Oral Mucosal Lesions

What counts as an oral mucosal lesion

The mouth is lined by mucosa, a moist, thin layer of tissue that heals quickly. "Oral mucosal lesion" is the umbrella term dentists and doctors use for any change in that lining. Symptoms depend on the type:

• pain, stinging or burning, often worse with spicy, acidic or salty foods
• a raw or rough feeling, or no symptoms at all
• bleeding when brushing or eating
• a change in color: white, red, yellow, brown, blue or black
• a lump, thickening or area that feels different to the tongue
• numbness, or difficulty chewing, swallowing or moving the tongue (in more serious lesions)

Painless lesions are not automatically harmless. Early oral cancer is often painless.

Types of oral lesions by appearance

Ulcers and sores

White lesions

• Oral thrush: creamy white patches that wipe off, leaving a red, sore base. Common in babies, denture wearers, people using steroid inhalers and those with diabetes or weak immunity.
• Leukoplakia: a white patch that does not rub off, linked to tobacco and alcohol. It is considered potentially precancerous and is usually biopsied.
• Lichen planus: lacy white lines on the inner cheeks, sometimes with red, sore areas. Long-lasting and immune-related.
• Frictional keratosis and linea alba: a white line or patch from cheek biting or rubbing.

Red lesions

• Erythroplakia: a velvety red patch. It is less common than leukoplakia but carries a higher risk of being precancerous or cancerous.
• Geographic tongue: map-like smooth red patches with white borders that move around the tongue. Harmless.
• Denture stomatitis: redness of the palate under a denture, often from yeast.

Dark, brown or black lesions

• Amalgam tattoo: a flat blue-gray spot near a filling, from silver filling particles. Harmless.
• Physiologic pigmentation: even brown coloring of the gums, common in people with darker skin.
• Smoker's melanosis and some medicines (minocycline, antimalarials) cause brown patches.
• Black hairy tongue: a dark, furry coating on the top of the tongue from overgrown papillae, linked to smoking, antibiotics and poor brushing.
• Oral melanoma: rare, but a new, growing, irregular dark patch, most often on the palate or gums, needs a biopsy.

A black lesion with stinging at the base or sides of the tongue could be a blood blister, a pigmented lesion or an ulcer stained by food or medicine. Because it is unusual, have it examined.

Lumps and swellings

• Fibroma: a smooth, firm, painless lump from repeated biting, usually on the cheek.
• Mucocele: a soft, bluish, fluid-filled bump on the lower lip from a damaged salivary gland.
• Torus: a hard, bony bump in the middle of the palate or under the tongue. Normal.
• Pyogenic granuloma: a red, bleeding growth on the gums, common in pregnancy.
• Papilloma: a small, cauliflower-like growth caused by HPV.

Causes and risk factors

• Injury from teeth, braces, dentures, toothbrushing or hot food
• Infections: herpes simplex, Candida yeast, coxsackie virus, syphilis and HPV
• Immune conditions: lichen planus, celiac disease, Crohn's disease, Behçet's disease, lupus and pemphigus
• Nutritional deficiency: iron, vitamin B12 and folate deficiency cause ulcers and a sore, smooth tongue
• Medicines: chemotherapy, NSAIDs, nicorandil, methotrexate and some blood pressure drugs
• Tobacco (smoked or chewed), betel nut, heavy alcohol use and HPV infection, which raise the risk of precancer and cancer

How oral lesions are diagnosed

A dentist or doctor will ask how long the lesion has been there, whether it hurts, and about tobacco, alcohol, medicines and other symptoms. They will examine the whole mouth and feel the neck for lymph nodes.

• Swab or scraping: for thrush or herpes.
• Blood tests: for anemia, vitamin deficiencies or celiac disease when ulcers keep coming back.
• Biopsy: a small sample taken under local anesthetic. Any lesion lasting more than 2 to 3 weeks without a clear cause, any non-removable red or white patch, and any hard lump or ulcer should be biopsied.

Treatment

Treatment depends on the cause:

• Canker sores and injuries: remove the irritant, use a soft toothbrush, avoid spicy and acidic foods, and use benzocaine gels or antimicrobial mouthwashes. Prescription steroid pastes help severe cases.
• Thrush: antifungal drops, gels or lozenges, plus denture hygiene.
• Cold sores: antiviral cream or tablets started at the first tingle.
• Lichen planus: topical steroids for painful flares and regular monitoring.
• Leukoplakia and erythroplakia: stopping tobacco and alcohol, biopsy, and removal or close follow-up depending on the findings.
• Oral cancer: surgery, often with radiation or chemotherapy, by a head and neck team.

Rinsing with warm salt water (half a teaspoon in a cup of water) can soothe most sore lesions.

Prevention

Stop smoking or chewing tobacco, limit alcohol, see your dentist regularly for an oral cancer check, fix sharp teeth or poorly fitting dentures, and get the HPV vaccine if eligible.

Frequently asked questions

What are the symptoms of oral mucosal lesions?

Symptoms range from none at all to pain, stinging or burning with food. You may notice a sore, a white, red or dark patch, a blister, a lump, bleeding or a rough area. Lesions that are painless, hard, or last more than 3 weeks need checking.

When should I worry about a lesion in my mouth?

See a dentist or doctor for any lesion that lasts more than 3 weeks, a white or red patch that does not wipe away, a hard lump, a bleeding sore, numbness, or a growing dark spot. These features need a biopsy to rule out precancer or oral cancer.

What causes a black lesion in the mouth?

Most are harmless: amalgam tattoos from fillings, natural pigmentation, blood blisters, smoking-related pigment or black hairy tongue. Rarely, a new, growing or irregular black spot is oral melanoma. Any dark patch that appears without explanation or changes should be examined.

Are oral lesions on the tongue serious?

Most tongue lesions are bite injuries, canker sores, geographic tongue or enlarged taste buds, and heal within 2 weeks. An ulcer or patch on the side or underside of the tongue that lasts more than 3 weeks should be checked, because these are common sites for oral cancer.

Is an oral mucosal lesion contagious?

Only some are. Cold sores (herpes), hand, foot and mouth disease, syphilis sores and HPV papillomas can spread through close contact. Canker sores, lichen planus, geographic tongue, leukoplakia and injuries are not contagious.