Age 46, Male

More than seven months ago I had two or three painful canker sores -- seemingly caused by cheap coffee. I get them sometimes, on my tongue or in my mouth, and of course they always disappear. The one that didn't disappear is on my right retromolar pad, at the exact center of where the mandibles always mash together. (And it seems to get grazed by those two very back teeth.) The sore was throbbing and painful for a good week or so, and I figured that was because of its location, always being rubbed on when chewing or just keeping my mouth shut. I also have bruxism/TMJ issues on that side and have for many years.

After about a week the ulcer stopped hurting and did shrink...but even after seven months hasn't vanished, though I know there was healing. The part where the ulcer stops hurting and changes for the better happened on schedule, but then that stopped. For several months it's just been a shriveled tiny white flapping-bump version of how it began. Its crater seems mostly "filled." I can move it around, and it will hurt a little if I press on it -- but otherwise it's not noticeable. If I left it alone and never touched it, it may shrink further but I wonder if it's mostly just scarring or a traumatic ulcer that can't ever vanish because of the frictional area where it is. It's always being impacted when I eat or have my mouth closed, after all. And I didn't measure the thing when it was new and open and throbbing, but I'd say it's now about the size of a very tiny Nerds candy, at the most. Certainly smaller, just still there.

I actually had three dentist visits for something else, several weeks after it first began to heal, and the visits included X-rays. I didn't mention it because I still just figured back then that it was slow to vanish. She must have seen it but didn't mention it either. But that was five months ago and I didn't think any of it would still be there. I have no other symptoms or indications of a problem. But when something like this sticks around and you Google it, you basically get a cancer diagnosis. Of course I can see my dentist again and ask, but before getting in I wondered if the folks here had any thoughts.

Hello Greg124,

Welcome to the OCF Forums,

My two cents, take them with a large grain of salt and seek professional medical opinion:

If you have any kind of even painless white or red patch in your oral cavity that has not gone away, and that cannot with absolute certainty be explained as something benign, I would be seeking a biopsy as soon as you can, or an explanation that fully satisfies your concerns by a medical/dental doctor on what the definite cause of that unhealed lesion is. (and I'd still be seeking a biopsy if I were you, even if you have to insist on it)

I would call your dentist immediately and request an urgent appointment to see about an oral surgery consult for biopsy, or possibly an ENT surgical consult for biopsy if it is too far back for an oral surgeon to be able to biopsy. They may see what is going on and it may have an obvious mechanical/dental cause of friction that you mentioned. But I'd be asking those questions very pointedly. Can you with absolute certainty say a biopsy is not at all indicated?

This does not mean it is necessarily cancer, but you want to find that out as soon as you can, to catch it early. Or if it is potentially precancerous condition. Or if it is absolutely benign. Biopsy is THE way to know which.

I had a "potentially precancerous condition", leukoplakia (white patch) on my tongue, that when biopsied came back showing tissue with moderate epithelial dysplasia (abnormal but not cancerous cells in the oral epithelium tissue layers.)

That triggered being booted to another oral surgeon who specialized in cancer and monitoring and treating dysplastic lesions for annual follow ups.

I was told the lesion I had, presented a roughly 1 in 10 chance of the tissue and surrounding area spawning cancer at some point in my life.

About 4 years later, a tiny little pimple like protrusion errupted in that same area, that did not go away and was just ever so mildly painful (not like my canker sores which can be brutal).

That thing was biopsied and came back microinvasive oral squamous cell carcinoma. The pimple thing was probably the size of a nerd candy piece.

It was caught nice and early, just barely past being carcinoma in-situ. So we have high hopes the very partial glossectomy I underwent may be curative.

Still more dysplasia was found during the partial glossectomy.

So the whole field cancerization phenomenon means apart from any possible missed cancer (very unlikely) that was already there, new cancer tumors may yet arrive out of the potentially precancerous tissues that are known to still be there.

Best case scenario if you get biopsied it comes back confirming it is some benign condition, no need to worry at all about it.

Middle scenario would be well the tissue isn't completely normal, (dysplasia), and you are at a heightened risk of developing cancer. Then you'd watch it like a hawk and any time it changed for the worse be looking for another biopsy and immediate work up.

Not great possibly scenario would be it is already cancer, but you want to know, and you want to know that as soon as you can to get your treatment plan figured out.

Another thing to ask about, (and these forums really should just be a basis for you to figure out questions to ask your doctors/dentists, you'll want it straight from the expert, not that they can be absolutely relied on to make the right calls, but they should be able to explain to you the why's and wherefore's and if you come prepped with intelligent questions you can hopefully advocate well for yourself, and don't be shy about seeking a second opinion if they can't answer your questions and concerns to your satisfaction) is the theory (I think) that even constant irritation from bad teeth fitment, sharp dental appliances, etc... that kind of chronic irritation itself can be a cancer trigger.

So even if a biopsy came back benign, if things changed over the years and slowly gets worse or something like that, it would still seem wise to me to once again see if a biopsy is indicated.

Best wishes as you move forward, hopefully just some dumb dental rub irritation that can be explained definitively and fixed quickly so all lesions heal. But if it can't be made to be healed from obvious dental causes in a couple/few weeks, I'd be pounding that door down for a biopsy.

Sincerely,

CQ