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ULY CLINIC

12 Septemba 2025, 00:42:11

Mouth Lesions

Mouth lesions include ulcers (most common), cysts, firm nodules, hemorrhagic lesions, papules, vesicles, bullae, and erythematous lesions. They may occur on the lips, cheeks, hard and soft palate, salivary glands, tongue, gingivae, or mucous membranes. Many are painful and easily detected, while some are asymptomatic and require a thorough oral examination.

Causes include trauma, infection, systemic disease, drugs, or radiation therapy.

History and Physical Examination

History:
- Onset, duration, pain, odor, or drainage.
- Associated skin lesions or systemic symptoms.
- Complete drug, allergy, and medical history, including malignancy, sexually transmitted disease, I.V. drug use, infection, or trauma.
- Dental history: oral hygiene habits, frequency of dental exams, recent dental visit.
Examination:
- Inspect lips for color and texture.
- Examine and palpate buccal mucosa and tongue, including underside and floor of the mouth.
- Inspect oropharynx, teeth, and gums; note missing, broken, or discolored teeth, caries, debris, inflamed or bleeding gums.
- Palpate neck for adenopathy, especially in tobacco or alcohol users.

Medical causes

Cause	Typical Presentation / Findings
AIDS	Oral candidiasis, bacterial or viral infections; Kaposi’s sarcoma on hard palate (red, blue, or purple lesions; may ulcerate)
Actinomycosis (cervicofacial)	Small, firm, flat, painless swellings on oral mucosa or jaw/neck; abscesses, fistulas, purulent yellow discharge
Behçet’s syndrome	Painful ulcers on lips, gums, buccal mucosa, tongue; possible genital, ocular, skin lesions; young males affected
Candidiasis	Soft, elevated plaques on buccal mucosa, tongue, palate, gingivae; acute atrophic: red/painful, chronic hyperplastic: white/firm
Discoid lupus erythematosus	Erythematous areas with white spots/striae on tongue, mucosa, palate; skin lesions on face, neck, ears, scalp; alopecia if scalp involved; more common in women 30–40
Erythema multiforme	Sudden vesicles/bullae on lips, mucosa; symmetric macules/papules on hands, limbs, face, neck; may involve eyes/genitals; fever, malaise, organ involvement possible
Acute necrotizing ulcerative gingivitis	Sudden gingival ulcers with grayish pseudomembrane; tender gums, intermittent bleeding, halitosis, fever, enlarged neck lymph nodes
Herpes simplex 1	Vesicles on oral mucosa, tongue, gums, cheeks; rupture to painful ulcers with yellowish crust; fever, pharyngitis, lymphadenopathy
Herpes zoster	Painful vesicles on buccal mucosa, tongue, uvula, pharynx, larynx; unilateral red nodules progressing to vesicles/scabs; fever, malaise, pruritus along nerve distribution
Inflammatory fibrous hyperplasia	Painless, pink, smooth nodular swelling of buccal mucosa; usually from trauma/irritation
Leukoplakia / Erythroplakia	White lesion (leukoplakia) or red velvety lesion (erythroplakia); may indicate dysplasia or early squamous cell carcinoma; irritation or tobacco-related
Pemphigoid (benign mucosal)	Thick-walled vesicles on oral mucosa, conjunctiva; desquamative gingivitis; may cause dysphagia, hoarseness, blindness; chronic course
Pemphigus	Thin-walled vesicles and bullae; painful oral lesions, raw patches; associated pruritus; systemic skin involvement
Pyogenic granuloma	Soft, tender nodule/papule/polypoid mass on gingiva, lips, tongue, buccal mucosa; bleeds easily; may ulcerate with purulent exudate
Squamous cell carcinoma	Painless ulcer with elevated indurated border; often on lower lip, tongue edge, floor of mouth; risk factors: chronic smoking, alcohol
Aphthous stomatitis	Painful ulcers on dorsum of tongue, gingivae, hard palate; minor: small gray membrane with red halo; major: larger, painful, last up to 6 weeks, may scar
Syphilis	Primary: solitary painless chancre; secondary: multiple painless ulcers with grayish plaque, rash, lymphadenopathy, fever; tertiary: gummas on oral mucosa
Systemic lupus erythematosus	Erythematous oral areas with edema, petechiae, superficial ulcers; may have arthritis, butterfly rash, photosensitivity

Other causes

Drugs: Chemotherapy, penicillin, sulfonamides, gold, quinine, phenytoin, aspirin, barbiturates, inhaled steroids.
Radiation therapy may directly induce oral lesions.

Special considerations

For painful ulcers, provide topical anesthetic such as lidocaine.

Patient counseling

Avoid irritants and report warning signs.
Teach proper mouth care and oral hygiene.

Pediatric pointers

Causes in children: chickenpox, measles, scarlet fever, diphtheria, hand-foot-mouth disease.
Neonates: candidiasis or congenital syphilis may cause oral lesions.

References

American Dental Association Survey Center. Survey of dental practice: Income from the private practice of dentistry. Chicago, IL: ADA; 2011.
Selvi F, Ozerkan AG. Information-seeking patterns of dentists in Istanbul, Turkey. J Dent Educ. 2012;66(8):977–980.