QUERY:
My husband has been suffering for about the past 15 years with aching in his mouth, particularly under his tongue, and a bad acidy taste in this mouth. He has seen our dentist (who could not find anything wrong) and our family doctor. Our doctor feels that the problem is caused by stress but my husband disagrees. He gets these "attacks" anywhere from 2 - 10 times per year and they seem to last approximately 1 - 2 weeks. The aching in his mouth, when he gets one of these "attacks" is constant and makes him miserable. He tries to combat the strong acid taste in his mouth by sucking on hard candies and taking Tums. He is 40 yrs. old, 5'10" and about 175 lbs. and in good health. He hasn't had any bloodwork done yet to try to diagnose his problem. Actually, he just tolerated it until about a year ago when I told him maybe someone could do something to help him. He has indicated that he fears this may be caused by some sexually transmitted disease, although he confided this with our doctor and our doctor says no. Do you have any suggestions of what his problem can be, some direction we can turn to put an end to his suffering. When he has it, it bothers him so much. He rinses out his mouth with Listerine, warm salt water, you name it, he's tried it. He did comment that it used to bother him more when he drank beer...which he used to do a lot, but not at all since 1996. Do you know what his problem is? Thank you.
ANSWER:
Hello and welcome to The Inn! I'm glad you asked the question - it sure
sounds like a frustrating situation but one that your husband's doctors have
been unable to pin down. Maybe it is one of those things that bother the
patient more than the doctor so nothing gets done about it....
In any case, I do have a suggestion for you to consider. Under the tongue
are some salivary glands. When we eat, they squirt out saliva to help
digest some of our food while we are chewing it, in preparation for
swallowing. These glands have little ducts that allow them to release the
saliva into the mouth. The ducts themselves can get stones in them, causing
a blockage and that block can cause pain, aching, and swelling. This
condition is called "saliolithiasis". I have seen patients in excruciating
pain from one of these salivary stones, and have seen people who get
recurrent attacks. This could also be responsible for changing his taste
sensation in his mouth. These ducts can also have narrow areas called
strictures that can cause symptoms when they are blocked. The salivary
glands can also get infected with bacterial infections or viruses and this
too can cause some of the symptoms he has been experiencing. However, it
seems more likely to be a blocked duct because his symptoms, although
recurrent and bothersome, are not acute, severe, or accompanied by a fever
or swelling.
To find out if this is the problem, he could see ear-nose-throat specialist
(otolaryngologist) while he is having the symptoms. If that exam does not
give the answer, perhaps some imaging studies would help. Sonography, CT
scans, and sometimes plain xrays can see one of these stones lodged in the
duct. There is also a special test called a "sialogram" that specifically
looks for these stones.
Alcohol (beer) acts as a diuretic, causing some dehydration, and that will
make a salivary gland stone more likely to occur. That could explain why it
was worse when he drank beer. People who get these stones are advised to
avoid alcohol because it can cause an attack.
Sucking on lemon drops during one of these attacks will often bring relief
because it increases the flow of saliva and helps to flush out the duct.
Sometimes surgery is required to remove a truly blocked stone but it is not
a major procedure and easily done by a specialist.
In any case, this is the possibility that I would want to rule out before I
gave up on figuring out these recurring symptoms! See if your husband can
consult an otolaryngologist to look into it. I would reassure him that it is
safe to tell the doctor all of his symptoms because the likelihood that it
is something like a sexually transmitted disease is very small. It is much
more likely to be something treatable, but he will never know unless he
shares his whole story with the right doctor.
Good luck to you, and best wishes.