Expert: Joel S. Teig, DMD, Diplomate ABOMS, retired - 6/7/2008

Question
HELLO DR. TIEG...I HAVE HAD AN IRRITATED AREA ON THE LEFT LOWER LATERAL TONGUE FOR 2 YEARS.  MY 2ND BIOPSY IN JANUARY HAS REVEALED NOTHING SERIOUS, EXCEPT MINOR MUCOSITIS AND POSSIBLE LICHEN PLANUS.  IT HAS REMAINED CONSTANT IN THIS ONE AREA, FEELING AS THOUGH I HAVE BURNED MYSELF WITH SOMETHING JHOT.  I HAVE HAD TWO LOWER AND ONE UPPER LEFT MOLARS REPLACED, BUT STILL FEEL IRRITATION WHEN MY TONGUE PASSES OVEER THESE CROWNS.  2 ARE GOLD AND ALL HAVE BEEN SMOOTHED OUT.  I HAVE BEEN APPLYING LYDEX ORALLY FOR 4 WEEKS, NOW , WITH NO CHANGE.  I AM WANTING TO HAVE THESE TEETH EXTRACTED, BUT THE ORAL SURGEON SAYS THEY ARE NOT CAUSING THE IRRITATION.  WOULD A MED-PAK OF WEEKLY PREDNISONE BE HELPFUL, AS I AM AT MY WITS END WITH THIS CHRONIC DISCOMFORT, AND FEAR THAT THIS MINOR DYSPLASIA WILL TURN INTO SOMETHING SERIOUS IF LEFT UNRESOLVED.  I AM EVEN MAKING AN APT. WITH AN ORAL PATHOLOGIST AT THE UNIVERSITY OF FLORIDA FOR POSSIBLE ANSWERS.  NEURALGIA PAIN PILLS JUST DO NOT DO IT, OTHER THAN DEALING WITH THE SYMPTOMS.  ANY SUGGESTIONS?  THANKS  FESTCLASS@AOL.COM

Answer
Jay -  Of course without a direct examination it is a little difficult to be sure what is going on.  I'm a little uncomfortable with you using the Lidex as the topical medication used.  When placing it on the tongue, it is quickly dissolved and has a minimal effect.  You dentist or surgeon should, instead, prescribe a medication Kenalog in Orabase.  It too is a steroid based medication to reduce inflammation, but it sticks to the tongue and provides direct contact with the area for much longer.  

So rather than starting a med-pak which can have some negative side effects, have the dentist or surgeon change the topical medication to the tongue and I think you will have a better chance of reducing the area.  Just so you know, if you were not explained this in the past, once the area has gone to Lichen Planus, it is more like a callous lesion which may not totally go away.  Once the irritation is decreased with the orabase most of the Lichen Planus should get better.

I wish you well and hope it all gets better soon.  If you have additional questions, feel free to contact me again.