Health Library Mouth Problems, NoninjuryFrom Healthwise

It is not unusual to have a problem with your mouth from time to time. A mouth problem can involve your gums, lips, tongue, inner cheeks, the roof of your mouth (soft and hard palates), under your tongue, your neck, or your teeth. Your mouth may be dry, or food may not taste right. You may have bad breath or a sore on your lip, gums, or tongue that makes it hard to eat or talk. Many of these problems can get better with home treatment.

Common mouth problems include:

• Sores, such as cold sores (also called fever blisters), canker sores, and impetigo. Canker sores develop inside the mouth, while cold sores and impetigo usually affect the area around the outside of the mouth.
• Infections, which can be caused by a virus (such as herpes simplex) or a bacteria (such as epiglottitis or a sexually transmitted disease). An infection is more serious when it causes rapid swelling of the tongue or throat and blockage of the airway.
• Tender, red splits or cracks at the corner of your mouth (angular cheilitis), which can be caused by infection, a diet too low in vitamins, and over-closure of the mouth in someone who has been without teeth or dentures for some time.
• Chapped lips, which may be caused by dry, windy, cold, or very hot weather.
• Dry mouth (xerostomia), which may be caused by dehydration, breathing through your nose, anxiety, and many medicines. Over time, having a dry mouth increases your risk of mouth infections, gum disease, and dental cavities.
• Thick, hard white patches inside the mouth that cannot be wiped off (leukoplakia). This is commonly caused by irritation of the mouth, such as from a rough tooth or poorly fitting denture rubbing against tissue or from smoking or using smokeless (spit) tobacco.
• Thrush, a common infection of the mouth and tongue caused by the yeast Candida albicans. Thrush appears on the mouth and tongue as white patches that look like cottage cheese or milk curds. When the patches are wiped away, the underlying area appears red and raw and may bleed. In babies, thrush may cause a rash in the diaper area.
• Taste changes. Your sense of taste may be decreased, lost, or changed, such as a metallic taste in your mouth.

Your tongue may become sore or swollen, or it may change color or texture. A buildup of food and bacteria on the tongue may make the tongue look thick or furry (" hairy tongue"). Often the problems will go away if the surface of the tongue is regularly brushed with a soft-bristled toothbrush. If your tongue problem is from some local irritation, such as tobacco use, removing the source of the irritation may clear up the tongue problem. Rapid swelling of the tongue can be caused by an allergic reaction, which can interfere with breathing. For more information, see the topic Allergic Reaction.

Bad breath (halitosis) or changed breath can be an embarrassing problem. Make sure that you brush your teeth twice each day and floss once a day to decrease the bacteria that can cause bad breath. Brushing your tongue can also help.

The use of alcohol and tobacco can cause many mouth problems. Your chances of having oral cancer are increased if you smoke, use smokeless (spit) tobacco, or use alcohol excessively.

Mouth problems may occur more commonly with other conditions and diseases, such as diabetes, Down syndrome, and HIV (human immunodeficiency virus). Many medicines also can cause mouth problems.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

• Severe dehydration:
  • In children
  • In adults
• Moderate to severe difficulty breathing:
  • In children
  • In adults
• Rapid swelling of the throat or tongue that makes breathing hard
• Drooling with trouble breathing or without being able to cry or make sounds (epiglottitis)
• Difficulty chewing or moving the tongue with other loss of function
• Lower teeth or jaw pain with unexplained chest pain or that occurs with any other symptoms of a heart attack

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have the following symptoms, evaluate those symptoms first.

• A suspected allergic reaction: Go to the topic Allergic Reaction.
• Mouth or dental injury: Go to the topic Mouth and Dental Injuries.
• Toothache or gum problem: Go to the topic Toothache and Gum Problems.

	Yes	Do you have problems chewing, swallowing, or moving your tongue?
When to See a Doctor See significance of problems chewing, swallowing, or moving your tongue if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have sudden problems chewing or moving your tongue? Yes Is your baby having problems swallowing or unwilling or unable to eat? Yes Do you have severe problems swallowing with mild difficulty breathing? Call your health professional today if you answer "Yes" to any of the following questions. Yes Are you having unexplained moderate problems chewing or swallowing? Yes Are you having unexplained moderate problems moving your tongue? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had mild problems chewing, swallowing, or moving your tongue for longer than 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a tongue problem?
When to See a Doctor See significance of a tongue problem if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Is your baby having problems swallowing or unwilling or unable to eat? Yes Is your tongue so swollen that you are having mild problems breathing? Yes Are you having problems swallowing because your tongue is so swollen? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a strawberry- or raspberry-colored tongue and a sore throat? Yes Do you have a strawberry- or raspberry-colored tongue and do you have a fever or think you have a fever? Yes Do you have a strawberry- or raspberry-colored tongue along with a rash? Yes Does your baby have white patches on his or her tongue and he or she is acting fussy? Yes Are you being treated for thrush but your symptoms are getting worse? Yes Are you being treated for thrush but your symptoms have not gotten better after 3 to 4 days of treatment? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Do you have a black or brown coating on your tongue that has not gotten better with 24 hours of home treatment? Yes Do you have an unexplained sore tongue that has not gotten better with 24 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had white or red patches on your tongue for more than 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have one or more sores in or around your mouth?
When to See a Doctor See significance of mouth sores if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Is your baby having difficulty swallowing or is unwilling or unable to eat? Call your health professional today if you answer "Yes" to any of the following questions. Yes Does your child have a general feeling of illness? Yes Do you have a rash? Yes Do you have increased pain, swelling, redness, or warmth around the sore? Yes Is the area around the sore increasingly tender to the touch? Yes Do you have pus in or around the sore? Yes Do you know or think you have a fever? Yes Do you have one or more sores on or near your lip that have crusty, honey-colored drainage? Yes Are you concerned a new sore was caused by sexual contact? Note: If you think that you have been exposed to a sexually transmitted disease (STD), it is important to be evaluated promptly by a health professional. This will help prevent serious health problems for yourself and reduce the risk of transmitting the infection to others. Do not have sexual contact while waiting for your appointment. This will reduce the possibility of spreading a disease to your partner. Your partner may need to be checked as well. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around a sore for 24 hours or longer? Yes Have you had swollen gland (lymph node) in the neck or under the jaw for 24 hours or longer? Yes Do you have a painful sore that has not gotten better after 48 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you had sores for 2 weeks or longer? Yes Do you frequently develop sores? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have white or red patches in your mouth?
When to See a Doctor See significance of white or red patches if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Does your baby have white patches in his or her mouth and difficulty swallowing or is unwilling or unable to eat? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have white patches on the roof of your mouth? Yes Does your baby have white patches in his or her mouth and is acting fussy? Yes Are you being treated for thrush, but your symptoms are getting worse? Yes Are you being treated for thrush, but your symptoms have not improved after 3 to 4 days of treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had white or red patches in the mouth without other symptoms for 2 weeks or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have cracking, splitting, or chapping at the corners of your mouth or on your lips?
When to See a Doctor See significance of cracking, splitting, or chapping at the corners of your mouth or on your lips if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased mouth or lip pain, swelling, redness, or warmth? Yes Is the area around your mouth and lip increasingly tender to the touch? Yes Do you have pus draining in or around your mouth or lip? Yes Do you know or think you have a fever? Yes Do you have cracking or splitting on, around, or near your lips with crusty, honey-colored drainage? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around the cracking, splitting, or chapping for 24 hours or longer? Yes Have you had swollen gland (lymph node) in the neck or under the jaw for 24 hours or longer? Yes Do you have painful cracking and splitting that has not improved with 48 hours of home treatment? Yes Do you have severely chapped lips that have not improved with 3 to 4 days of home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a dry mouth?
When to See a Doctor See significance of dry mouth if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you have symptoms of moderate dehydration? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Does a dry mouth make it hard to talk, eat, swallow, or wear dentures despite 24 hours of home treatment? Yes Have you had symptoms of mild dehydration for 24 hours or longer and you are unable to drink enough to replace lost fluids? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Do you wake up at night or in the morning with an extremely dry mouth? Yes Have you had a dry mouth that has not improved with 2 weeks of home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think a medicine may be the cause of your mouth problem?
When to See a Doctor See significance of medicines if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you think a medicine may be the cause of your mouth problem? Note: Call the health professional who prescribed the medicine to determine whether you should stop taking the medicine or take a different one. An appointment may not be necessary. If you are taking a nonprescription medicine, stop taking the medicine. Call your health professional if you feel you need to continue taking the medicine. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you noticed changes in the way your breath smells?
When to See a Doctor See significance of breath changes if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you have a fruity odor to your breath? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Do you have bad breath, changed breath, or an odd breath odor that has not improved with 1 week of home treatment? Yes Have your family or friends told you that you have bad breath? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are your dentures or other dental appliance causing discomfort?
When to See a Doctor See significance of uncomfortable dentures or dental appliance if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Are your dentures or dental appliance broken? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Are your dentures or dental appliance causing discomfort? Yes Do sharp edges on your dentures or dental appliance irritate your mouth? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have burning, tingling, or numbness inside your mouth or your lips?
When to See a Doctor See significance of burning, tingling, or numbness if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had steady burning, tingling, or numbness inside your mouth or lips for 48 hours or longer? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had burning, tingling, or numbness that comes and goes for longer than 1 week? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you noticed changes in the way things taste?
When to See a Doctor See significance of taste changes if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had a metallic taste in your mouth for 48 hours or longer? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Are taste changes interfering with your enjoyment of food, and home treatment is not helping? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a lump, thickening, or growth in your mouth?
When to See a Doctor See significance of a lump, thickening, or growth if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had a lump, thickening, or growth in your mouth for 2 weeks or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Dehydration: Go to the topic Dehydration.
• Sore throat: Go to the topic Sore Throat.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Mouth problems are common and can be very annoying. However, most mouth problems are minor and will clear up with home treatment and time. Simple home treatment measures, such as increasing your fluid intake to prevent dehydration and using a humidifier inside your home, can relieve many mouth problems. Try home treatment when you have one of the following mouth problems:

• Chapped lips. Avoid licking or biting your lips. Protect your lips with lipstick or a lip balm, such as a water-based product. If your lips are severely chapped, build a barrier by applying petroleum jelly, such as Vaseline, for a short time and then switch to a water-based product. Avoid sun or wind exposure. Using a humidifier in your home may help.
• A dry mouth. Avoid caffeinated beverages, tobacco, and alcohol, all of which increase dryness in your mouth.
• Bad breath, a bad taste in your mouth, a black or coated tongue, or " hairy tongue". You can freshen your breath by brushing your teeth, tongue, roof of your mouth, and gums. Sometimes just rinsing your mouth with fresh water will freshen your breath and make your mouth taste better.

Problems with the way food tastes

Simple changes in your diet can help if you are having problems with the way food tastes.

• If your food lacks flavor, try a variety of sauces, seasonings, and marinades, such as barbecue sauce, ketchup, meat marinades, mustard, salad dressings, soy sauce, spices, herbs, or teriyaki sauce.
• If your food tastes too sweet, add a bit of salt or lemon juice or choose tart, salty, or spicy snacks in place of sweet snacks.
• If your food tastes too salty, add a bit of sugar to tone down the saltiness or try bland foods and cook without adding seasonings or spices.

Sore or ulcer inside your mouth

Changes in your diet can also help if you have a sore or ulcer inside your mouth, such as a canker sore.

• Drink cold liquids, such as water or iced tea, or eat Popsicles or frozen juices. Use a straw to keep the liquid from coming in contact with your mouth sore.
• Eat soft, bland foods that are easy to swallow, such as ice cream, custard, applesauce, cottage cheese, macaroni and cheese, soft-cooked eggs, yogurt, or cream soups.
• Cut foods into small pieces, or grind, mash, blend, or puree foods.
• Avoid coffee, chocolate, spicy and salty foods, citrus fruits, nuts, seeds, and tomatoes.

Pain relief

• If you have a painful sore on the outside of your lip, apply ice to the area when you first feel a sore coming on (tingling or prickly feeling at the site). This may help reduce the pain and dry out the sore. Apply the ice directly to the sore—5 minutes on, 10 minutes off—repeating as desired.
• Rinse with an antacid, such as Maalox or Mylanta, or dab it on your sores with a cotton swab.
• Avoid very hot, cold, or sweet foods and drinks if they increase your pain.
• Apply petroleum jelly, such as Vaseline, to ease the cracking and dryness of a lip sore.
• Use a lip protector, such as Blistex or Campho-Phenique, to ease the pain. Don't share your lip protector with others because cold sores are contagious.
• Puncture a vitamin E capsule and squeeze the oil onto the sore. This soothes inflammation and protects the sore.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment.

• New symptoms develop.
• Signs of dehydration develop.
• Signs of infection develop.
• Symptoms persist or become more severe or frequent.

Many mouth problems can be prevented. Try some of the following home prevention measures to prevent:

• Cold sores. Avoid direct physical contact with people who have a cold sore. Remember, cold sores are caused by a contagious virus (herpes type 1). Children often become infected by contact with parents, siblings, or other close relatives who have cold sores.
• Canker sores. Avoid injury to the inside of the mouth and foods that can trigger a canker sore.
• Bad breath. Practice good dental care: Brush your teeth twice each day and floss once a day.
• Dry mouth. Make sure you are drinking enough fluids to avoid dehydration. Hard candies can increase saliva and help prevent problems with a dry mouth.

Tobacco can cause mouth problems. Do not smoke or use other tobacco products. For more information, see the topic Quitting Tobacco Use.

Avoid alcohol, which can cause a dry mouth, bad breath, and increase your risk of canker sores.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• What is your main symptom?
• When did your symptoms start?
• Have you had this problem before? If so, do you know what the cause was at that time? How was it treated?
• What home treatment have you tried? Has it helped?
• Have you started on any new medicines or had a change in the dosage of a medicine?
• What is your routine for taking care of your teeth and gums? When did you last visit a dentist?
• Do you have any health risks?

• Allergic Reaction
• Basic Dental Care
• Bulimia Nervosa
• Chickenpox (Varicella)
• Cold Sores
• Exposure to Sexually Transmitted Diseases
• Facial Problems, Noninjury
• Genital Herpes
• Gum Disease
• Mouth and Dental Injuries
• Quitting Tobacco Use
• Rash, Age 11 and Younger
• Shingles
• Sinusitis
• Sore Throat
• Strep Throat
• Stress Management
• Teething
• Thrush
• Tooth Decay
• Toothache and Gum Problems

Author:	Susan Van Houten, RN, BSN, MBA	Last Updated: December 1, 2006
Medical Review:	Martin Gabica, MD - Family Medicine William M. Green, MD - Emergency Medicine Steven K. Patterson, BSc, DDS, MPH - Dentist
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