| Lesion | Clinical features | Management |
| Lesions of the gums |
| Eruption cyst/hematoma | - Normal finding
- Dome-shaped cyst
- Associated with eruption of teeth
- Cyst fluid may be mixed with blood (eruption hematoma)
| |
| Gingival pigmentation | - Normal finding in dark-skinned children
| |
| Retrocuspid papillae | - Firm, round, pink to red papule
- 2 to 3 mm (0.1 inches) in diameter
- Located on the inner gum below the lower canines
- Often bilateral
| |
| Parulis ("gum boil") | - Associated with primary tooth abscess
- Soft, solitary, reddish papule on the outer gum above or below the abscessed tooth
- Drainage or pus may be observed
| - Complete pulpectomy or extraction of involved tooth
|
| Gingival overgrowth |
| | - Associated with longstanding gingivitis or chronic mouth breathing
- Erythematous gums with shiny, friable surface that bleeds easily
- Involves the gums between the teeth and at the margins of the teeth
| - Often resolves with adequate plaque control
- May require gingivectomy
|
| | - Associated with leukemia, particularly AML
- Edematous and hemorrhagic
| - Treatment of underlying disease
|
| | - Commonly precipitated by phenytoin, nifedipine, and cyclosporine A
- Painless, firm, fibrous overgrowth
- Bleeding is uncommon
- May progress to cover the crown of the tooth
| - Meticulous oral hygiene
- Discontinuation of offending drug, if possible
- May require gingivectomy
|
| | - Onset in early childhood
- Progressive nonhemorrhagic fibrous enlargement
- May be associated with failure or delay of primary or permanent tooth eruption
| - Meticulous oral hygiene
- Gingivectomy
|
- Vascular (localized juvenile spongiotic gingival hyperplasia)
| - Localized erythema of the attached gingiva of the front teeth
- Most common in female adolescents
| |
| Gingival recession | - Associated with abnormally erupted teeth
- Narrowing of the gums above and below the teeth
| - Orthodontic repositioning of malpositioned teeth
- Gingival grafting may be necessary for severe recession
|
| HIV gingivitis (linear gingival erythema) | - Brightly inflamed gums at the margins of the teeth
- Bleeds easily
- Painful
| - Debridement
- Antibiotics
- Antibacterial oral rinses
|
Other gum lesions: - Hemangiomas
- Irritant fibromas
- Peripheral ossifying fibromas
- Pyogenic granulomas
- Peripheral giant cell granulomas
- Traumatic ulcers
- Aphthous ulcers
- HSV gingivostomatitis
| Clinical features and management of these lesions are described in the section on "Lesions that occur at multiple sites" |
| Lesions of the tongue |
| Ankyloglossia | - Tongue movement is restricted by a short, tight frenum between the tongue and floor of the mouth
| - May require frenotomy (refer to UpToDate content on ankyloglossia in children)
|
| Congenital melanotic macules | - Present from birth
- Single or multiple, asymptomatic, hyperpigmented macules
- Range from 3 mm to 3 cm (0.1 to 1.2 inches) in diameter; size increases proportionally as the child grows
- No family history of systemic conditions associated with mucosal pigmentation (eg, Peutz-Jeghers syndrome)
| |
| Geographic tongue | - Pink to red, slightly depressed lesions with irregular, elevated, curvilinear white or yellow borders
- Pattern of lesions changes continuously
| - Does not require treatment
- Avoidance of acidic foods and beverages is helpful if the lesions are sensitive
|
| Fissured tongue | - Marked central fissure from front to back of tongue
- Smaller fissures radiate laterally from the central fissure
| - Removal of trapped food particles through brushing of the tongue
|
| Mucoceles | Clinical feature and management of mucoceles are described in the section on "Lesions of the lips" |
Other tongue lesions: - Hemangiomas
- Lymphangiomas
- Irritation fibromas
- Traumatic ulcers
- Aphthous ulcers
- Thrush
- HSV gingivostomatitis
- HFMD
| Clinical features and management of these lesions are described in the section on "Lesions that occur at multiple sites" |
| Lesions of the lips |
| Herpes labialis (fever blister, cold sore) | - Vesicular eruption of skin adjacent to lip
- Vesicles rupture to form ulcers and crusts
- Caused by HSV
| - Refer to UpToDate content on treatment of HSV type 1 infection for treatment indications and options
|
| Angular cheilitis (perlèche) | - Painful fissuring at the corners of the mouth
- Usually caused by Candida albicans
| - Maintain oral hygiene
- Apply barrier cream or petrolatum
- May require antifungal therapy (refer to UpToDate content on angular cheilitis)
|
| Abnormalities of the labial frena |
- Persistence of raphe between the upper labial frenum and the palatal papilla
| - May lead to widely spaced front teeth (diastema)
| - Diastema may require orthodontic treatment
- May require frenotomy
|
- Extension of frenum to central incisors
| - May lead to gingival recession and bone loss
| - May require frenotomy to prevent bone loss
|
| | - May be associated with Ehlers-Danlos syndrome
- May be associated with infantile hypertrophic pyloric stenosis
| - No treatment required
- Monitor for signs and symptoms of Ehlers-Danlos syndrome and infantile hypertrophic pyloric stenosis
|
| Mucoceles and ranulas | - Painless swelling, smooth walled, bluish or translucent
- Usually <1 cm (0.4 inches) in diameter
- Usually located on the inside of the lower lip but may occur on the tongue or floor of the mouth (ranula)
| - May spontaneously resolve
- Surgical excision with associated minor salivary gland for mucoceles that interfere with function or cause discomfort
- Surgical treatment, ranging from incision and drainage to marsupialization to excision for ranulas
|
Other lip lesions: - Hemangiomas
- Lymphangiomas
- Irritation fibromas
- Pyogenic granulomas
- Traumatic ulcers
- Aphthous ulcers
- Thrush
- HSV gingivostomatitis
- HFMD
| Clinical features and management of these lesions are described in the section on "Lesions that occur at multiple sites" |
| Lesions of the palate |
| Herpangina | - Lesions progress from yellow/greyish-white papules to vesicles to shallow ulcerations
- The lesions most frequently involve the soft palate, tonsils, and uvula
- Typically occurs in children age 3 to 10 years
| - Supportive care to prevent dehydration
- Symptomatic treatment of pain
|
Other palatal lesions: - Irritation fibromas
- Traumatic ulcers
- Aphthous ulcers
- Thrush
- HSV gingivostomatitis
- HFMD
| Clinical features and management of these lesions are described in the section on "Lesions that occur at multiple sites" |
| Lesions of the buccal mucosa |
- Hemangiomas
- Lymphangiomas
- Irritation fibromas
- Aphthous ulcers
- Traumatic ulcers
- Thrush
- HSV gingivostomatitis
- HFMD
| Clinical features and management of these lesions are described in the section on "Lesions that occur at multiple sites" |
| Lesions that occur at multiple sites |
| Hemangioma | - Red or bluish-red, raised, moderately firm to palpation
- Appear early in life, enlarge during infancy, and regress during childhood
- May occur on any oral mucosa (eg, gums, tongue, lips, palate, buccal mucosa)
| - Refer to UpToDate content on management of infantile hemangiomas
|
| Lymphangiomas | - Pink to reddish-blue, soft, compressible
- May be present at birth or develop early in life
- May occur on the tongue, lips, or buccal mucosa
| - May require surgical resection or percutaneous chemoablation
|
| Irritation fibroma | - Pale, pink, smooth, firm, <1 cm (0.4 inches) in diameter, sessile or pedunculated base
- Usually occur on the tongue, lip, palate, or buccal mucosa, but may occur on any mucosal surface
| - Surgical excision if it interferes with function
|
| Peripheral ossifying fibroma | - Traumatic overgrowth that contains mineralized tissues (eg, bone, calcifications)
- Predominantly occurs on the gingiva
| - Surgical excision down to the bone
|
| Pyogenic granuloma (lobular capillary hemangioma) | - Bright red lesion with rapid growth, friable surface, easy bleeding
- May be triggered by trauma
- More common in females
| |
| Peripheral giant cell granuloma | - Bluish-purple traumatic overgrowth
- Typically occur on the gingiva
- Slightly more common on the lower gums
- More common in children with mixed dentition and adults between 30 and 40 years of age
- More common in females
| |
| Traumatic ulcers | - Occur on the gums, tongue, lips, palate, and buccal mucosa
| - Spontaneous healing with removal of source of trauma
|
| Aphthous ulcer | - Localized, shallow, round to oval ulcers with grayish base
- Occur on the gums, tongue, lips, palate, and buccal mucosa
| - Refer to UpToDate content on aphthous ulcerations
|
| Thrush | - White plaques on the tongue, lips, palate, and/or buccal mucosa
| - Sterilization/decolonization of items placed in the mouth (eg, pacifiers, bottle nipples)
- Topical or systemic antifungal therapy may be warranted for symptomatic patients
- Refer to UpToDate content on oropharyngeal candidiasis in children
|
| HSV gingivostomatitis | - Red, edematous marginal gingivae
- Clusters of small vesicles that become yellow after rupture and are surrounded by a red halo
- Vesicles occur on the gums, tongue, lips, hard palate, buccal mucosa, and perioral skin
| - Supportive care to prevent dehydration
- Symptomatic pain control
- Topical barrier cream
- Oral acyclovir may be warranted (refer to UpToDate content on herpetic gingivostomatitis in young children)
|
| HFMD | - Oral vesicles, small cutaneous lesions on the hands, feet, buttocks, and genitalia
| - Supportive care to prevent dehydration
- Symptomatic pain control
|
