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6am
6am  
1130am
1130am  
QUESTION: As you can see these two pics were taken 5 hours apart. Notice the difference from 6 am when I woke up until
Now at 1130 am after talking eating and swallowing? Looks red and irritated and inflamed. Didn't really look like that when I woke up. So it's gotta be from talking and eating during day. Can't be at night Bc it looks better when I wake up. Question is could the tmj on opposite side be causing a lack of mobility in jaw and causing there not to be enough room for tongue in mouth hence these issues? Is that a possibility? Here are the two pics.

ANSWER: Steve -  You may not want to hear this, but from the diminished inflammation in the early morning versus a little later in the day, I think you are causing the problem.  Whether you are pulling out your tongue with your fingers or just sticking it out you are causing the irritation.  As I have told you previously, you need to leave this area alone.  Get it out of your thoughts.  Don't look, don't touch and don't stick your tongue out.  I know this is tough for you to do, but it is important to allow healing to occur.

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This am
This am  
This morning
This morning  
QUESTION: Dr Joel -
I am not doing anything to cause the problem between those hours. I simply go to work and am a teacher then during lunch time I go check it and that's when I notice the change. I don't randomly keep sticking tongue out I only do that to take picture. I think it's from chewing and swallowing. After eating maybe the fissures get inflammed causing redness. Or, I explained the tmj situation on opposite side but haven't heard back from you about that possibility. I think the tmj on opposite side is causing my tongue to sit on lower teeth and when I eat maybe it's rubbing against teeth or accidentally getting bit without me knowing it. Again, if it were trauma why doesn't it hurt? There is zero pain. Here it is this morning

ANSWER: Steve -  it appears to be low grade trauma, but it is still trauma.  When we walk in a shoe that does not fit well and we get a blister, that is trauma, but likewise a low grade.  So trauma occurs in many forms and with you it is difficult for me to determine that cause.  So the cause is present and you need a proper evaluation to determine that.

---------- FOLLOW-UP ----------

QUESTION: Well as you know I've had numerous evaluations. After all these evaluations it's still there. A biopsy wouldn't even tell the cause. It will likely show inflammation but we still wouldn't know cause. But to me it's gotta be a mechanical issue.

Answer
I agree that it is mechanical.  For that reason you need to be properly evaluated by a knowledgeable dentist and oral and maxillofacial surgeon or team of dentists and surgeons at a major oral and maxillofacial surgeon residency.  You are fortunate to live in Rhode Island.  Within a short drive are three facilities to properly evaluate you.  

I suggest that you call the oral and maxillofacial surgical residency programs at Massachusetts General Hospital (Dr. Maria Troulis), Boston University Dental School (Dr. Pushkar Mehra) or Tuft University School of Dental Medicine (Dr. Maria Papageorge).  At each of these, when you call, you want to be examined by the attending doctor I listed above and not a resident doctor.

This is the path to the cause you need to follow if you want a resolution or, at least, discovering the cause.  

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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