please see this website which explains who a oral medicine specialist is. They also have a link to find a specialist by location. So you should find someone in your area.

http://www.aaom.com/
Expert:  dermdoc19 replied 2 years ago.
Since you have paid Dr. Attili, there is no need or obligation to pay again for this supplemental answer. Dr. Attili has recommended a dental organization to you. I agree that it would be prudent to be sure you do not have a dental problem before proceeding further. However, if your problem is not dental, then I feel a dermatologist specializing in oral medical problems would be a good approach. If the dentist cannot find anything wrong with your mouth, you may have what is referred to as the BURNING MOUTH SYNDROME. This is a burning of the mouth with or without dryness, or dysgeusia ( disordered taste). With BMS there is no obvious lesion, laboratory abnormalities, or systemic ( internal) disease. Some medical conditions and medications can cause this and this is secondary BMS. For some reason BMS is much more frequently found in women. The typical patient is a postmenopausal woman with a dry mouth, altered taste sensation ( metallic or bitter). The tongue is most commonly involved. BMS seems to come on out of the blue without a preceding precipitating event. If yours is typical it seems to worsen as the day progresses. The cause is basically unknown. Hypotheses include neurologic disorders, salivary gland problems, taste disturbances, atrophy of the mucous lining of the mouth, an psychological problems.
In an evaluation, as Dr. Attili suggests, you should see a dentist first to rule out such problems as denture problems or neglected dental issues. After that other possibilities should be addressed: these would include patch testing to rule out a 1) contact dermatitis to metals, acrylates, flavorings and preservatives 2) Infectious causes such as Candida, bacterial overgrowth or viral problems 3) Inflammatory diseases that occur in the mouth such as lichen plants, pemphigus, bullous pemphigoid, apthosis ( canker sores) , or geographic tongue...these are all conditions in which dermatologists would have far more experience in treating than dentists.
Nutritional deficiency such as Iron, B vitamins, folate and zinc
Neurologic: trigeminal neuralgia, glossopharyngeal neuralgia ( nerve problems involving the nerves that innervate the mouth).
Pharmacologic: as mentioned above an number of medications can cause this problem
Gastro-Intestinal problems: Crohn's Disease, Reflux
Endocrine: Diabetes, estrogen deficiency, thyroid problems
Autoimmune: Sjogren's Syndrome, lupus, fibromyalgia
Psychological factors: Depression, anxiety.
If all the above have been adequately ruled out you have primary BMS. Secondary BMS can be treated by addressing the above.
Treatment:
First, realize that this is not serious. Not cancer.
Topical medications thought to be of benefit include clonazepam, lidocaine, capsaicin, and doxepin.
The problem with Capsaicin is that it can cause GI distress. Doxepin has actually not been studied but works in patients with oral cancer pain.
Pills which benefit include: Neurontin, pregablin, amitriptyline, paroxetine, sertraline,clonazepam, pramipexole. If you want to go a bit holoistic: alpha-lipoic acid may help.
Psychologic intervention may also help,
Most patients with this problem have sought care from multiple providers including dentists and oral surgeons, internists, primary care providers and ENT specialists. Many patients are not aware of the expertise of dermatologists in this field and seek treatment from them after all else has failed. I would advice you to find a dermatologist who has special expertise in this field.
As I have already offered, I would be happy to provide you with the name of a dermatologist who limits his practice to this area of our specialty. Just let me know!
Expert:  dermdoc19 replied 2 years ago.
One other fact I would like to emphasize: Most dermatologists will also brush this problem off. We are generally too busy to sit down and provide the evaluation a patient with this problem requires. This is why I am so adamant that you see a dermatologist who specializes in this problem.
Expert:  dermdoc19 replied 2 years ago.
I am curious, has someone diagnosed you with Burning Mouth Syndrome yet? Would appreciate an answer. Thank you.
Expert:  dermdoc19 replied 2 years ago.
Well, the question will close soon. I have to disagree with my colleague Dr. Attili in that I think you would be better served by seeing a dermatologist than a dentist. So, feel free to come back to this site after you have consulted with various dentists and other doctors, if you would like further direction. If you do have Burning Mouth Syndrome you would benefit from the care of someone experienced in the treatment of this condition.

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