Is the Sore in My Mouth an Oral Lesion?

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

Can Exercise Improve My Mental Health?

Exercise is great for your body—and your mind. When you engage in any physical activity, your brain releases “feel-good” chemicals (dopamine, serotonin, oxytocin, and endorphins) that boost your mood. In addition, forming long-term exercise habits can reduce your risk for neurological diseases, such as dementia.

Anna Hickner, PsyD

In this Q&A, Anna Hickner, PsyD, Supervising Psychologist and Assistant Professor, Icahn School of Medicine at Mount Sinai, and a trained yoga and meditation instructor, explains how increasing your activity can lead to a healthier, happier mind.

How does not getting enough exercise affect my mental health?

Leading a sedentary lifestyle can have many adverse effects on your physical, emotional, and mental well-being. Additionally, if you are not sleeping well and don’t move much during the day, this can have a compounding effect of worsening sleep and mood without inducing the benefits of the “feel-good” chemicals that exercise offers. As a result, you may find it harder to function or interact effectively with others.

Quick tips:

  • Creating an exercise routine can help you feel grounded and regulate stress
  • Achieving exercise goals boosts the brain’s reward center and builds self-esteem
  • Even small activities, such as walking during your lunch break, can make a big difference

How does exercise affect my mood?

There has been a lot written on the association between exercise and mental health, including how exercise induces the production of our natural “feel-good” chemicals. But exercise has additional benefits—for example, certain activities, like sports, are great outlets for socializing, and exercise, in moderation and well before bedtime, in general helps regulate sleep. Becoming more active may also motivate you to eat well in order to fuel your body, which can have a positive impact on mood. Some studies indicate people might demonstrate better memory and attention after a workout, which is most noticeable when exercise is consistent and the effects are studied over a longer period.

How can exercise improve my mental health in the long term?

Turning exercise into a routine that helps you achieve goals, such as losing weight or becoming fitter, can be gratifying and help build self-esteem, as long as you have reasonable expectations and stick to your goals. When you complete an activity, such as a race, or compete in a team sport, there can be an extra boost in your neurochemical rewards center, which offers a feedback loop for motivation to continue to engage in the activity. When you do this in moderation, exercise transforms into a habit that provides physical, emotional, and psychological benefits. It is important to find an activity that is enjoyable so you can easily stick with it. Another long-term benefit of exercise is that it is shown to reduce the risk of neurodegenerative diseases, such as Alzheimer’s disease and dementia, due to the stimulation of blood flow in the brain.

How much exercise do I need to get these benefits, and at what intensity?

It is usually better to be active than not. That said, some studies show walking is just as beneficial as running, whereas others find intensity matters. Regardless, a minimum of 150 minutes of moderate to vigorous movement each week is often cited as ideal, as well as the importance of elevating your heart rate.

While intensity can be beneficial, too much may stress your body or lead to injury, so consistency and moderation are important. Having a routine can keep you grounded and helps regulate stress. If intense exercise feels daunting, find an activity you enjoy that gets you moving, and that you can do regularly. You can also combine exercises, such as swimming, dancing, walking, or kick-boxing classes, mixing exercises that are leisurely on some days with more intense ones on others.

What are some simple ways to increase my activity to improve my mood?

Small activities can add up. If you have a desk job, get up and stretch or go for a mini walk every hour or so. Take the stairs instead of the elevator, bike instead of taking the bus or driving, park far away so you have to walk further. These are all examples of small, daily changes that can bring big benefits. You can also try fitness trends, such as “exercise snacks,” in which you do a vigorous activity for as little as two minutes. Whether you lack the time or a place to work out, finding small ways to increase exercise can improve both your health and mental well-being. Exercising outside on a regular basis can also improve your mood.

How does my gut health contribute to my mental well-being?

Gut health is also important for mental health—some research indicates that microbiome and inflammation can affect mood. Consuming food that offers adequate macronutrients (carbs, fats, proteins, water, and fiber) as well as micronutrients (vitamins and minerals) is imperative to feeling energized, meeting the day’s demands, and staying motivated. Increase your consumption of whole foods, limit processed foods, caffeine, alcohol, and sugar, and consult a dietician if you feel you need help.

Celebrating Asian/Pacific American Heritage Month: Why Diversity Matters in Health Care

Alex Ky-Miyasaka, MD, Professor of Surgery at The Mount Sinai Hospital, seeing patients at the Chinatown clinic in Manhattan.

Asian American, Native Hawaiian, and Pacific Islander Heritage Month, also known as Asian/Pacific American Heritage Month, is observed in May in the United States. It celebrates the culture and historical contributions of Asian Americans and Pacific Islanders (AAPI) to the country, as the month marks the arrival of the first Japanese immigrants in 1843 and commemorates the completion of the transcontinental railroad in 1869, whose tracks were largely laid by Chinese immigrants.

AAPI people in this country are extremely diverse and represent a wide range of races and ethnicities, socioeconomic and educational backgrounds, and ability to access health care. In New York City, this group encompasses more than 1 million people from more than 30 different ethnicities, speaking more than 50 different languages. Providing effective health care to such a varied group can be challenging, but it is important for health care institutions and providers to keep diversity at top of mind as they connect with patients.

“It is our responsibility to ensure we’re evaluating how we can best provide care to all of our patients,” says Amanda Rhee, MD, Professor of Anesthesiology, Perioperative and Pain Medicine, and Inaugural Director of the Center for Asian Equity and Professional Development at Mount Sinai. “There’s a growing body of evidence that people receive different care based on gender, disability, and language spoken.” When it comes to conversations about the differences in care that patients receive, AAPI communities are often left out—for example, some may not know that 24 percent of AAPI individuals in New York City live in poverty, and as a result might be unable to access appropriate care, says Dr. Rhee, citing a report on poverty in New York City.

“Specifically for Asian Americans and Pacific Islanders, from our patient satisfaction surveys, we know that our patients are telling us that we have room to improve, and how we can deliver care for them better,” says Dr. Rhee. “I say this in the overarching context of approaching all our patients with an open mind, so that we can understand anyone’s background better, and do our best to meet people where they are.”

In this Q&A, Dr. Rhee explains the importance of culturally sensitive and compassionate care, and how Mount Sinai is working to improve that competence.

Why is it important to consider cultural needs of a patient when providing care? Might there be consequences for failing to do so?

Communication between our clinical teams and patients is so critical, not only for the medical side of the care, but also compassion and empathy. Cultural and language barriers could present a challenge for some of our AAPI patients. There could be certain sorts of traditions that may seem different to our clinical providers or teams, which could appear obstructive.

For example, in some Asian cultures, there’s a belief that drinking warm fluids can help people who are feeling ill, and they or their family members might want to bring in warm soups and drinks for the patient. But if the patient is in a situation where they should not eat or drink anything, such as before a procedure, these well-intentioned family members may not understand that, and conflicts and challenges in communication can lead to confusion and dissatisfaction. It would be better if our clinical teams, patients, and family members could better align expectations and help understand each other better.

What does it take for a health system or organization to provide culturally sensitive and inclusive care?

Normalizing things or traditions that seem different, and highlighting the diversity of the people whom we take care of, is an important way to do that. Having really engaging educational sessions or tabling events at an institution are effective ways to help providers understand how these different traditions are meaningful in these different cultures—and understanding these differences can have an impact on whether a patient gets better or not. And I think that better understanding also leads to more empathy and improved connections between provider and patient.

What work might be needed to improve AAPI communities’ care experience?

An important piece boils down to building trust. Patients and their families want to know they are being listened to. Our clinical teams have to be open-minded to cultural differences and communicate to patients and their families that they’re there to help and receive feedback. Once that trust is established, when we need to explain how certain rituals or traditions might run counter to care, that advice might be better received by the patients and family members.

What has Mount Sinai been doing toward providing culturally sensitive care for AAPI communities?

In recent months and years, Mount Sinai Health System has dedicated resources and launched initiatives toward improving competence and cultural sensitivity for its AAPI patients. Here’s a snapshot of what we have done:

  • Asian Health Services
    Initially launched at Mount Sinai Beth Israel to serve the population in Chinatown and lower Manhattan, the team providing personalized care for AAPI communities has been expanded systemwide, across all eight hospitals. Asian Health Services includes multilingual Asian providers in different medical specialties, medical interpreters, and culturally competent staff to help patients navigate health care. The website has been updated to include information about specialists, their locations, and languages spoken.
  • Guidance on translation services
    Mount Sinai has been working with its Language and Communication Access Services to provide more culturally competent translation and interpretation services for AAPI patients, including guidance on cultural differences and cues. The service is provided free of charge and can be arranged through clinical teams to be made available during care.
  • Cultural cue handouts for providers
    Cultural cue handouts that were originally available for providers under Asian Health Services are in the process of being rolled out systemwide. These resources include information about differences between traditional remedies and Western health care and various cultural norms that might affect decision-making.
  • Educational events
    For Asian/Pacific American Heritage Month, there is a series of events to celebrate and raise awareness of AAPI culture, held across all eight hospital campuses. These seek to deploy education in a meaningful way, by highlighting similarities and differences across cultures. The Center for Asian Equity and Professional Development also hosts webinars and events throughout the year.
  • Curriculum for cultural sensitivity training
    In its early stages, the Center for Asian Equity and Professional Development is developing a program to train providers who wish to be more informed about caring for AAPI patients. The goal is to eventually improve health equity among AAPI communities.
  • Partnerships with community organizations
    Mount Sinai is working with community partners, such as the Chinatown YMCA, to provide health information and education. These include preventive care, tips on healthy living, and resources to access care at Mount Sinai.

“I hope that what we can build is heightened awareness about the specific needs of our AAPI patients,” says Dr. Rhee. “I would hope these efforts will create a way of thinking for all of our care providers to identify any kind of disparity that a patient may be experiencing, so that we can address challenges in this space for all of our patients.”

Amanda Rhee, MD, Professor of Anesthesiology, Perioperative and Pain Medicine, and Inaugural Director of the Dean’s Center for Asian Equity and Professional Development at Mount Sinai

Who are the Asian Americans/Pacific Islanders in New York City?

Asian American/Pacific Islander (AAPI) is a broad term, but it is not a monolithic description of their experiences and situations. In New York City, the largest and one of the most diverse cities in the country, understanding the diverse socioeconomic and health access conditions of AAPI people is crucial to population health. Pulling from two city agency reports, here’s a snapshot of Americans and immigrants of Asian and Pacific Islander descent in New York City.

>1 million

AAPI people in NYC; 14 percent of the city’s 8.5 million population.

>30 different ethnicities

A group speaking more than 50 different languages.

13 percent

of immigrants of Asian/Pacific Islander descent are undocumented, compared to 16 percent of NYC immigrants overall.

46 percent

of AAPI households report having limited English proficiency, compared to NYC’s overall average of 23 percent. For Asian/Pacific Islander immigrants specifically, that number is 59 percent.

40 percent

of AAPI individuals in NYC on average have income below 200 percent of the federal poverty level, compared to the city’s average of 39 percent. However, subgroup variances are large, with lows including Filipino (20 percent) and Japanese (23 percent) individuals, and highs including Bangladeshi (58 percent) and Pakistani (53 percent) individuals.

AAPI people in NYC by the numbers

Bird Flu: What You Need to Know Now

You may have seen recent news reports about the bird flu virus and the possibility that this virus could affect humans and our food supply, notably with milk from cows. Government health officials say there is no reason for concern, and experts at Mount Sinai agree.

“People should be aware, monitor the situation, and follow the guidelines of health authorities,” says Bernard Camins, MD, MSc, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System.

The issue arose when a bird flu virus was detected in dairy cows in eight states. The concern is that this virus could pass to consumers who drink milk from infected cows.

The Food and Drug Administration (FDA) says tests have shown the commercial milk supply is safe. The FDA says the pasteurization process heats milk up to a high enough temperature to kill harmful germs, and milk from sick cows is diverted and not sold. Even if virus is detected in raw milk, pasteurization eliminates pathogens to a level that does not pose a risk to consumer health, according to Dr. Camins and the FDA. Recent testing by the FDA has shown that pasteurization is effective at inactivating the bird flu virus, and this testing did not detect any live, infectious virus.

Although bird flu viruses do not normally infect humans, sporadic human infections have occurred, according to the U.S. Centers for Disease Control and Prevention (CDC).

Click here for the latest updates from the CDC and click here for the latest from the FDA

On Monday, April 1, the CDC announced that one person in Texas had tested positive for a strain of the bird flu virus referred to as H5N1. The person was exposed to dairy cattle that were presumed to be infected.

The patient reported eye redness and is recovering. The patient was told to isolate and was treated with an antiviral drug for flu, according to the CDC. This is the second person reported to have tested positive for bird flu in the United States. A previous human case occurred in 2022 in Colorado.

The CDC says the risk these viruses pose to the public remains low. It recommends that people should avoid being near sick or dead animals. Also, people should not prepare or eat uncooked or undercooked food or related uncooked food products, such as unpasteurized (raw) milk or cheeses, according to the CDC. Dr. Camins says people should normally avoid eating avoid raw milk and raw cheeses because of the potential for contracting other infections and not just bird flu.

According to the New York State Department of Health, bird flu is caused by a group of viruses that occur naturally in wild birds. Animal health officials are watching closely for bird flu in poultry and wild birds in the United States. Early detection of the virus in poultry and wild birds is important to prevent the spread of bird flu, especially into commercial poultry flocks, the Department says.

Seasonal Allergies in Kids and How to Manage Them

Most everyone enjoys the warmer days of spring and the budding flowers and trees all around. But this also means that the pollen count is high and allergy season is back too. For parents, it’s always nice to send the kids outside to play. But when kids experience allergies, it can be frustrating. The sneezing, runny nose, itchy watery eyes, and nasal congestion can seem endless.

Scott Sicherer, MD

Managing spring allergies doesn’t need to be so difficult, and if you understand what triggers your child’s allergies, you can help them feel better. The key is to try to limit your child’s exposure to pollen from trees, flowers, grasses, weeds, and mold.

Here are the top ten ways to help give you child—and you—relief from seasonal allergies from a a leading pediatric allergist, Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute and Chief of the Division of Allergy and Immunology in the Department of Pediatrics.

  • Plan ahead and follow the weather and pollen counts. When the counts are elevated or when it is windy, plan for indoor activities and go outdoors when the counts go down and wind lessens. If traveling, look at the pollen count in that area and plan accordingly.
  • Keep the windows closed at home and in the car and use the air conditioner instead. Make sure to clean the filters often to keep the pollen away.
  • After being outdoors, change clothes and rinse off, and shower to wash away the pollen that may be on your child’s body.
  • Pets can bring pollen inside the home, so wipe them down with a damp cloth and bathe them regularly.
  • Wash your child’s hands after playing outdoors so pollen particles don’t go on the face or in the eyes. If your child plays outdoors, have them avoid wet moist areas where mold can grow and tall areas of grass. Keep your child indoors when the grass is mowed.
  • Use nasal rinses to eliminate the irritants.
  • Drink lots of fluids and stay well hydrated.
  • Wear a hat and sunglasses to avoid pollen going in the eyes when outdoors.
  • You can try to lessen your child’s symptoms by giving them over-the-counter medications like antihistamines, decongestants, nasal steroids, and eye drops.
  • Notify your child’s school about their allergies and symptoms and be sure an allergy treatment plan is in place.

If you have questions or if you are concerned that your child may have allergies, contact your child’s pediatrician and/or a pediatric allergy specialist.

What Do I Need to Know About the Rise in Measles?

You may have seen recent news reports about a rise in measles cases. While there have been a small number of cases, the risk of a widespread outbreak is low due to high vaccination rates in the United States. However, measles can be a concern for people who are unvaccinated, especially children traveling abroad to countries where immunization is low.

According to the Centers for Disease Control and Prevention (CDC), measles cases in the United States originate from unvaccinated international travelers. If you plan to travel internationally, you should ensure you and your loved ones are protected against measles before departure, no matter where you are going.

Kristin Oliver, MD, MHS

In this Q&A, Kristin Oliver, MD, MHS, Associate Professor, Pediatrics, Environmental Medicine and Public Health, and Global Health, Icahn School of Medicine at Mount Sinai, discusses the recent uptick in measles and explains new federal guidelines allowing children to get vaccinated as early as six months if traveling abroad.

Why are measles cases higher than usual?

There are several reasons. First, unvaccinated people who are traveling to and from countries with low immunization are likely catching measles and bringing it to the United States. Second, rates of measles vaccination have declined since the COVD-19 pandemic. Some parents were unable to get their children properly vaccinated during the pandemic or lack access to vaccines; others are hesitant about getting kids vaccinated. Some people may be unaware that their child needs to get a second dose of the vaccine to be fully protected.

What are the symptoms?

The first stages of measles look like many childhood illness: A cough, runny nose, high fever, and red eyes. After a few days, patients develop a red rash on their face that spreads to the rest of the body—the telltale sign of measles.

Who is most at risk?

Most people in the United States received the standard two-dose measles vaccines as children and are immune. If an unvaccinated person comes in contact with an infected person, their chances of catching measles are extremely high. According to the CDC, children less than five years old and adults older than 20 (especially those who are immunocompromised or pregnant) are more likely to experience complications. These include diarrhea, ear infections, pneumonia, and swelling in the brain. About one in five unvaccinated people in the U.S. who get measles is hospitalized.

When can I get my child vaccinated?

In general, the measles vaccine is a two-dose series. Children get the first dose between 12 and 15 months, and the second dose between four and six years old. However, the CDC recently changed its guidelines for parents with children who plan to travel internationally.

Under these guidelines, the recommendation is for kids to get early vaccines before they travel. Babies who are six to 11 months old are eligible for their first dose before travel. Children over 12 months old who have already received their first dose should get a second dose before travel. For example, if you plan to travel abroad with a two-year-old who received their first dose at age one, you should get them a second dose before you leave. Check with your pediatrician before you travel to learn about when your child should be vaccinated.

How can I get my child vaccinated?

Schedule an appointment with your child’s pediatrician. If you plan to travel abroad, let your pediatrician know so they can schedule the vaccines appropriately. If you are unsure about whether your child is up-to-date on vaccines, speak with their pediatrician. If you do not have a regular pediatrician, low- or no-cost immunizations are available through the New York City Department of Health and Mental Hygiene.

How can I protect my baby if they are too young to be vaccinated?

The best way to protect a baby too young to be vaccinated is to make sure you, your friends, and family are up to date on vaccines. If your baby is unvaccinated and you are traveling in a region where vaccination rates are high, the risk of exposure is low. If you are traveling to a country with low immunization rates, the risk is higher. Keep in mind that even in countries with high immunization, there may be communities within those countries where immunization is low. It’s important to research the location and communities you plan to visit to fully understand the risk.

I don’t know my vaccine history. How can I know if I’ve been vaccinated for measles?

You can get a blood test from your doctor to see if you’re immune. You may also be able to check the immunization records of the city where you grew up.

 

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