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Swallowing is a very complex process and any interruption in the swallowing process can lead to dysphagia. Some 50 pairs of muscles controlled by several nerves help an individual to swallow. There are 3 stages of swallowing:
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Aphthous Ulcers (Canker Sores): These mouth sores are NOT contagious and can appear as a pale or yellow ulcer with a red outer ring. They can appear alone or in clusters. These are very painful and can last 5-10 days. The cause is not clear but may be related to: a virus; temporary weakness in the immune system (like a cold); hormonal changes; mechanical irritation; stress; or low levels of vitamins/minerals. The treatment does not provide a cure but is aimed towards relieving discomfort and prevention from infection. A topical corticosteroid such as Kenalog, may be prescribed. |
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Cold Sores: Also known as fever blisters, these sores are caused by the herpes simplex virus and are very contagious. This virus is usually dormant but can be activated by conditions such as stress, fever and trauma. Usually there is tenderness, tingling or burning before the sore actually appears. The sores begin as blisters and then crust over and last about 7-10 days. Although there is no cure, treatment includes using an antiviral ointment, such as acyclovir. |
Oral Candidiasis (Thrush): Thrush is a yeast infection of the mucous membranes of the mouth and tongue and is caused by forms of a fungus called Candida. This is a normal organism that lives in your mouth and is kept in check by healthy organisms that also live there. When your resistance to infection is low, the fungus can grow, leading to the lesions in your mouth or on your tongue. |
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Taking antibiotics or steroid medications, being very old or young, poor health, having diabetes, being on chemotherapy or having HIV/AIDS can increase your chance of getting thrush. Thrush appears as whitish, velvety lesions in the mouth and on the tongue. Under the white there is red tissue that may bleed. There are antifungal mouthwashes or lozenges that can be used to treat this infection. The long term out-look for thrush is dependent on your immune status and cause of the immune deficit. |
Oral Lichen Planus: This is an inflammatory condition that affects the lining of the mouth. It usually occurs on the inside of the cheeks but can affect the gums, tongue, lips and other parts of the mouth. This is not an infectious disease, and is not contagious, but may last weeks or months. There are often small, pale raised areas or bumps that form a lacy network on the tongue or inside the cheeks. |
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It may advance into a painful erosive lesion. The mouth may be sore, dry and have a metallic taste. The cause is not known but may be triggered by an allergic or immune reaction. There is no cure for oral lichen planus, so the treatment focuses on managing the symptoms.
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Oral Cancer: Mouth cancer commonly involves the tissue of the lips or tongue but may also occur on the floor of the mouth, cheek lining, gums or roof of the mouth. Most oral cancers are called squamous cell carcinomas and may spread rapidly. Smoking cigarettes and other tobacco use is associated with 70-80% of oral cancer cases. Heavy alcohol use is another activity that increases one’s risk of developing oral cancer. |
Oral cancer presents as a lump or ulcer, pale or dark in color and may be painless. Some individuals have tongue pain, swallowing difficulty, mouth sores or abnormal taste. A biopsy of the lesion confirms the diagnosis of cancer. Surgical excision is usually recommended. Radiation therapy and chemotherapy may be indicated when the tumor is larger or has spread to lymph nodes in the neck. |
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Keep your Mouth Healthy! Oral Self-Care
Practice good oral hygiene.
Limit alcohol consumption and don’t use tobacco products.
Adjust your diet.
Have regular oral examinations.
Smell & Taste
Smell or taste disorders are relatively common and can have a significant impact on quality of life. The senses of smell and taste allow us to enjoy foods and serve as an early warning system against dangers such as fire, smoke, spoiled foods, chemicals and toxins. Smell and taste disorders, especially in the elderly, have been implicated in weight loss, malnutrition, impaired immunity and worsening of medical conditions.
Many individuals, who complain of problems with taste, actually are experiencing problems with their sense of smell.
Smell
Two nerves in the nose are responsible for the sense of smell. The olfactory nerve is located in the upper part of the nose and connects directly to the brain. The olfactory nerve is responsible for the quality of smells such as rose, lemon and grass. The second nerve, the trigeminal nerve, gives one the sensation of odors, warmth, coolness, sharpness and irritation (i.e. ammonia and alcohol).
Taste
The sense of taste comes from taste buds located on the tongue and throat. The basic taste sensations are sweet, sour, bitter, and salty. The trigeminal nerve also provides the sensation of foods such as stinging, burning, coolness and sharpness.
Causes of Smell and Taste Disorders
Smell Disorders
Common causes for smell disturbance are nasal and sinus disease (allergies, polyps, sinusitis and enlarged adenoids), upper respiratory infections (“colds”), head trauma (skull and nasal fractures) and cigarette smoking. Less common causes are medications, cocaine use, toxic chemicals (benzene, chlorine, paint
solvents, insecticides) and industrial agents (ashes, chromium, iron). Uncommon causes include tumors, psychiatric conditions (schizophrenia, depression) and endocrine disorders.
Taste Disorders
Common causes for taste disturbance include mouth infections (yeast, herpes, gum disease), medications, oral appliances (dentures), dental procedures (tooth extraction, root canal) and age. Less common causes are nutritional deficiencies (Zinc, Copper, B3 and B12), malnutrition, kidney and liver disease, cancer and HIV, tumors, head trauma, and toxic chemical exposure (benzene, chlorine, sulfuric acid). Uncommon causes include psychiatric conditions (depression, anorexia, bulimia), epilepsy, migraine headaches, multiple sclerosis, diabetes, hypothyroidism and Sjogren’s syndrome.
Evaluation for Smell and Taste Disorders
A physical examination may detect the cause for a taste or smell disorder. The nose and mouth is examined to look for evidence of infections, inflammations or other disorders. Tests to detect loss of smell include a “scratch-and-sniff” test. Laboratory and imaging studies such as a CT scan or MRI may be ordered to detect abnormalities of the nose, sinuses, mouth, brain and nervous system.
Treatments for Smell and Taste Disorders
Smell disorders may be successfully treated if there is blockage of the nasal passages from polyps, allergies or infections. Medications such as nasal sprays, decongestants and oral steroids may be helpful in improving the sense of smell. Improvement may be noted if one stops certain medications that are affecting one’s sense of smell or taste.
Quitting cigarette smoking will often lead to improvement in the sense of smell and taste. In general, if loss of smell is caused by head injury, the prognosis for recovery is poor. Most individuals that regain their sense of smell after head trauma do so within 12 weeks of injury.
Individuals with permanent loss of smell need to be aware of issues of personal hygiene (body odor), safety (smoke alarms, spoiled food), health and appetite. Improving the appearance and flavor of food with salt, spice, texture, temperature and color, is helpful in making eating more enjoyable.
