Clinical Review

ABC of oral health

Swellings and red, white, and pigmented lesions

BMJ 2000; 321 doi: 10.1136/bmj.321.7255.225 (Published 22 July 2000)
Cite this as: BMJ 2000;321:225

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  1. Crispian Scully,
  2. Stephen Porter

    Swellings

    It is not unknown for people to discover and worry about oral lumps, but they usually first notice a lump because it becomes sore. Pathological causes include a range of different lesions, but neoplasms are most important (see earlier article).

    Mucocele in a typical site

    Causes of salivary gland swelling

    • Inflammatory (mumps, ascending sialadenitis, recurrent juvenile parotitis, HIV sialadenitis, other infections such as tuberculosis, Sjogren's syndrome, sarcoidosis)

    • Neoplasms

    • Cystic fibrosis

    • Duct obstruction

    • Sialosis

    • Drugs (such as protease inhibitors)

    • Deposits (such as amyloid)

    Most salivary swellings are caused by mucoceles in minor glands in the lower lip. These are best removed surgically. In the major glands salivary duct obstruction is more common, but sialadenitis, Sjogren's syndrome, and neoplasms are important causes to be excluded. It can be difficult to establish whether a salivary gland is genuinely swollen, especially in obese patients. A useful guide to whether a patient has parotid enlargement is to look for outward deflection of the ear lobe, which is seen in true parotid swelling.

    Management —Diagnosis is mainly clinical, but investigations such as serology for autoantibodies or HIV antibodies, liver function tests, and needle or open biopsy may be indicated. Treatment is of the underlying cause.

    Lesions which may present as lumps or swellings in the mouth

    Normal

    • Pterygoid hamulus

    • Parotid papillae

    • Lingual papillae

    • Unerupted teeth

    Developmental

    • Haemangioma

    • Lymphangioma

    • Maxillary and mandibular tori

    • Hereditary gingival fibromatosis

    • Von Recklinghausen's neurofibromatosis

    Inflammatory

    • Abscess

    • Pyogenic granuloma

    • Crohn's disease

    • Orofacial granulomatosis

    • Sarcoidosis

    • Wegener's granulomatosis

    • Others

    Traumatic

    • Epulis

    • Fibroepithelial polyp

    • Denture granulomas

    Cystic

    • Eruption cysts

    • Developmental cysts

    • Cysts of infective origin

    Fibro-osseous

    • Fibrous dysplasia

    • Paget's disease

    Hormonal

    • Pregnancy epulis or gingivitis

    • Oral contraceptive pill gingivitis

    Drugs

    • Phenytoin

    • Cyclosporin

    • Calcium channel blockers

    Blood dyscrasias

    • Leukaemia and lymphoma

    Neoplasms

    • Benign and malignant

    Others

    • Angio-oedema

    • Amyloidosis

    Red oral lesions

    Most red oral lesions are inflammatory in nature, but some are potentially malignant, especially erythroplasia.

    Causes of red lesions

    Widespread redness

    • Candidiasis

    • Iron deficiency

    • Avitaminosis B

    • Irradiation mucositis

    • Lichen …

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