A. This is termed glossitis and a red, raw, painful tongue can occur. Often there is no obvious cause. Simple measures usually bring relief but if they do not, within a few days, see the doctor. The physician will check for underlying causes. A sore tongue may be a symptom of another disorder which needs treatment. Regular mouth rinses with warm, salty water every hour or two often bring relief. (One teaspoonful of common salt to a glass of warm water. Rinse and spit out.) Addition of a few drops of mild antiseptics and anaesthetics to the fluid sometimes may give added comfort.

Vitamin C, 1,000 mg 2-3 times a day, and the Vitamin B Complex (e.g., one high potency B complex, mineral tablet or capsule once or twice daily) has its adherents and may assist. See the doctor if these are not quickly successful. Many complaints such as food allergies, dental disorders, anaemias, nutritional disturbances, diabetes, etc., can cause the symptoms.

Q. The lips are an awfully important part of the body. Not only are they readily obvious to anyone who looks at your face but they may become awfully tender. They often become cracked, specially in cold, windy weather. How can people treat and prevent this?

A. It is common for the lips to crack and become tender at the

corners and discharge. Superimposed infection with bacteria and

fungi is common and this prolongs the discomfort.

Simple chapping of the lips is common in cold weather or if

exposed for a period to hot dry or cold winds.

Cleanse the corners of the lips regularly with warm water or a

weak antiseptic solution (such as pink-only Condy’s solution).

Repeat every few hours. Then apply a simple cream. Ordinary

toilet lanoline often helps.

If this is ineffective see the doctor. He may recommend cleansing with liquid paraffin then applying a steroid cream, particularly one containing anti-bacterial and anti-fungal additives, such as Kenacomb or Pimafucort cream.

Vitamin C, Vitamin B complex, and minerals often help. For simple chapping of the lips, either lanoline or any lanoline based lip-stick is good. It usually takes several days to heal. Avoid winds and excessive exposure to the elements. This is important to promote healing and prevent recurrences.

Q. Is it possible for cancer to develop on the lips?

A. Yes. Leukoplakia. As the name implies this is a whitening of the mucous lining of the lips or tongue. It is usually fairly apparent. This needs prompt medical attention. It is a precursor to cancer and there is no simple way of knowing when the cells are becoming cancerous. Never neglect this symptom. Any persisting sore on the lips may be an early cancer. Avoid lip sunburn.

Q. I believe that thrush can infect the mouth, specially in children. What are the symptoms and the treatment?

A. This is a white, patchy discolouration that commonly occurs on the tongue and inside the cheeks of babies and small children. It may occur anywhere in the oral cavity. Surrounding mucous membrane is often red and bleeding occurs if an attempt is made to remove the curd-like patches. It may be painful. It is caused by an organism called Candida albicans, which is present in about one third of normal mouths. It gets out of hand under certain circumstances, such as when receiving broad spectrum antibiotic therapy and in states of malnutrition. But it can also occur for no obvious reason. Very healthy, well cared for babies are often victims. Diagnosis is usually obvious. The old fashioned and hideous looking (but very effective) remedy of painting the inner part of the mouth with gentian violet has now passed. Placing a few drops of Natamycin (1%) suspension into the child’s mouth after each feed is generally successful (Pimafucin suspension). This is usually given by the doctor.

Q. What about ulcers around the lips and gums and on the tongue and inner parts of the cheeks? So many people seem to develop these horrid sores.

A. There are two fairly common types, aphthous ulcers and Vincent’s angina.

Apthous ulcers are shallow yellowish lesions that may occur on the tongue, inner part of the cheek, the lips and gums. They are usually very painful and are surrounded by a red margin. The lymph glands under the jaw usually swell and are tender. Sometimes a fever occurs.

The cause is unknown but nuts, chocolates, citrus and other fruits are often blamed and are avoided during treatment. Bland mouth washes are usually ordered (such as hot, salty water every few hours. Adding Ora-sed may assist). Vitamins are often

advised, such as Vitamin C 1,000 mg with each meal, and the Vitamin B Complex.

See the doctor, as these ulcers may persist for days and weeks making eating, drinking and the use of salty or spiced foods uncomfortable.

The doctor may prescribe lozenges containing hydrocortisone. One of these sucked two or three times daily (placed between the cheek and gum, well back in the oral cavity) can effect a cure in a short period of time (Corlan pellets). These must be used under medical supervision for they are potent preparations. They may be used at the first sign of recurrence.

The anti allergy powder sodium cromoglycate (Intal) applied locally often helps.

Medical hypnotherapy sometimes cures these with one session. This may indicate there is a psychosomatic basis for their occurrence.

Q. What about the other kind you mentioned, the Vincent’s angina?

A. Vincent’s angina is an ulceration of the back part of the throat (the oropharynx). It may be caused by the herpes simplex virus or a spirochaetal infection. Until the advent of metronidazole, 200 mgm tablet 8 hourly for 3-4 days (Flagyl), treatment was usually ineffective. Tinidazole (Fasigyn) is also effective. This may be prescribed by the doctor. Simple mouth rinses, plenty of fluids and simple, easy-to-swallow foods assist in the acute stages.

Q. Are there any other kinds of ulcers that we should know about?

A. Certainly. Breaks in the mucous lining of the lips, mouth and tongue can occur for numerous other reasons. Simple biting is a common cause. This is often seen in adolescents of school age, particularly if emotional conflicts are present. It may be a nervous reflex habit, much like nail-biting and hair-pulling. It can lead to the production of chronically sore and ulcerated areas.

Poor dental hygiene, such as broken teeth, is also a common cause of ulcers and sores in the mouth. Any persisting sore in the oral cavity, on the lips or tongue should be checked out by the physician. Cancer of the tongue, although not common, still may occur and can be a lethal disease if untreated.

In these days of increasing social permissiveness, syphilis is increasing in incidence. Mouth ulcers may be an indication of this disease and it necessitates prompt diagnosis and therapy.

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