Dental and Oral Health | Mount Sinai Today

Is the Sore in My Mouth an Oral Lesion?

Updated on Apr 21, 2023 | Dental and Oral Health, Ear Nose Throat, Your Health

Have you noticed a wound in your mouth that is not healing? Maybe you also noticed it has a bump or area that seems unnaturally firm to the touch? If these symptoms sound familiar to you, you may have an oral lesion.

Mohemmed Nazir Khan, MD

In this Q&A, Mohemmed Nazir Khan, MD, an Assistant Professor at the Department of Otolaryngology at Mount Sinai-Union Square and a surgeon at Mount Sinai’s Head and Neck Institute—Center of Excellence for Head and Neck Cancer, explains the importance of detecting oral lesions early. While regular dental appointments are important, anything that looks or feels suspicious should be checked out immediately.

“Even if it turns out to be nothing, it is better to be safe than sorry,” he says. “I know the thought of a consultation can be scary, but the earlier we intervene, the better your outcomes will be.”

What is an oral lesion?

An oral lesion is an abnormal cell growth in your mouth, which has the potential to become cancerous. There are several telltale signs that you should look for, including:

A cut or sore in the mouth that becomes painful and has an underlying bump. This may be accompanied by bumps on the neck, but they are rare.
Unusual white or angry-looking red patches; an ulcerated, or cratered, lesion that is painful.
An unusually firm area of your mouth.
Numbness or loss of function, such as your tongue deviating to one side when you stick it out.

What is the difference between an oral lesion and a canker sore?

You may mistake some signs of oral lesions for a canker sore, formally known as an ‘aphthous ulcer.’ However, there are several key differences. For one, an oral lesion is not usually painful when it first appears, unlike a canker sore. Also, canker sores tend to be flat, with edges that appear angry and red. Most important of all, a canker sore will usually heal in two to three weeks. An oral lesion will not.

Usually, an oral lesion is easy to spot because it is front and center, such as on the tongue. If you have a wound or area of firmness in your oral cavity that does not get better over the course of a month, you need to have it examined because that is an indicator of an oral lesion.

Oral lesions are not commonly associated with the human papillomavirus (HPV). Furthermore, the signs are similar for both adults and children. However, the lack of risk factors among young people suggests that there is a genetic predisposition at play. This does not rule out environmental triggers, such as scratching from a misaligned incisor. But the hypothesis is that the irritation is the spark that lights the match for the genetic predisposition.

What are the most common types of oral lesions?

There are six different kinds of oral lesions:

Oral lichen planus, a chronic inflammation that often appears as white patches on your inner cheek or other parts of your mouth, which has no known cause.
Candidiasis, a fungal infection caused by candida, a type of yeast, which often appears as white patches in your mouth with some degree of redness or soreness.
Leukoplakia, white patches typically caused by constant injury or irritation.
Erythroplakia, which appears as red lesions in the mouth, bleeds when irritated, and is linked to alcohol and tobacco use.
Oral cavity cancer, which often appears as a sore or lump on the lips or in the mouth, and is also linked to alcohol and tobacco use.
The herpes simplex virus, which often appears as a cluster or a single small painful blister in the mouth, but may also look like a sore.

What should I do if I think I have an oral lesion?

You should make an appointment with a dental professional for a physical examination. In cases where your doctor has a high clinical suspicion of oral lesions, such as angry red patches, a biopsy may be performed, which will be done in the office. This involves numbing the area before removing a small sample for analysis. For patients who present with enlarged lymph nodes, a doctor normally collects a sample using a needle biopsy. The biopsy is invaluable because it establishes the diagnosis so the doctor can proceed with treatment. It also gives us the ability to reassure patients who have a premalignant lesion that just requires monitoring.

In cases involving cancerous or moderate-to-high risk precancerous lesions, doctors may recommend surgical removal. This is typically done using open surgery as most patients present with oral lesions on the tongue. However, at Mount Sinai’s Head and Neck Institute—Center of Excellence for Head and Neck Cancer, we are typically able to remove most oral lesions with few incisions. But we will remove the lymph nodes from the neck on the ipsilateral—or the same side—as the lesion if the tumor has a thickness of four millimeters or more. In cases involving bone structure, such as the jaw or midface, we will remove the lesion in collaboration with oral and maxillofacial surgeons. This allows us to better reconstruct boney structures and also achieve the best outcomes for your dental rehabilitation.

If the diagnosis reveals that the lesion is a stage two or higher cancer, we will recommend radiation therapy post-surgery. We will also recommend chemotherapy if there are positive margins following surgery—meaning that not all of the cancer could be removed—or if there is extranodal extension of the tumor, which means that the cells have spread beyond the lymph nodes.

For tumors that are located low on the tongue, or close to the floor of the mouth, we recommend microvascular reconstruction using skin and fat from other parts of the body. This allows us to preserve essential functions, such as your ability to eat and talk.

What should I expect following treatment?

Recovery differs based upon the extent of the surgery. For example, patients who undergo primary tumor removal without reconstruction are often discharged the same day and are started on a soft diet to promote healing. Patients who undergo lymph node removal are normally discharged the next day with a drain. Patients who undergo bone reconstruction are fitted with a nasogastric tube for a week to promote healing. In all cases, the goal at Mount Sinai is to get you back to eating and drinking as quickly as possible.

After surgery, we consult with patients every two months for the first year and conduct a surveillance scan at three months to ensure that all looks well. If subsequent scans show no signs of lesions, we gradually reduce the number of consultations to once a year after year five.

How can I prevent oral lesions?

You can take several steps to reduce your risk of developing an oral lesion:

Maintain a healthy diet
Practice proper oral hygiene by brushing and flossing daily
Avoid betel nut chewing, which can lead to significant scaring and increased risk for oral cancer
See a dental professional twice a year

To make an appointment with Dr. Khan, call 212-844-8775.

Make an appointment with Dr. Khan online.

How Do I Know If My Wisdom Teeth Must Go?

Updated on Jun 30, 2022 | Dental and Oral Health, Your Health

The painful appearance of wisdom teeth is a rite of passage for many teenagers and young adults. These third molar teeth often present during the transitional period between childhood and adulthood, thus earning their name, “wisdom teeth.” Their presence can cause many issues, such as pain, swelling, crowding in the mouth, and even cysts and tumors. Many people who develop these problems need to have the teeth extracted, although there are some fortunate individuals who do not develop them or even need to have them removed.

To increase your wisdom about these molars, Michael D. Turner, DDS, MD, Chief of Oral and Maxillofacial Surgery at The Mount Sinai Hospital, answers patients’ most frequently asked questions.

Do we need wisdom teeth?

In our mouths, we typically develop three sets of molars, which are the wide teeth in the back of the upper and lower jaws. Your “wisdom teeth” are the third set of molars, which are the most posterior teeth. Typically, they fully develop at age 18, although this happens slightly earlier or later for some.

Wisdom teeth were most useful for early humans who, thousands of years ago, had a diet of tough meat, roots, and leaves. Now, most people eat food that has been softened by cooking so the jaws have decreased in size and have become too small to accommodate three sets of molars. Because of this, the third molars, for the most part, do not erupt fully. We call this an “impaction.”

What are some signs and symptoms that wisdom teeth are coming in?

Symptomatic third molars can present in multiple fashions, including:

Jaw pain
Swelling overlying the third molar sites
Pus and foul odor from the site
Halitosis, also known as bad breath

If your wisdom teeth are impacted—not emerging—and causing pain, they should be removed during an individuals’ late teens to their mid-twenties to decrease the amount of complications from the surgery that can occur.

However, if impacted teeth are not causing any symptoms, your dentist may not recommend removal, since extraction of impacted third molars should be based on the clinical and radiographic findings. So, if they are not causing pain, you might be one of the lucky few who will not need to have the teeth removed.

What should I expect during a wisdom tooth extraction?

Wisdom tooth extraction is typically performed as an outpatient procedure. Patients can have the procedure with just local anesthesia or with sedation, depending on their preference. Often the procedure is complete in one hour, although, this depends on both the complexity of the extraction and the number of teeth being removed.

After the removal of the teeth, most people are swollen. This swelling takes three to four days to resolve. Full recuperation generally takes five to seven days, so if parents do not want kids to miss school, the summer or winter breaks are the best times to schedule. Most patient’s pain can be controlled by ibuprofen, although sometimes a small amount of a stronger pain medication is prescribed.

What complications should I look out for following surgery?

Dry socket is a problem that occurs about two to three days after surgery. It happens when the blood clot, which forms at the base of a tooth extraction, is dislodged—or dissolves—before the area can sufficiently heal. Without the blood clot’s presence, the underlying bone is exposed, causing pain and a bad taste and smell. Most patients report that healing is proceeding as normal and then, suddenly, they experience a pulsing sharp pain in the area of the extraction. Fortunately, dry socket can easily be managed by your surgeon by cleaning the area and applying a medicated dressing.

Post-surgical infections are rare and if they occur, are not apparent until three or four weeks following the surgery. Typically, infection is an effect of the bone healing, although food that gets caught in the extraction socket while healing can be the culprit. Post-operative antibiotics have not been shown to prevent infections from occurring. Patients are only prescribed antibiotics if there is an active infection.

The most significant complication that can occur due to the removal of the lower third molars is a change in nerve sensation to the lower lip, teeth, chin, and gums. Although this side effect occurs at about the same rate regardless of age, the rate of permanent sensation change increases with age. If you wait until you are older, then you are at a much higher risk.

My wisdom teeth are not causing me any pain. What happens if I never have them pulled out?

If the teeth are completely impacted and surrounded by bone, most likely nothing will occur. Although, occasionally the developmental cyst that is present around the third molar can transform into an aggressive and destructive cyst, or rarely, into a benign tumor.

However, if your wisdom teeth have partially emerged, they can become decayed, cause decay on adjacent teeth, or become infected.

If you, or your child, are experiencing signs that your wisdom teeth are emerging, it’s best to make an appointment with your dentist.

Make an appointment with Dr. Turner at the following locations:

Mount Sinai Union Square
Otolaryngology and Oral and Maxillofacial Surgery
10 Union Square East, Suite 5B
New York, NY 10003
212-844-6881

Mount Sinai Doctors East 85th Street
Otolaryngology and Oral and Maxillofacial Surgery
234 East 85th Street, 4th Floor
New York, NY 10028
212-241-9410

Learn more about Oral and Maxillofacial Surgery at Mount Sinai

Smiling for Two—The Importance of Oral Health in Prenatal Care

Updated on Jun 30, 2022 | BFWHRI, Dental and Oral Health, OB/GYN, Women's Health

Pregnancy is a special time in the life span to secure the oral health of mothers and their young children. Pregnant women often experience changes in oral health due to increased inflammatory response to dental plaque. Uncontrolled and untreated, inflammation in the gums and bones in the mouth (periodontal disease) can induce a systematic inflammation response, affecting the health of both mom and baby. Prior research suggests a potential association between periodontal disease in pregnant women and adverse birth outcomes. Additionally, pregnant women with untreated dental caries—tooth decay—can increase the risk of dental caries for young children by transferring caries-generating germs like Streptococcus mutans, from her mouth to the baby’s mouth. In young children, dental caries may require extensive treatment involving sedation or even general anesthesia if the child cannot tolerate chair-side procedures. The costs associated with such procedures often create major financial and psychosocial burden in families.

Oral Health is Prenatal Health

Preventive, diagnostic, and restorative dental procedures are safe throughout pregnancy and effective in improving and maintaining oral health. However, more than half of mothers do not receive periodic dental cleaning during pregnancy. Education, race/ethnicity, dental insurance, and household income have all been associated with the usage of dental services and oral health outcomes. Some women are misinformed that all dental treatments should be delayed after delivery, and sometimes they worry about potential adverse effects of routine dental care to the fetus. Given the importance of oral health during pregnancy for the health and well-being of mothers and their babies, the American College of Obstetricians and Gynecologists (ACOG) in 2013 stated that ‘women should routinely be counseled about the safety and importance of oral health care during pregnancy, and should be referred for dental care as would be the practice with referrals to any medical specialists.’ ACOG made it clear that oral health is an integral part of prenatal care. Healthcare providers from both medicine and dentistry acknowledge that preventive, diagnostic, and restorative dental treatment is safe throughout pregnancy and is effective in improving and maintaining oral health.

As a mother of a young child and pediatric dentist, I believe oral health knowledge among pregnant women is the key to securing the oral health of both women at childbearing age and their young children. In 2014, I was a pediatric dental resident at The Mount Sinai Hospital ; I was also pregnant. I had begun a prenatal oral health education program with prenatal coordinators in East Harlem and the Bronx that integrated oral health education and care coordination into CenteringPregnancy, their prenatal group oral health education model. Before I joined Mount Sinai in 2014, I was involved in the publication of the national oral health guidelines for pregnant women as a dental officer at the Department of Health and Human Services. Three years after this publication, I found that the majority of clinicians, both physicians and dentists, were not aware of these guidelines. Most of my pregnant friends in prenatal groups were told to go to the dentist after delivery, unless they had a dental emergency. I was surprised by the gap between science and practice and decided to investigate the root causes. Three levels of issues generated this gap: provider training, patient education, and practice coordination.

Bridging the Gap to Improve Prenatal Dental Care

First, dental providers, primary care providers, and administrative staff need to be trained based on the most updated guidelines to advance the oral health of expecting mothers and their babies. Pregnancy should not be a reason to avoid necessary dental care, but rather it needs to be seen as a teachable moment, empowering mothers to secure their oral health as well as their baby’s healthy smile. With the current national guidelines and published best practices, we can achieve this.

Secondly, we need to acknowledge that mothers, not the pediatric dentist, are often the primary care providers. They decide what to put in the bottle, which snacks to give, and how often to brush their child’s teeth. Because of this, pregnant women and mothers should be educated on the relationship between mother’s oral health and baby’s oral health and be encouraged to receive necessary dental care, and practice home oral hygiene activities along with a low-sugar diet.

Finally, we need to build a system that is meaningful and sensible to pregnant women and connect them to oral health care. Even if care providers know the importance of oral health and are willing to provide appropriate and necessary dental services and referrals, and even if pregnant women value oral health for themselves and their babies, low-income pregnant women may not be able to access dental services without system-level support. New York is one of the states that provides comprehensive dental care for pregnant women enrolled in Medicaid. However, how many of these low-income pregnant women actually know about this coverage? How many know how to find dental facilities who accept their insurance during pregnancy? These are the questions we need to consider. Coverage is important, but patients may need help in the interpretation and utilization of such coverage.

How COVID-19 Has Impacted Dental Care

Currently, we have a new challenge – dental care during and after the COVID-19 crisis. At the beginning of this outbreak, the New York Times published, “The Workers Who Face the Greatest Coronavirus Risk.” Dentists and dental hygienists were at the far-right corner of the graph were depicting that those in the profession have the most frequent exposure to COVID-19 and the closest proximity to others during their workdays. As dental settings have unique challenges that require specific infection control strategies, CDC published “Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response” to resume non-emergency dental care, which was on hold during the initial outbreak of COVID-19 by state order. It recommends balancing the need to provide necessary services while minimizing risk to patients and dental health care personnel.

Mount Sinai dental clinics have been serving patients with emergency dental cases during the pandemic, and we are in the process of providing routine dental care.

Although we face many challenges, this can be a time of opportunity as well. Dentistry has centered on a “drill-fill-bill” model, where definitive treatments are incentivized. However, as dentists work to minimize aerosol exposure while preventing oral health diseases, dental procedures that focus on disease management and prevention are on the spot. These procedures include silver diamine fluoride application to arrest dental caries and indirect pulp cap with Hall technique crowns—which may not require high-speed dental drills. There are also many efforts within the Mount Sinai Health System to integrate oral health into its existing primary care and prenatal care strategies.

Since 2019, the CenteringPregnancy programs at The Mount Sinai Hospital and the Mount Sinai Adolescent Health Center have embraced an interactive oral health education model where pregnant women are connected to Mount Sinai dental facilities if they do not have a dental provider. Mount Sinai OBGYN providers, pediatricians, and prenatal care nurses plan to integrate oral health education and care navigation into their existing care models. While we continue to provide our patients with excellent, up-to-date dental care, we are committed to focusing on these upstream approaches where the new norm for children’s oral health becomes no caries. Furthermore, this new norm will include the systems of care that value health as well as health care.

Hyewon Lee, DMD, MPH is a former U.S. Public Health Service officer at the Department of Health and Human Services, a member of the Blavatnik Family Women’s Health Research Institute and an Assistant Clinical Professor at the Department of Dentistry at The Mount Sinai Hospital. Her goal is to integrate oral health into primary and prenatal care to advance the oral health of mothers and young children.

I Have A Cavity. Is It Safe to See My Dentist?

May 4, 2020 | COVID-19, Dental and Oral Health, Health Hub, Your Health

Although many are under stay at home measures due to the novel coronavirus pandemic, there are still some everyday issues that cannot be avoided—like dental pain. But, can you see a dentist during this time? John L. Pfail, DDS, Chief of the Department of Dentistry at the Icahn School of Medicine at Mount Sinai, explains which procedures can be addressed and which will have to wait.

Are dental procedures still being done in the office?

Currently, the American Dental Association (ADA) and the New York State Dental Society will only allow emergency procedures. COVID-19 is spread through respiratory droplets from the nose and throat. Some dental procedures can create large amounts of these droplets in the air, for example through cleanings and fillings, which could spread the virus.

Out of an abundance of caution, elective surgery, routine restorations like fillings and all procedures involving the use of an ultrasonic scaler—which is used to clean teeth as well as remove stains and plaque—have been postponed. If patients are experiencing mild discomfort, they should contact their dentist who can evaluate and advise if they should wait until a possible reopening of offices in late May.

What types of procedures are considered an emergency?

Emergency procedures depend upon the level of pain or discomfort the patient is experiencing. However, these procedures would include the following:

Emergency treatment for pain and swelling

Depending on severity these would include medicated restorations—fillings, drainage of swellings and infections, as well as the removal of the inflamed nerve tissue of a tooth—pulpotomy

Extraction of severely mobile, fractured, or decayed teeth

Denture adjustments of sore spots

These spots should be attended to as they can lead to open wounds that may become further complicated, causing infection.

Refilling prescription medications

Please consult with your dentist. With the advent of telemedicine, you may not need to come in to the office to be seen.

I have an emergency dental procedure. Is the office safe?

Yes, it is very safe as dental offices follow strict protocols on infection control and asepsis–being free of any disease causing organisms, this includes viruses and bacteria.

Additionally, the ADA is currently completing new guidance for when dental offices reopen for all procedures. Social distancing will be maintained, patients will be screened with temperature checks, and visitors will be limited. These are just a few of the changes that will be noticed in the dental office.

Watch Mount Sinai's COVID-19 Facebook Live series

Tricks or Treats for Teeth: Tips for Happy and Healthy Halloween

Oct 23, 2015 | Dental and Oral Health, Health Tips, Your Health

Halloween is that sweet time of year when children enjoy dressing up in their favorite costume and go trick-or-treating collecting candy and treats from their friends and neighbors. The holiday of pumpkins and scary ghosts also marks the beginning of a holiday season ahead that brings more treats and desserts like Christmas cookies and fruitcakes.

Parents can take steps to keep their children’s teeth healthy during this time, explains Laurie Hyacinthe, DMD, Director, Pediatric Dental Medicine Residency at the Mount Sinai Health System and Icahn School of Medicine at Mount Sinai. (more…)