Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
I'd like to publicly thank Dr. Linda Harel for her kind and
compassionate care of one of my family members. We have often
mentioned in this column the fact that doctors are often
maligned but rarely given credit: Dr. Harel should be aware
of my deepest appreciation for her efforts as a
shaliach of the Rofei kol bossor.
Last week we discussed the teeth, I'd like to continue the
series with a further discussion of the mouth and then we
will discuss the other structures of the face in future
columns.
Thrush is a fungal disease of the mouth with painful ulcers
and white plaques. It is most common in infants but adults
with impaired immune systems, such as cancer patients and
those receiving a lot of antibiotics, can suffer from this as
well. The treatment is usually washing the mouth out with
antifungal solutions.
Tonsils are disease fighting organs located in the back of
the throat, next to that "thing" that hangs down in the back
of the throat. For our trivia fans, that "thing" is called a
uvula. The tonsils usually become smaller as one ages,
sometimes disappearing altogether. In some, they persist and
may get infected -- leading to the well known syndrome called
strep throat. This disease classically presents with a white
coating on the tonsils, pain on swallowing and fever.
Sometimes, the strep can invade deeper, causing abscesses and
sometimes it can even affect the heart and kidneys. This
however, is rare, and the disease responds very well to
penicillin, even though there is a movement today not to even
use antibiotics.
Another disease that presents similarly is mononucleosis.
This disease does not respond to antibiotics and brings with
it a profound weakness. It sometimes leads to chronic fatigue
syndrome (CFS). Both diseases have swollen glands. A throat
culture may help differentiate, but they may not be entirely
reliable. Basically, one who has had strep throat in the past
usually gets it again. If one suffers from strep throats more
than twice a year, a consultation with the ear nose and
throat doctor is in order as the tonsils may need to be
removed.
Tonsils can, rarely, become cancerous, but all other mouth
cancers are extremely rare unless one is a smoker. Also,
white painful little dots on the tonsils are usually viral.
In Israel they call this angina, but the correct name is
herpangina. Antibiotics do not help.
There are some severe mouth and neck infections, but they are
rare except in those with poor hygiene.
Pain in the neck is often swollen glands, but occasionally it
is a stone in the salivary glands which are located in the
neck and are responsible for making saliva, the liquid in our
mouths which begins the digestion process.
A last word on the mouth would have to concern halitosis, or
bad breath. While some infections can cause this, such as
strep throat, often it is due to food particles stuck in the
mouth, either in the tonsils or in the guns. I would suggest
good dental hygiene. Mouthwashes are not the solution if
brushing and flossing are not done. Next week, the nose and
sinuses. Write me in care of the Yated.
Should readers be interested in a lecture on medicine in
their town, please contact me through the Yated.
