1. There is no substitute for direct examination and biopsy. Going by your description, this could be one of the following:
a) The red raised stringy patch under your tongue may be a patch of Erythroplakia
which is most probably related to tobacco use.
b) It may also be an inflamed Wharton's Duct (sub mandibular salivary gland
duct). There may also be a stone or debris in the duct. You should take an x-ray to rule out a stone. A sialogram
is also possible after the inflammation subsides. Antibiotics which are excreted in saliva, such as clindamycin
are best suited in such situations.
c) A localized inflammation of a normal structure, or a dental abscess
could also cause referred pain
to the tooth and ear.
or Erythroplakia is considered benign but a potential precancerous lesion with a risk of turning cancerous in 5 to 15% persons.
4. Stopping the irritative factor, such as tobacco in your case, lowers the risk. It is good to hear that you have quit. Usually, the Erythroplakia stabilizes or reduces after the original irritation that caused it has been stopped.There are some other causes besides tobacco which can lead to other types of Leukoplakia / Erythroplakia.
5. One option for you is a brush biopsy with Oral CDX which you can easily arrange for.The other is a full biopsy followed by histopathological examination. Long term follow up is needed.
6.If may help if you could e-mail an image of your floor of mouth to email@example.com with 'Attn: Dr. Sumit Bhatti' as the subject line.
7. Congratulations on quitting heroin and your monocyte count should not be of any significance.