'Obstruction of salivary duct at the palate of the mouth'... mild dysplasia grade 1

[davidst01]

I noticed a mouth ulcer in my upper palate (upper roof of mouth) in sept last year when I was in bkk. The dentist gave me some steroid cream and it basically went away and came back twice a month for many months.

There are are 2 photos attached. When it appears on my upper palate it feels like a pimple when I touch it with my tongue. The dr's refer to this as a 'vesicle' that has fluid inside.

When it goes away it looks like a lesion:

I returned to bkk in december and saw an ENT guy at Bumrungrad who was hopeless

In early Jan it returned again and I went to a dental pathologist in Isaan who recommended I get a biopsy from an ENT at the local hospital. The dr did this and the biopsy mentioned that I have 'mild dysplasia grade 1'. The diagnosis was that it was Mucosa, soft palate

3 weeks later it returned to my upper roof of mouth and I went to another international hospital where there was a respected dental pathologist who is also a professor of Dentistry at one of the government uni's in bkk

He said that my problem could be any one of the following 4 things:

1. Recurrent Apthous ulcer

2. Infection- viral or bacterial. If it was viral ie HPV the surface of the lesion would be irregular and mine was smooth as indicated in the 2nd photo. If bacterial it could be hand, foot mouth disease or Hypergina

3. Other auto immune disease

4. Superficial mucocele- benign salivary gland disease. Sometimes the minor salivary gland over the mucosa gets obstructed and saliva gets inside. The dental pathologist said that its is 'reactive' and that he has only ever seen it in the lower mouth and that it can happen in the upper palate but it is rare.

I'm going to get another biopsy to check the mild dysplasia diagnosis. I think its prudent for me to obtain an independent second opinion as the current gold standard is the finding of epithelial dysplasia on a tissue biopsy.

Have you ever had this in your mouth before? Did you ever ascertain what was causing this problem.

Ive read another source on the www that stated ''Oral potentially malignant lesions are characterised most frequently by the appearance of white patches (Leukoplakia) on the oral mucosa. Overall malignant progression in these lesions is only in the order of 5% and there are no currently accepted markers to distinguish those that may progress from those that may not'.

I unfortunately read an article on the Uk daily mail newspaper about a women who ignored a mouth ulcer for many months that soon turned fatal.

I suppose that Im worried that my mouth ulcers keep coming back but the dr said the fact that they are recurrent indicates that it cant be cancerous / fatal. Its the ones that dont go away in the mouth for many weeks or months that are the dangerous ones.

I simply want to find the reason why this is coming back now for 7 months now. Its duly noted that last month I also had 2 red ulcers on the left side of my mouth and a few on the right side in addition to the vesicle indicated in the first photo. All went away after a week or so.

Please make comments if you can assist. I want to try and send this thread to experts in the States and Europe to get further opinions. The diagnosis by the dr's in thailand has been good but nothing has been mentioned about the cause and indeed the treatment.

[thepool]

Believe you have two options

1. Attended the Chulalongkorn University Dental Hospital (you may need a Thai person to assist navigating the bureaucracy )

OR

2. Seek assistance at home.

The pics are not of great assistance owing to the low level of definition however if know to a dental practitioner at home, he she, may be prepared to offer an opinion based on the pics and copies of any reports which are held.

[Sheryl]

He has already seen a dental pathologist at a govt university hospital (possibly Chula).

OP:

"Mucosa, soft palate" is not a dioagnosis. That is simply where the sample came from. Grade 1 dysplasia was the diagnosis on pathology.

I don't understand your statement "the current gold standard is the finding of epithelial dysplasia". Gold standard for what? Your biopsy found mild dysplasia. If you want, you can ask for another patghologiost to read the slide. But together with the fact that the lesion appears and disappears it is pretty evident you do not have cancer at this time nor a very advanced pre-cancerous lesion.

Apthous ulcers would indeed fit with what you describe, including the sores that you had on the sides of your mouth. The cause of apthous ulcers is often unknown, but it can also be due to deficiencies of certain nutrients (iron, various B vitamins, folic acid), stress, and some medications. They can also sometimes be due to other underlying systemic diseases.

If it were me, I would start by taking a high potency B complex supplement or multivitamin/mineral supplement. If that doesn't do the trick, then I'd have a thorough physical check-up to exclude an underlying disease as cause. Might be wise to get your B12 levels checked when you do, especially if you are over 50. (oral B12 is not always well absorbed), and tyo include a VDRL (blood test for syphilis).