Q. I noticed white spots around my wisdom teeth after chewing tobacco for 10 years. What could it be?
Hello doctor,
I am 24-years-old. I noticed white spots and a line around my wisdom teeth approximately three to four months back, getting slightly bigger than before. My dentist advised me to get my right wisdom tooth removed, and I have had a cracked tooth on the same side for almost two years. There are no symptoms like pain or other difficulties except for the white spots, and I have been chewing tobacco excessively for nearly 10 years. I have attached the images of the white spots. I do not suffer from other illnesses and have not taken any medications. Kindly give your advice on what could it be? Could it be cancer? Also, should I get my wisdom teeth removed?
Hello,
Welcome to icliniq.com.
I have read your query and can understand your concern.
After analyzing the images you have attached (attachments removed to protect the patient's privacy), I suspect the whitish areas might be due to;
1) An impact of the amalgam (silver) filling in the particular tooth.
2) Trauma from biting using the wisdom tooth.
As of now, you do not require tooth removal as the tooth is symptom-free. However, if it shows any symptoms, you need to get the tooth removed.
Also, It would be helpful to analyze your condition better if you could answer the following questions;
1) Have you gotten these wisdom teeth filled? If yes, when?
2) Do you get your cheek area bitten by teeth sometimes?
3) Do you place snuff (tobacco) in that particular area?
Kindly revert with the answers.
Hello doctor,
Thank you for your reply.
1) The only tooth with a filling is the seventh tooth, which was filled with amalgam seven years back.
2) I occasionally get my cheek bitten by the teeth, but it is not very often.
3) No, I place tobacco on my upper lip's right or left side. I have stopped using tobacco for the last two years. Instead, I use one nicotine pouch per day.
I also found three palpable cervical lymph nodes, which are smaller than half a centimeter, and the lymph node in front of my ear is around one centimeter. Also, my cheek is slightly bigger on the particular side.
Kindly give your opinion on changing the amalgam filling to a different one?
Hello,
Welcome back to icliniq.com.
1) The amalgam filling can cause lichenoid reactions (an adverse reaction caused due to certain substances), initially presenting as a non-painful white spot lesion. Therefore, I suggest you get the amalgam filling replaced with a glass filling or light cure filling.
2) Frequently getting bitten by teeth can cause such whitish areas, whereas nicotine patches do not have such impact.
3) However, the concern right now is lymph node enlargement. If the lymph nodes are hard on picking with fingers and painless, I suggest you consult with an oral and maxillofacial surgeon.
4) Also, I suggest you take the following medications;
Tablet Amoxicillin and Clavulanic acid 625 mg twice daily for five days.
Tablet Acelofenac 100 mg, Paracetamol 325 mg, and Serratiopeptidase 15 mg twice daily for five days.
Apply Kenacort 0. 1 % (Triamcinolone acetonide) paste on the area twice daily for 15 days.
Revert after 15 to 20 days to check the status of the lesion and decide the further course of action.
I hope this helps.
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