dental disorders
Oral Growths
Etiology of Oral Growths
Oral growths can be Benign Premalignant (dysplastic) Malignant Most oral growths are benign; there are numerous types. This photo shows an oral growth caused by chronic irritation. In this case, a fibroma on the inside of the cheek formed due to rubbing from orthodontic braces. DR P. MARAZZI/SCIENCE PHOTO LIBRARY This example of an oral squamous papilloma is an ordinary wart (verruca vulgaris), appearing as a raised, rounded, flesh-colored lesion on the surface of the tongue. DR P. MARAZZI/SCIENCE PHOTO LIBRARY This photo shows a wart appearing as a pedunculated papilloma (exophytic growth, cauliflower-like) on the underside of the tongue. HPV can be a cause. CLINICA CLAROS/SCIENCE PHOTO LIBRARY Creamy white patches are seen inside the mouth and may bleed when scraped off. This finding is typical of thrush, which is caused by infection withCandida. Image provided by Thomas Habif, MD. This photo shows a close-up of a ranula (center) in a person's mouth. Ranulas are mucoceles that occur in the floor of the mouth (generally larger than mucoceles that occur elsewhere in the oral cavity). The source of mucin content in ranulas is usually the sublingual gland (also occasionally from the submandibular gland duct). CLINICA CLAROS/SCIENCE PHOTO LIBRARY Torus palatinus is a common bony hard mass that occurs along the midline of the hard palate (often bilaterally, as is visible here). DR P. MARAZZI/SCIENCE PHOTO LIBRARY A benign growth of the lingual aspect of the mandible is visible here on the left side of the patient's mouth. © Springer Science+Business Media This photo shows a labial mucocele, a benign mass consisting of a swollen sac filled with mucus. Mucoceles are often fluctuant, although some can feel firmer to palpation. DR P. MARAZZI/SCIENCE PHOTO LIBRARY Pleomorphic adenoma is the most common intraoral benign neoplasm. The palatal mucosa is the most common site of occurrence. DR. P. MARAZZI/SCIENCE PHOTO LIBRARY This patient has a large right-sided parotid salivary gland tumor. The whitish papules on her skin are an incidental finding due to yaws (a chronic cutaneous infection caused byTreponema pallidumsubspeciespertenue). Image courtesy of K. Mae Lennon and Clement Benjamin via the Public Health Image Library of the Centers for Disease Control and Prevention. Chronic irritationcan cause a persistent lump or raised area on the gingiva. Benign growths due to irritation are relatively common and, if necessary, can be removed by surgery. In 10 to 40% of people, benign growths on the gingiva reappear because the irritant remains. Occasionally such irritation, particularly if it persists over a long period of time, can lead to premalignant or malignant changes. may occur in the mouth (oral squamous papillomas). Ordinary warts ( Warts ) can infect the mouth if a person sucks or chews one that is growing on a finger. Candidiasis (Mucocutaneous) None Cystsof many kinds cause jaw pain and swelling. Often they are associated with an impacted wisdom tooth and can destroy considerable areas of the mandible as they expand. Certain types of cysts are more likely to recur after surgical removal. Various types of cysts may develop in the floor of the mouth. Often, these cysts are surgically removed because they make swallowing uncomfortable or because they are unattractive. Mucoceles (mucus retention cysts and ranulas)are painless, benign, intraoral swellings due to cystic or pseudocystic accumulations of salivary gland mucus. They are often traumatic in origin. By far the most common lesion, mucoceles most often occur inside the lateral lower lip and often have a bluish translucent color due to presence of spilled mucin under the mucosa. They are usually the result of accidentally biting the (lower) lip and occur when salivary flow from a minor salivary gland is obstructed. Most mucoceles disappear in a week or two. Ranulas are large, usually bluish mucoceles on the floor of the mouth. Treatment is surgical excision. Atorusis a rounded projection of bone that forms in the midline of the hard palate (torus palatinus) or on the inner aspect of the mandible (torus mandibularis). This hard growth is both common and harmless. Even a large growth can be left alone unless it gets traumatized during eating or the person needs a denture that covers the area. Gardner syndrome is a type of Familial Adenomatous Polyposis , a hereditary disorder of the gastrointestinal tract that involves multiple colorectal polyps. Patients who have Gardner syndrome often present with multiple oral osteomas that may clinically resemble multiple torus lesions, particularly in the body and angle of the lower jaw. Keratoacanthoma None Odontomasare overgrowths of tooth-forming cells that look like small, misshapen extra teeth. In children, they may get in the way of normal tooth eruption. In adults, they may push teeth out of alignment. Large odontomas may also cause enlargement of the maxilla or mandible. They are usually removed surgically. Salivary Gland Tumors None White, red, or mixed white-red areas that are not easily wiped away, persist for>2 weeks, and are not definable as some other condition may be dysplastic. The same risk factors are involved in dysplastic changes as in malignant growths, and dysplastic changes may become malignant if not removed. is a flat white spot that may develop when the oral mucosa is irritated for a long period. The term leukoplakia is used when a white lesion on the oral mucosa cannot be characterized as any other definable lesion. The irritated spot appears white because it has a thickened layer of keratin, which normally is less abundant in the oral mucosa. Factors often associated with the development of idiopathic oral leukoplakia include tobacco use; alcohol consumption; deficiencies of vitamins Vitamin C Deficiency , Erythroplakiais a red and flat or worn-away area that results when the oral mucosa thins. The area appears red because the underlying capillaries are more visible. Erythroplakia is a much more ominous predictor of oral cancer than leukoplakia. Mixed lesionsshow intermixed areas of leukoplakia and erythroplakia and also may be precursors of cancer. People who use tobacco, alcohol, or both are at much greater risk of Oral Squamous Cell Carcinoma . For people who use chewing tobacco and snuff, the insides of the cheeks and lips are common sites. In other people, the most common sites for cancer include the lateral borders of the tongue, the floor of the mouth, and the oropharynx. Oral cancer can have many different appearances but typically resembles dysplastic lesions (eg, white, red, or mixed white-red areas that are not easily wiped away). 1.Kwiek B, Schwartz RA: Keratoacanthoma (KA): An update and review.J Am Acad Dermatol74(6):1220-1233, 2016. doi: 10.1016/j.jaad.2015.11.033 