Common problems in the mouth area

Dry mouth (xerostomia)

Especially people in old age complain about a very annoying dry mouth. The clinical examination excludes local inflammation or diseases of the salivary glands (ultrasound) and sometimes there is no clearly definable underlying disease. Very often, there are several factors that can lead to xerostomia. A very important factor is medication, which must be taken regularly and as a side effect can lead to a dehydration of the mucous membranes. But there are also general conditions that promote the symptoms, such as high blood pressure, high blood sugar, anaemia, depression and so on. And last but not least, our mucous membranes become “naturally” drier in the course of life, which is further promoted by the fact that older people no longer drink as much as younger people do. Although a “cure” of dry mouth is often not possible (comparable to the dryness of the eyes), we have various nursing methods and herbal remedies at hand to make the symptoms more bearable.

Burning mouth syndrome (glossodynia)

This is a common symptom affecting mostly middle-aged or older women. The causes are extremely diverse and can be of local nature, for example, because of a dry mouth, oral hygiene or dental prosthesis materials. Sometimes glossodynia is a symptom of common diseases such as metabolic disorders (vitamin deficiency, iron deficiency), endocrine disorders (menopause, diabetes mellitus) and many other medical conditions treated by internists. The therapy consists in the treatment of the underlying disease, the cessation of harmful substances, in rehydrating measures and in the relief of symptoms by locally effective drugs or herbal remedies.


Mild and recurrent pain in the mouth and throat area is common and occurs especially at chronic mouth breathing, but also in smokers. Primarily, the causes should be combated, but the complaints can also be pragmatically relieved with locally pain-relieving sprays or lozenges and in the case of severe pain also with painkillers.
Very strong pain on swallowing, often associated with fever and general fatigue, occur during the classic inflammation of the tonsils (tonsillitis). Most of these are viral and do not need to be treated with antibiotics. Infectious mononucleosis (Pfeiffer’s glandular fever, “kissing disease”) is also viral. It is a highly contagious disease that primarily affects adolescents and young adults and frequently causes a sore throat as a first symptom, but can later also lead to fatigue, loss of appetite, fever, headache and cause body aches. The causative agent, the Epstein-Barr virus EBV, attacks not only the tonsils and lymph nodes of the neck and other lymph node stations, but also the spleen and liver. This fact must be taken into account. If the clinical findings do not clearly indicate a viral or bacterial cause of tonsillitis, a rapid streptococcal test may be performed. The bacterial tonsillitis (Streptococcans angina), but also scarlet fever, which is caused by the same pathogen, must be treated with antibiotics to prevent late complications such as rheumatic fever with involvement of the heart valves (endocarditis) or kidneys (diffuse, haemorrhagic glomerulonephritis).
The chronic inflammation of the palatine tonsils usually manifests itself in mild, constant or recurring pain at swallowing, but also in the formation of so-called “amygdalolith” (detritus), a mixture of dead cells and bacterial products, which smell very unpleasant and can lead to bad breath (halitosis).

Palatine tonsil removal (tonsillectomy),
pharyngeal tonsil removal (adenectomy)

When speaking about tonsils, one usually means the palatine tonsils (Tonsillae palatinae), which are recognisable in the mirror in one’s own throat. However, the palatine tonsils are only one part of the so-called Waldeyer’s pharyngeal ring, a system of defence tissue, which includes the pharyngeal tonsil (adenoid, colloquially often referred to as “polyps”), the lingual tonsil (Tonsilla lingualis) and other defence tissue.
In the past tonsils were removed almost “routinely”. Today, the indication for tonsillectomy is far more restrained, not least because of the risk of secondary bleeding, even though today tonsillectomy is a frequent routine operation. If a patient suffers three times from acute bacterial tonsillitis (streptococcal angina) in two consecutive years, or has even had a complication (such as a peritonsillar, retro- and parapharyngeal abscess), removal of the tonsils is recommended. Removal of the palatine tonsils may also be indicated if they are chronically inflamed and lead to disturbing smelly breath (Halitosis).
Especially in children the pharyngeal tonsil is an issue. The removal of the pharyngeal tonsils is indicated if the nasal breathing of the child is limited due to enlargement, if the child does not thrive due to chronic inflammation of the adenoid or if recurrent middle ear infections occur.
Whether the removal of the palatine tonsils, or the pharyngeal tonsil is recommended is discussed in detail after a thorough examination by the ENT specialist together with the patient or in the case of children, together with the parents.
If a tonsillectomy or adenectomy is performed, it will be done under general anaesthesia and the length of stay in the hospital is between 1–3 days. After the surgery, physical effort should be minimised to reduce the risk of secondary bleeding.

Mucous membrane changes in the mouth

Oral diseases are common and occur in various manifestations. As this is often a borderline area with dermatology, mutual consultations may be necessary. In addition to inflammation due to viruses (for example, the “oral thrush” seen especially in children), bacteria and fungi can also lead to changes in the oral mucosa. Many people suffer from recurrent aphthae, the cause of which is often unknown and can be treated with local medications to alleviate the symptoms. One should not wait to visit to a doctor, in particular with tumours in the mouth, as they can be malignant, especially after many years of nicotine and/or alcohol consumption. Such changes must be surgically removed and the patient should quit smoking, if possible.

What to do with vesicles (aphthae)

An aphthous ulcer is a painful mucosal injury, most commonly in the oral cavity. The causes for this are largely unclear, but a certain genetic predisposition seems to play a role, as they seem to run in families. Possible additional factors may be oral mucosal injury (teeth?), but also the consumption of various foods (such as nuts) or the use of sodium lauryl sulfate-containing toothpaste. Stress seems to be an important factor in the development of aphthae.
In rare cases, aphthae occur as a result of or in connection with general disorders (such as vitamin B12, iron or folic acid deficiency, M. Behçet, inflammatory bowel disease).
As troublesome as vesicles (aphthae) are, they are usually harmless. After an initial phase of a few days with increasing pain, a white ulcer develops and then the pain decreases again and the aphthae generally heals without scarring within the course of 1 to 2 weeks even without therapy.
Since the pain is in the foreground, the treatment is primarily to alleviate the pain a little. There are various medications, which are available without prescription in any pharmacy (e.g. Oralmedic, Pyralvex, Bloxaphthe).
In addition, there are also a number of home remedies that alleviate the symptoms of an aphthae. You can dab the affected areas with baking soda, the juice of aloe vera, tea tree oil or vitamin C (tablet crushed) or also with a camomile tincture. Rinsing with green tea is also soothing. This relieves the pain and the inflammation heals faster. The regular intake of vitamin C is supposed to reduce the occurrence of aphthae.

Changes of the tongue surface

Our tongue surfaces change according to our general condition, and they look very different in different people. Nevertheless, we are sometimes startled by striking changes, such as the wandering rash of the tongue (Lingua geographica), a hair tongue (Lingua villosa nigra), or a plicated tongue (Lingua plicata). In most cases, these changes are harmless morphological variants and do not cause any discomfort, but nevertheless a check should be made to rule out the rarer inflammatory, but also general medical conditions.