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Mouth Diseases

Skin in the mouth

02/26/2009

Question:

What would cause the skin in my mouth to shed daily. It is very anoying. It take a couple of hours for it to compleatly shed. Sometimes it will shed twice a day, but usually it is once a day.

Answer:

The oral cavity is lined by epithelium, referred to as oral epithelium or oral mucosa. The oral lining is designed to act as a protective barrier against microbial challenges, to protect from abrasion, and to be flexible enough to not tear on a regular basis. In other words, it must be able to withstand chewing (mastication) and swallowing, act in conjunction with saliva to keep from sticking with the teeth, and provide a minor barrier to both chemical and thermal irritation.

This tissue replenishes itself on a regular basis and undergoes what is known as terminal differentiation. Similar to a conveyor belt, the tissue changes its shape and composition as it moves from the connective tissue base (basal lamina) up to the oral cavity proper.

When it reaches the oral cavity it “sloughs off” kind of like flaking skin does (dandruff). When this occurs a new outer layer is in place and the process continues. This sloughing helps remove adherent bacteria and yeasts, and occurs approximately every 25 days for the cheek tissue and every 40-50 days for the gingiva or gum tissue.

Now, certain things can alter this normal process, including chemical or thermal injury (i.e., alcohol or mouthwashes or toothpastes can cause premature sloughing).

Thermal injury like a “pizza burn” from the hot sauce under the cheese can cause a second-degree burn to the oral mucosa and this can result in premature sloughing. Hot sauces and/or smoke can have a similar effect, but may be more site specific.

Cytotoxic chemotherapies for cancer therapy can stop the terminal differentiating mechanisms and with no turn over, the patient develops what is referred to as “oral mucositis”.

In your case I don’t know what is actually happening; many reports in the literature describe oral epithelial shedding for unknown reasons. Most cases point to the fact that there is some form of generalized irritant that is precipitating this to occur.

Finally, there are a set of epithelial diseases know as vesiculo bullous diseases that ultimately result in severe blistering and mucosal disruption. These diseases are related to specific defects in anchoring proteins between the epithelial cells and normal cell-to-cell adhesion is altered and thus results in loss of attachment of the tissue.

I would strongly recommend that you have this problem evaluated, either by your primary care physician or dentist. This will alleviate any needless concerns and may help resolve the condition.

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Response by:

Richard J Jurevic, DDS, PhD Richard J Jurevic, DDS, PhD
Formerly, Assistant Professor of Biological Sciences
School of Dental Medicine
Case Western Reserve University