Expert: Mark Bornfeld DDS - 11/26/2007

Question
Hi there. Thanks for taking the time to read and reply.
Everytime I go to the dentist I get this really aggravating problem.... my tongue swells up, i get what looks like bite marks on the side of my tongue (i'm not biting on my tongue 100% sure), and i get a frequent sticky coating that looks yellowish orange if i wipe my tongue on something. The coating gets worse when I eat sugar or starcy foods. It effets my speech and therefore effects my ability to interact with people. I have tried brushes, salt water rinses, scraping my tongue, tea tree oil, mouth wash, peroxide, thrush medications like nyastin, and anything else i was able to find online suggested. I miraculously recently found a forum where people had the same problems as me.. their descriptions may be helpful as well: http://ehealthforum.com/health/topic39108.html
This can flare up from a simple teeth cleaning or getting a cavity filled.
I am recovered from a 4 year battle with severe bulimia (throwing up 2x a day for 4 years) and have a pretty weak immune system and bad anemia in result (hemoglobin level was 9 a couple years ago, now i think it might be 10). I mention these just because i don't know if they're related to my mouth problems.

Any help would be great. Thanks.

Answer
Dear Melissa,

Swelling of the tongue after dental treatment suggests angioedema-- a type of allergic reaction. The "bite marks" to which you refer are probably tongue scalloping due to pressure against the insides of the lower teeth secondary to the tongue swelling. It is also common to develop canker sores on areas of the tongue that have experienced minor injury, such as might follow increased pressure from the teeth due to tongue swelling.

You might consider whether you should be tested for allergy to a range of substances that may be encountered in the dental environment-- perhaps latex (perhaps from contact with latex gloves worn my dentists or dental hygienists), certain dental cleaning pastes, or perhaps benzocaine or other ester-class anesthetics, commonly used for topical use on the gums prior to cleaning. All these substances (and others) are potent allergens, and have potential for provoking angioedema and other allergic responses.

I would caution you against comparing your experience with those of other lay persons on the internet. The mouth has a very limited repertoire of symptoms for a wide variety of completely different conditions, and it is easy to confuse them using perfunctory comparisons. The contributors to the web site you reference only have one definite thing in common-- none of them consulted with their dentists, so their recommendations don't carry the weight of either diagnostic or therapeutic expertise.

I recommend that you consult your medical doctor for allergy testing, and allow your dentist to collaborate on the search by documenting the various products he uses during the typical office visits you have had. Together, your doctors are more likely to arrive at a reliable answer.

Hope this helps..

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY