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Mouth Issues – Episode 102

open mouth

Mouth Issues

Ulcers

They are uncomfortable and mostly non-serious.  Also known as “canker sores”.  Can take 2-3 weeks to completely heal.  Anything lasting over 3 weeks should be checked out by your doctor or dentist.  Ulcers can appear on the inside of the cheeks or lips, the roof of the mouth, or the tongue.  A minor ulcer versus a major ulcer is determined by the size of the sore and the layers of skin affected.  Any ulcer that is bleeding should be checked out despite the length of time.  The edges are red while the center can be yellow, white, or grey.  And they are PAINFUL!!

Ulcers can be caused by acidic or spicy foods, braces, stress, hormones, and some medications (such as beta-blockers for blood pressure or NSAIDs).  Nutritional deficiencies can increase your risk of ulcers.  Malabsorption due to conditions like celiac or deficiencies in B-vitamins and iron are the most common culprits.  Also, decreased immunity can make the skin inside the mouth more prone to ulcer recurrence.

Thrush

This is a yeast infection the mouth caused by the overgrowth of Candida, known as oral candidiasis.  It appears as white patches on the inside of the cheeks, tongue, or roof of the mouth, and the spots cannot be scraped off.  Candida is normal in the body and is kept in balance by the rest of the body’s normal flora.  Overgrowth can occur after antibiotic treatments, during times of decreased immunity due to treatments or disease states, or from inhaled steroid treatments.

Thrush is treated with a topical antifungal that the doctor directs you to swish around in the mouth to coat the affected areas, usually Nystatin.  If yeast is wide-spread, a systemic antifungal will be used.  Probiotics are a great way to keep your normal flora in balance.

Angular cheilitis (ky-ly-tis)

Cheilitis = inflammation of the lips.  This is the cracking that can occur in the corners of your mouth.  Many sources will tell you this is caused by a vitamin deficiency – like B-vitamins, iron, and zinc.  Other times, it may be a wound caused by contact dermatitis from increases contact with the tongue or your hands, and then they may become infected with normal skin bacteria or other bacteria in saliva.  An infected wound is one that doesn’t ever appear to heal.  Fungal infections, in the same way, cause the skin to crack open and appear overly dry and never-healing.

Lie Bumps

Transient Lingual Papillitis (swollen taste buds).  They can appear to be white or red, and they can be asymptomatic or very bothersome.  Not sure what exactly causes it.  Definitely NOT caused by lying.  *I used to think they were “lye bumps” as in sodium hydroxide that is a strong base and used to be popular as a detergent.*

Cleft lip/palate

A birth defect that has a strong genetic component, but also linked to environmental components that have not been pinpointed yet.  A cleft lip or palate is a result of parts of the mouth and face not fusing together during fetal development, and requires surgical correction after the baby is born.  The oral and nasal cavities are supposed to be separate and when they are not, it can increase the risk of sinus and ear infections.  Ear tubes are usually recommended.

Even after repair, a child may require speech and occupational therapies to develop the muscles needed for normal speech and eating habits.  Many times, a follow-up surgery is required as the child grows, and many other types of mental support are needed.

Bonus

*Mouth Cancers: the most common cause of mouth cancers is tobacco use (smoking, chewing).  It can start out as something that appears minor like a mouth sore, but can develop quickly into something deadly.  In the end, it can result in large areas of the mouth having to be surgically removed.

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Probiotics

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Mouth Parts – Episode 101

bright red lips in a slight smirk behind a window covered in droplets of water

Mouth Parts

Lips:  They are red due to blood flow.  They have lots of nerve ending so they can be very sensitive.  Our lips are used to manipulate food as we eat and make sounds as part of our speech.
* The Divot above the center of your upper lip is called the philtrum.

Gums:  They are also known as the gingiva.  Even though they are wet and look fleshy, healthy gums are quite resilient.

Teeth: They are used for chewing, and possibly as a tool.  Healthy teeth and gums seal together tightly to keep out invaders.  We will talk about teeth in a separate episode.

Tongue:  It is a muscular organ made up of many muscles and nerve endings.  It just happens to be an organ that we can voluntarily move around.  We use our tongue to manipulate food and to make sounds for speech.  And, of course, it is covered in taste buds.  We will cover all of this in a separate episode.

Hard Palate:  A flesh-covered bone that connects the upper teeth.  Our tongue will smash food against it when we eat and use to make certain sounds in speech.

Soft Palate: It is a muscle behind the hard palate and it moves up to close off the nose when we swallow and sneeze.  It also interacts with the back of the tongue to make certain sounds when we talk.

Palatoglossal arch:  It marks the front edge of the soft palate.

Palatopharyngeal arch: It makes the back edge of the soft palate and the end of the “mouth”.

Salivary Glands

Parotid glands: The largest salivary glands are located by your jaws, below your ears.
Submandibular glands: They are located under the jaw and back molars
Sublingual glands: They are located under the tongue, behind your chin.
~1000 of mini glands: They cover the buccal (cheek) tissue, soft palate, uvula, and tongue to keep everything moist.  This is what allows the inside of the mouth to be known as a mucous membrane.

Sublingual papilla: This is the folds of skin under the tongue.  This area contains many blood vessels close to the surface.  Medicine development has learned this is a great place for medication absorption directly into the bloodstream.

Palatine raphe (ray-fee): This is the seam down the middle of the hard palate.

Frenula: Plural for frenulum.  These are folds of skin that connect one place to the other.  You have three: for your upper lip, lower lip, and tongue.

Uvula: Latin for “small bunch of grapes”.  It is attached to the soft palate and contains a gag reflex trigger.  It is also involved in snoring if it dries out.

 

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Sneezing

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Manifesto [Show Notes]

Post-Manifesto Tidbits

This is the heart and soul of why I have produced this podcast for 100 episodes.  My Manifesto, if you will.

The podcast is going to take a break for the summer to regroup and plan new and fun things!

In the meantime, catch up on episodes you missed or re-listen to them all!

If you want to stick close for sneak peaks of new adventures and the reboot, join the Pharmacist Answers Podcast Community on Facebook

If you’ve enjoyed the first chapter of The Pharmacist Answers Podcast, please leave a rating and review on your favorite podcast app.

The new home for show notes is intelleximed.com

Thank you so much for letting me be in your ears each week.

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Sneezing [Show Notes]

Sneezing is very forceful in your body.

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The inside of your nose is covered with mucous membranes, and that mucus traps up things so they don’t get into your lungs.

Some little particles float through the air and into your nose.  They will land on those mucous membranes and irritate it.  That irritation sends a signal to your sneeze center of your brainstem.

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Brainstem

Sneezing Details

The sneeze center sends out several signals.  One goes to your diaphragm to tell it to compress the lungs to force the air out.  Another signal goes to your tongue to have it direct the air through your nose.  The last signal goes to your eyes – it is really true, you can’t sneeze with your eyes open.

So your abs contract and your diaphragm forces your lungs to exhale, your tongue directs the air to go out your nose, so the mucus plus the things that irritated your nose flies out of your face.

*Mythbusters sneeze experiment*

The proven statistics on sneezes is that they travel about 40 mph but only go about 20 feet.

Holding in a sneeze can be painful and damaging.  By holding in all that air, you can rupture your eardrums, damage your tear ducts in your eyes, fracture your nasal cartilage or bones, or cause nose bleeds because of the blast against your sinus passages.

Sneezing Advice

There’s so many tricks about trying to stop a sneeze – most of them involve counter-pressure on other spots on your face or body.

The best advice for stopping a sneeze is to blow your nose to get out the irritants before the body blasts it out with a sneeze.

You will never ever sneeze when you’re sleeping.  So morning sneezing fits are normal for a lot of people.  This is because all the dust and stuff you breathe in while you’re sleeping finally irritates your body.  So morning congestion and sneezing is normal to help clear all of that out.

We’re unsure why people will sneeze in other situations like sudden exposure to bright light or changes in air pressure or temperature.  Another unsual trigger is an over-full stomach.  Multiple people have reported they feel nauseous and once they sneeze, the sick feeling goes away.  I dunno….

If you do have to sneeze, make sure you cover your face.  Use the elbow technique!

*Mythbusters hanky*

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Nose Issues [Show Notes]

Nose issues that cause your breathing to fail

  • Congestion from allergies, viruses, or infections.
  • Deviated septum – the septum (the bone that separates the nasal cavity and divides your nostrils) can get crooked and change the size and access of the nostrils or nasal cavity.  Can be from trauma, or may gradually get crooked from chronic pressure.
  • Turbinate Hypertrophy – over-growth of tissue covering the turbinates (tissue-covered bones that add warmth and moisture to the air you breathe). This can lead to snoring.  May be treated by steroid nasal sprays or surgery to remove extra tissue.
  • Nasal Polyps – uneven overgrowth of mucus membranes (symptoms may be runny nose, post-nasal drip, stuffiness).  They are not cancerous.  Treated by snipping them out.
  • Sinus cancer – a single growing tumor that causes bulging, either around the eye, face, or mouth.

Nose issues that cause your smelling to fail

  • Age
  • Deviated septum (see above)
  • Polyps (see above)
  • Chronic sinus infections – the smelling sensors are inflamed or covered with mucus so much that they become damaged or less sensitive.
  • Smoking – smoke and toxins can damage smelling receptors in your nose.  Also, the receptors become so clogged up with smoke and tobacco molecules that there’s no room for other molecules to be detected.  This can be temporary or permanent.

Nosebleeds

  • In kids, this is usually from trauma (either bumps and bonks or picking).  Can also be caused by dry air in the wintertime (use vaseline in the nostrils).
  •  In adults, can be from hypertension (high blood pressure) or chronic use of blood thinners.

PSA: Treatment for a nosebleed:  DO NOT tip your head backwards!!!!!  It makes you swallow that blood!  THAT’S GROSS!!  Proper treatment:  pinch the nose and tip the head forward.  This allows a clot to form and clots stop the bleeding.

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Smell [Show Notes]

Smell Basics

Air goes in your nose and flows over the smell sensors.

Your nose and sinus cavities act as a resonating chamber for your voice.  That’s why you sound funny when you hold your nose or when your nose is stopped up from a cold or allergies.  This is important in talking and singing.

What makes something smell?

Volatile molecules evaporate at normal temperatures and pressures, so actually molecules of the thing are in the air and available to go in your nose.  Don’t think about this too hard….

The smelling sensors are on the roof of the nasal cavity –> olfactory receptors (olfactory is the fancy word for smelling).  The molecules fit into the receptors like a key in a key hole.  Our brain likes to categorize things, and so certain compounds have similar structures and get lumped together (“smells like eggs” but you know it’s not real eggs).

The olfactory receptors send the signals to the olfactory bulb (which is the area in the brain that translates all the smells and allows you to identify a smell).  It’s not a very long trip….

The olfactory bulb is a part of the limbic system (the emotion center).  this is why smell is more strongly connected to emotions and memory – even stronger than sight and sound.

Smell Tidbits

If you go to the perfume counter at a department stores, you’ll find that they all start smelling the same.  The perfume department will have coffee beans because it helps clean out the receptors.

Coffee-scented, caffeinated perfume <– free idea!!

Inflammation and mucus congestion blocked off the receptors.

No concrete evidence of why pregnant women get a “super smeller” during pregnancy.

One rogue molecule won’t make you smell something.

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Nose Anatomy [Show Notes]

Nose Basics

Your nose is responsible for breathing and smelling.  These things work better when it isn’t stopped up.

The part of your nose that you can see and touch is cartilage covered in skin.  There is bone above it, beside your nose, below it, and right in the middle (inside your head).  Part of the cartilage is stiff and hold shape, other parts of cartilage are soft for flexibility.

The nasal root (the bone that extends between your eyes) connected to the bridge of your nose (which is made of cartilage).  The tip is also called the lobe.  The wings are on each side of your nose that you can flare.  The nostrils is actually the holes.

There are 4 main sinus cavities

  1. Frontal sinuses = in your forehead, between your eyebrows
  2. Maxillary sinuses = run under your eyes, behind your cheeks
  3. Ethmoid sinus = right between your eyes, in the middle of your head, connected to your tear ducts
  4. Sphenoid sinus = under your sphenoid bone (in the middle of your head)

The sinus cavities are lined with mucous membranes that keep them moist and have lots of blood flow to them.  Their job is to warm and moisten the air you breathe in your nose before it goes into the lungs.  Your lungs don’t like cold air.

Mouth breathing is not very efficient. This is true in athletics as well as sleep.   But breathing out through your mouth can be useful because you can get a large amount of air out rather quickly and the lungs empty better.

You have a fast-flow and a slow-flow nostril – this has to help you perceive smell.  Sometimes almost as good as dogs.

The cartilage of your ears and nose never stop growing through your life.

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Ear Issues [Show Notes]

PSA:  Please don’t stick things in your ear any larger than your elbow…and that includes your finger.

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Outer ear = the part that you can touch
Middle ear = the area being the ear drum
Inner ear = the cochlea and area responsible for your balance

3 common ear problems

  • Ear infections (otitis media)
  • Vertigo (and motion sickness)
  • Tinnitus (ringing in your ear)

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*Ear wax

Ear Infections

The area behind your ear drum has air in it and that pressure is equalized through the eustachian tube.  If that area gets fluid in it, that fluid can grow bacteria and that leads to infection.  The natural motion of opening and closing your jaw helps massage the eustachian tubes and moves air in and out (like when you fly or drive in the mountains and you chew gum or yawn).

Cold and allergies can be the source of the fluid build up that leads to ear infection.  You may have decreased hearing, pain, decreased balance – infection can require antibiotics.

Vertigo

This is the sensation of spinning, dizziness, being off balance
The semi-circular canals are responsible for your balance.  If it get sloshed too much, or doesn’t level out exactly right, then the signals sent to the brain may translate to being off balance even though your body is upright.  The signal confusion is what can lead to nausea (it’s not actually happening in your stomach – at least not until you vomit!)
The fluid moving around in these canals are why kids can induce dizziness when they spin around in circles (think about the clothes in your washer during the spin cycle – they get pushed to the outside).
Medications  for vertigo are the same as some medications for nausea – plus they have drowsy side effects, so maybe you just sleep it off.
There are many suspected causes, but nothing definite or proven.

Tinnitus

Defined as ringing, buzzing, roaring, whooshing sound when nothing is actually making that noise.
Causes: hearing loss (either due to aging or exposure to loud noises); high blood pressure (pulsating); medications
One theory: the hairs in the cochlea are damaged so those frequencies of sound (usually high pitched sounds) can’t be picked up anymore; the brain fills in the gaps with “made up sound”.  This is NOT PROVEN!
High blood pressure can cause you to hear the blood pulsing through the blood vessels in your ears.

Medications that causing ringing in the ears

  • Aspirin (acute over-use)
  • Aminoglycosides (i.e. Gentamicin = antibiotic) – it has a small therapeutic window, too much can lead to ear damage, it stopped in time, permanent ear damage can be avoided
  • Quinine = usually asked for to help leg cramps, also medically prescribed to prevent malaria.  Can only be readily consumed by drinking tonic water.

Flavonoids are put in vitamins and advertised to help tinnitus.  Flavonoids are phytonutrients (nutrients you get from plants).  These nutrients can’t grow the hairs back in the cochlea.  Most of the vitamins and nutrients in the flavonoid vitamins have anti-oxidative properties, but I doubt that tinnitus is a major oxidation problem.

Audience Question

Can being slapped over time cause ringing in the ears?

  • Being bopped in the face and head can probably cause permanent damage to the structures on the inside and outside of your head.  Being hit in the side of the head can cause pressure build-up in the ear where the air causes the ear drum to rupture (like “boxing” the ears).
  • Slaps to the face (like “you jerk!” kind of slaps) don’t usually cause ear problems, but punches or slaps to the side of the head near or on the ears can possibly cause damage.

Prevent ear problems: be nice to your ears!

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Ear Anatomy [Show Notes]

Ear Basics

The auricle is the part of the ears you can see. It is made of cartilage (flexible tissue that doesn’t have a large blood supply).  Everything else requires a tool for the doctor to see inside.  And the doctor can only see to the ear drum.  The stuff behind the ear drum isn’t visible because of the membrane that blocks it.  The middle and inner ear are surrounded by your head bones.

Science of Sound

Sound is created when the air around us is compressed and then expands.  They move away from the source in circles (think radar or sonar or throwing a pebble in a pond).

The ear canal directs the sound waves towards the ear drum.

Sound gets translated in 2 main ways

  1. Identify the sound
  2. Identify if the sound has meaning

Inside Your Ears

The ear drum (tympanic membrane) vibrates according to the intensity of the sound and trigger the Hammer-Anvil-Stirrup cascade.

  • The ear drum vibrates the handle of the Hammer (Malus bone – yes, it’s a real bone).
  • The Hammer bangs on the Anvil (Incus bone).
  • The Anvil has a tail that is connected to the Stirrup (Stapes bone).
  • The Stirrup looks like the spurs on the back of boots.  It is connected to a membrane on the Cochlea and works like a plunger.

All of these bones are surrounded by air and the pressure is controlled by the Eustachian tube.  This is the access point for ear infections or congestion due to allergies or a cold.

The Cochlea is a bone full of fluid and lined with hairs and shaped like a spiraled sea shell.  The hairs pick up different frequencies of sound (sound wave frequency determines pitch).  If certain levels of hairs get damaged, then you will not be able to hear pitches in that range anymore.  If you unrolled the cochlea, it would be laid out low pitch to high pitch like a piano.  And these hairs are connected to the auditory nerves and turn sound signals into electrical signal to send it to your brain.

Semicircular canals of the cochlea are little bone chambers full of fluid and they control balance.  This works like a leveling bubble to help you stay upright.  If it becomes dysfunctional, then it may trigger vertigo.

The middle ear (the area behind the ear drum) is where most of the trouble happens – whether allergies causing stopped up ears, or colds leading to ear infections.

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Allergy Testing Experience [Show Notes]

Allergy Basics

Anaphylaxis = an out of control allergic reaction that can be life-threatening if medical treatment is not sought immediately
EpiPens are a first-step self-treatment in the case of a major allergic reaction or anaphylaxis.

My Allergy Testing Experience

I got 33 injections!!

Allergy testing started with a serum test as a baseline – just to see how strongly my histamine reaction was.

The injections are sub-dermal (under the dermis layer of the skin).  It’s the same level if injection that a TB skin test is done (to see if you’ve been exposed to tuberculosis).

The next step was a prick-test or scratch test – these plastic claw things that poke down in my forearms.  This test required me to sit completely still for 20 minutes.  COMPLETE TORTURE!

A picture of my right forearm where the nurse performed my allergy testing prick testA picture of my left forearm where the nurse performed my allergy testing prick test

Numbers 1-20 are plants (trees, grasses, flowers).  C = cat. D = dog (Good news – I’m not allergic to dogs!) M = skin mites (don’t think about this one too hard). CL = cockroaches.  The other letters are household and common molds.

The skin pricks on my forearm was a preliminary test to determine how much serum she was going to inject of each in my upper arms. The mites injection hurt the worse of all of them, but i had minimal reaction.

Slowest tattoo EVAR!
An image of my left upper arm where nurse injected allergens for my allergy testing, labeled with letters. An image of my right upper arm where nurse injected allergens for my allergy testing, labeled with letters.

My Results

One of my higher reactions was to Fescue (this is the type of grass that Ken grows on the farm as hay to feed the cows!)
The one the nurse was most concerned about was Cocklebur.

They didn’t want me to wash the mold markings off until I go in for a delayed reading a few days later.

The next step that they prefer you do is allergy shots – 2 years of weekly injections of what you’re allergic to in hopes to desensitize you to those triggers.  NOPE!  Not doing it!

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