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Mouth Diseases

Swelling and Pain on Roof of Mouth

11/09/2010

Question:

One day last week I tired to eat and as I chewed the food and tried to swallow it I got awful pains in the roof of my mouth and towards my throat, but not so far back as reaching my tonsils. Its hard to describe, but it felt like the insides were freezing up, or a similar feeling to when you get cramp in, or pull a muscle. It made it impossible to swallow, and the pain remained and got worse over the next few days to the point where I was in agony.

The day after it started I noticed I could feel bumps where the pain was - one on either side of the palate and one in the middle too, altough it was worse on the right side. Gradually the pain on the left and in the center eased slightly, but got worse on the right, and I ended up having toothache on my right side and earache.

I went to see a doctor who said she didnt have a clue what it could be, that she could see nothing abnormal and to see a dentist. The dentist confirmed that I did have swellings and slight redness, especially on the right said, but could not diagnose anything, and did not say anything about it being my teeth (the doctor thought maybe it was my wisdom tooth causing trouble. I did have pain from my top right wisdom tooth several years ago, but it was quite different to this).

I have looked in my mouth and now the swollen bumps have red speckles over them, and the bigger bump on the right is now developing a red border. A few days ago I had what looked like small ulcers on the underside of my tongue, with one larger one that was red in the middle, but I had no pain whatsoever from these, and they disappeared in two days.

What could this be? I am not a smoker, I did not eat anything spicy or hot enough to burn my mouth. I don`t feel ill in the slightest, and have no temperautre, although I did had quite a long cold several weeks ago. The day before it started I had eaten very little and ended the night with friends and drank a few vodkas with lemonade.

Answer:

This is difficult to come up with a definitive diagnosis without physically examining you and taking a detailed history. Since both a Physician and Dentist have seen you and they were perplexed by the presentation, I am at a greater disadvantage.

With that said, I would not be surprised if what is occurring is a most likely a herpes infection. The pain on the palate and posterior pharynx may have been a prodromal response. Primary HSV infection in the adult can occur and in many cases present as a pharyngotonsillar set of lesions very similar to what you have described.

I am not sure what you consider a “Bump” and the size and morphology of such. HSV lesions generally present as vesicles that rupture and thus result in small ulcerations. These can be extremely painful and the ulcerations can come together to form larger ulcerations. The palate (soft palate and hard palate) are frequent sites for lesions to develop. One thing that is concerning is the amount of pain you experienced, but that could be related to nerve beds involved and severity of infection. If it is HSV, the lesions and symptoms generally resolve in 10-14 days.

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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