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Tongue Sore
Tongue Sore  
Eighteen years ago, I had a quad helix put in.  Shortly after, I began experiencing irritation to the top of my tongue.  A callus developed, with a sore down the middle where the wire rubbed.  I don't remember how long I had it, but when my orthodontist saw the damage to my tongue at my next appointment, he immediate remove the device.  Over time, the swelling went down, but I still have a slight bump on my tongue, and the indentation from the wire is still clearly visible.  Occasionally, the area becomes irritate and sore.  I've attached a photo I took today, about 18 years after the device was removed.  Have you ever seen anything like this?  Is there anything I can do?

Answer
Dear Lindsay,

Thank you for your patience, as I am just getting around to answering several questions. My laptop is now repaired. You had written about certain tongue patterns due to an oral appliance that you had worn years ago.

As always, what I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise, or any form of treatment recommendation.  Indeed, in the ultimate analysis all final diagnoses and decisions, particularly clinical ones, should only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records that may be needed.

So Lindsay, let me examine your comments step by step. You wrote:

(1)
“Eighteen years ago, I had a quad helix put in.  Shortly after, I began experiencing irritation to the top of my tongue.”  

Tongue irritations are mainly due to physical/functional trauma with appliances. In some instances, the framework metal used, or the soldering material employed in the construction of certain appliances, such as a Hyrax Expander or a Quad Helix can evoke a metal relate sensitivity reaction. Just as some patients have issues with jewelry containing nickel, sometimes orthodontics appliances or brackets can elicit a similar reaction. Years ago a German company named Dentaurum offered a line of orthodontic brackets made of Titanium which was designed for patients with metal allergies. It sounds like your case is one related to the physical pressures of the tongue against the appliance.

(2)
“A callus developed, with a sore down the middle where the wire rubbed.  I don't remember how long I had it, but when my orthodontist saw the damage to my tongue at my next appointment, he immediate remove the device.”

When an appliance such as a Quad Helix presses against the tongue, the result is much like the effect on the shoulder of carrying a heavy purse or piece of  luggage wit a thin strap. The strap digs into the flesh of the shoulder leaving a temporary mark or welt. Likewise the framework of the Quad Helix can leave grooved in the tongue. Also, realize that a Quad Helix is generally used as an oral orthopedic expansion device to help broaden the transverse dimension of the upper jaw. That means the upper palate is already very small and constricted, and the tongue is already in a very small and compact space. Introducing a metal appliance means the tongue will now have to compete for room in an already small space. This is where the clinician has to carefully evaluate what type of expansion appliance to use and for how long. Your Orthodontist may have removed the appliance because it was too injurious to the tongue, or perhaps because the needed expansion had indeed been achieved.

The “callous” is simply a reaction of somewhat chronic exposure to trauma. A person uses a shovel when they start to garden in the spring may develop a callous on the palms as the skin reacts to similar “trauma”. This is usually reversible. Trauma to the tongue often is very transient and heals rapidly due to the intensive vasculature of the tongue. Notice that if you bite your tongue accidentally, it heals very rapidly.

(3)
Over time, the swelling went down, but I still have a slight bump on my tongue, and the indentation from the wire is still clearly visible.  Occasionally, the area becomes irritate and sore.  I've attached a photo I took today, about 18 years after the device was removed.  Have you ever seen anything like this?  Is there anything I can do?

I have looked at the photo. Thank you for including it. What I think you may have is a natural deep fissure of the tongue. There is a great deal of natural variety in the anatomy of the tongue, aside from size. Some people have naturally occurring grooves in the tongue, which may deepen over time. The appliance you wore actually coursed around the lateral edges of the palate and along the front. That is how a maxillary Quad Helix is constructed. The appliance indeed can impact the tongue, and no doubt did. The deep fissure accumulated plaque and bacteria and this in turn causes a skin reaction, a “callous” so to speak.

In the volume 2, issue 1 (2013) of  the European Journal of General Dentistry, Khan, Zaheer, and Gupta have an article titled “Oral psoriasis: A diagnostic dilemma”. There is a wonderful image of bilateral tongue fissures.  The case has profound similarities to your tongue patterns. Here is the link:

http://www.ejgd.org/viewimage.asp?img=EurJGenDent_2013_2_1_67_106822_u3.jpg

As I look at the location of the current tongue indentation, it seems to course more centrally in an anterior-posterior fashion. Trauma from a Quad Helix generally manifests bilaterally along the left and right lateral aspects of the tongue. Trauma, when present, tends to be more profound in the left and right posterior  lateral borders of the tongue where “two” of the “four” metal loops of the “Quad” Helix are located.

(4)
Final Comments and what to do.

I think what you are experienced Lindsay was concurrent conditions. You had trauma from the appliance and existing tongue fissures. The current image is consistent with tongue fissure anatomy, location, and orientation. It does not reflect the usual traumatic impressions left by a Quad Helix, although in your case this may have occurred. It has been 18 years since the device has been removed.

Generally any trauma aside from perhaps some severely profound injury such as portion of the tongue being cut off, etc. will heal. Sometimes portions of the tongue are removed due to oral cancer, often found along the borders of the tongue. Even in such cases, substantial recover takes place. Likewise in cases where people have had elective tongue piercings (a form of trauma) done for jewelry, the openings often heal shut if the bar or bell is not kept in place.

In your case Lindsay, I think there is nothing to be done. What you see is likely natural anatomy, possibly exacerbated by a past oral appliance.  The deep fissures are often harbor plaque, and so you may wish to more vigorously brush the tongue clean. A tongue scraper appliance can also be bought at most drug stores.  Finally, to manage the bacterial laden plaque accumulation in the deep fissures, you may wish to use a strong mouth rinse that has antibacterial properties. Yellow high strength Listerine brand mouthwash has the ADA  seal of approval for fighting gingivitis, and therefore should be effective in reducing tongue fissure related plaque and bacteria.

Good luck with this Lindsay. I think these naturally occurring tongue fissures are simply part of your normal anatomy, and judicious hygiene is the extent of what can be done. Again, thank you for your patience in awaiting my response. I hope you will find it helpful.



Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

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Paul Supan, DDS, MA, MPH

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First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

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Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

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American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

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Available upon Request.

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BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

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Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

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