Concerns About Oral White Patches
A 62-year-old woman, who quit smoking three decades ago and wears upper dentures, has been dealing with troubling changes in her mouth. She is completing her fluconazole treatment today, yet she continues to struggle with a persistent white patch on her tongue that fluctuates in size from day to day. Some days, the patch appears less noticeable, while on others, it becomes more prominent. The same pattern applies to the white patches on the roof of her mouth. In addition, she has observed a troubling habit of inadvertently sucking her dentures against the roof of her mouth, which leaves a sore ridge. After consulting with a dentist, she was informed that it appeared to signify geographic tongue, but she remains skeptical about this diagnosis. Despite her ongoing treatment, including two weeks of nystatin liquid and a short regimen of fluconazole, the condition hasn’t improved. She has also received a single 200 mg dose of fluconazole, followed by an additional two weeks of 50 mg daily doses, yet the patches remain persistent. Moreover, she experiences occasional pain while swallowing and has noticed slight inflammation and tenderness under her chin, where one of her lymph nodes seems swollen to the touch. This instability in her symptoms raises concerns about the effectiveness of her treatment and the underlying issues that need addressing.
Answers (1)
2/3/2026, 9:50:37 AM
OpenHealth AI
It's understandable to be concerned about oral white patches, especially given the persistence and fluctuation of your symptoms. The patches, coupled with soreness and swelling in your lymph nodes, require careful attention.
Key Points:
- The white patches could be related to oral thrush (which you've been treating), geographic tongue, or other conditions.
- The inflammation and tenderness under your chin may indicate an underlying issue that needs further evaluation.
Explanation: Persistent white patches in the mouth can result from various factors, including fungal infections (like thrush), irritation, or conditions like lichen planus or leukoplakia. Your history of using antifungal treatments suggests that thrush was a likely diagnosis; however, ongoing symptoms may indicate that it either hasn't fully resolved or that another condition is at play. The sore ridge from your dentures also indicates irritation that could contribute to your overall discomfort.
Pain while swallowing and swelling of lymph nodes suggest possible infection or inflammation that merits attention. Geographic tongue typically does not cause significant symptoms beyond the appearance of the patches, which is why it may not fully explain your ongoing pain and swelling.
Next Steps:
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Symptom Monitoring: Keep a journal of the appearance and discomfort of the patches, as well as any changes in swallowing or lymph node size. This will provide useful information for further evaluation.
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Maintain Oral Hygiene: Continue practicing good oral hygiene. Rinse your mouth with warm salt water to soothe irritation.
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Denture Care: Ensure your dentures fit properly and are clean. Consider revisiting your dentist to check for any adjustments needed to alleviate irritation on the roof of your mouth.
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Hydration and Diet: Stay well-hydrated and try to avoid foods that irritate your mouth or can cause pain when swallowing (like spicy or acidic foods).
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Follow-up: Given the persistence of your symptoms, including pain and lymph node involvement, consider seeking a second opinion from a healthcare provider who specializes in oral health or an ear, nose, and throat specialist (ENT). They may recommend further tests, such as a biopsy or imaging, to better understand the underlying issue.
Please take care to monitor these symptoms closely and adjust your care as needed. Let me know if you have any questions or need further information.
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