Chapter 16-Not normal but not abnormal

There are a few conditions that people have that are not sinister or worrying but that deviate from the normal and give cause for concern to the patient until they are reassured by a professional. It cannot be emphasized enough that if you notice something which you feel you have never noticed before go and see your dentist or of course your doctor if it is anywhere else but your mouth. The correct diagnosis is the most important thing.

Normal anatomy.

How often do we really look in our mouths? I mean really look close up, well how often do we really look at our leg? Well probably never. It is often not until we have traumatised a bit of ourselves that we really look and some bits of normal anatomy can look pretty alarming if we have never noticed them before.

As a general rule of thumb if something is in the midline [central] – it’s normal, if you have one on either side [bilateral], even if they don’t quite match- it’s normal but if something is only on one side [asymmetrical] – it’s not normal or rather you need someone who knows about these things to tell you what it is.

This rule does not follow for your skin as your skin is a whole body organ, in fact the biggest organ in your body, it’s designed to hold the bits in and protect you from infection.

Here are all the commonest things I can think of that people are sometimes worried about;-

Torus [plural- tori] mandibularis- these are bilateral [both sides] bony bumps on the inside of your lower jaw. Hook your index fingers over your teeth and down the inside of your lower jaw [mandible], feel side to side about half way along, chances are you have them. They are highly unlikely to be completely symmetrical but you have one on either side- normal.

Torus Palatinus- this is a central bony bump in the middle of your palate sometimes it’s as big as, and resembles half a walnut. This is highly unlikely to be symmetrical, but it’s in the midline- normal.

Bony exostosis- these are bony bumps over the outside of the roots of most/all of your top teeth. Sometimes they can be quite large and resemble a pie crust frill. These are normal, very occasionally you may grow a new one. If you grow more than 1 new one go and see the doctor this is sometimes a symptom of a condition called Gardener’s Syndrome where you also get polyps in your colon, part of your intestine.

Tongue papillae- All over your tongue you have papillae, and you have several different types [circumvallate, foliate, fungiform and filiform] apart from filiform these contain your taste buds, which detect different tastes- sweet, sour, salty, bitter and umami [savoury]. Some of them can look a bit alarming if you have never noticed them before. Most of us never look at our tongues until we damage them in some way usually by biting them. It can be a bit alarming to suddenly see something strange at the back. So if you notice a row of what looks like darlicks heads across the back of your tongue do not be alarmed these are your circumvallate papillae- they are on both sides- normal.

Parotid Papillae- Your parotid glands are a pair of major salivary glands that are more or less in front of your ears [they are what swell up when you get mumps]. They are known as exocrine glands, that is they make whatever it is they make, in this case saliva and then a bit of pipe work, a duct takes it to where ever it is it is needed [as opposed to endocrine glands that discharge directly into your blood system]. If you run your thumb up the inside of your cheek you will find a bump about in line with your upper first molar. This is the hood over the end of the parotid duct. You have one on either side- normal.

Common conditions.

These are conditions that are seen relatively frequently in patients, that need to be correctly diagnosed by a dentist to ensure they are nothing else and like anything that deviates from ‘normal’ should be kept an eye on by a professional at regular intervals.

Geographic tongue [erythema migrans] – this is a very common condition which affects about 2% of the population in the UK.  This is where [mainly] the top surface of the tongue [dorsum] has irregular pink/red map like areas which move, change shape sometimes within a few hours, these patches sometimes have a yellowish border. The cause is unknown, it often runs in families, not thought to be infectious, sometimes associated with psoriasis, diabetes, hay fever and certain foods. There is no cure but it is not anything to be worried about now or in the future. It may be sore with acidic foods such as tomatoes or citrus and sometimes with cheese. Very occasionally it is sore but I usually find that most people don’t know they have it until I point it out to them. If it is sore on a regular basis and avoiding certain foods doesn’t help your dentist can prescribe things that can help. It is important to get it diagnosed by a professional especially as it may be associated [goes together but not caused by] with diabetes and anaemia. I have defiantly picked up diabetes in one patient that I can think of because I was alerted by their geographic tongue.

Lichen Planus- this tends to affect people in their mid years [30- retirement] and affects about 2% of the population. There are various different types based on appearance but basically it consists of white/red patches on the skin inside your mouth which very occasionally can be painful. The cause is unknown and not thought to be inherited or infectious. Some people also get skin, nail and genital lesions. It is really, really important for this to be diagnosed and monitored by a professional as occasionally a cancer can develop within it. So if you have had it diagnosed at some stage or other it is really important that you do not let your dental visits lapse so it can be monitored. Occasionally people will have something that looks like lichen planus but it is only on one side in their mouths, this is a lichenoid reaction- a reaction to something that gives the appearance of Lichen Planus but isn’t, sometimes this happens next to a very old amalgam filling, the best thing is to replace this filling and see if it goes away. Do not be alarmed if your dentist either performs or sends you for a biopsy as sometimes he or she may wish to confirm that it is lichen planus and not something else more worrying.

The rules for everything are;-

Eat plenty of fruit and veg [5 a day].

Don’t; – smoke, drink more than 14 units, chew tobacco or betel nut, use other tobacco products- snuff or snus.

Good oral hygiene to eliminate bacteria, fungi and viruses.

Practice safe sex.

Go to the dentist at regular intervals as advised.

Go and see your dentist or GP if you notice;-

A new white, fiery red or speckled patch in your mouth.

An ulcer in your mouth or on your lip which doesn’t heal within 3 weeks.

A new lump in your mouth or on your lip that doesn’t go away within 3 weeks.

Why 3 weeks?

Because most things that are traumatic [you’ve damaged yourself in some way] or infective will go away or at least start to look a lot better in 2 weeks, add another week on for luck as some of us are slower healers than others. If you are not sure make an appointment, you can always cancel it nearer the time if it goes away.

Pain- is there for a reason, to alert us to something going on, don’t ignore it.

Prevention is better, simpler, cheaper and less painful than cure!

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