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Mouth Growths

by David F. Murchison, DDS, MMS

Growths can originate in any type of tissue in and around the mouth, including connective tissues, bone, muscle, and nerve. Growths most commonly form on the

  • Lips

  • Sides of the tongue

  • Floor of the mouth

  • Back portion of the roof of the mouth (soft palate)

Some growths cause pain or irritation.

Causes

Mouth growths can be

  • Noncancerous (benign)

  • Precancerous (dysplastic)

  • Cancerous (malignant)

Noncancerous growths

Most mouth growths are noncancerous.

A variety of noncancerous growths may occur in and around the mouth. A persistent lump or raised area on the gums (gingiva) should be evaluated by a dentist. Such a lump may be caused by a gum or tooth abscess or by irritation. Noncancerous growths due to irritation are relatively common and, if necessary, can be removed by surgery. In 10 to 40% of people, noncancerous growths on the gums reappear because the irritant remains. Occasionally such irritation, particularly if it persists over a long period of time, can lead to precancerous changes. Because any unusual growths in or around the mouth can be cancer, the growths should be checked by a doctor or dentist without delay.

Ordinary warts (verrucae vulgaris) can infect the mouth if a person sucks or chews one that is growing on a finger. A different type of wart—a genital wart (see Genital Warts (Human Papillomavirus Infection, or HPV Infection))—may be transmitted through oral sex. A doctor may remove an ordinary wart using one of several methods (see Warts : Treatment).

Thrush is a yeast infection of the skin and moist areas (such as the mouth and vagina) that often appears as whitish, cheeselike patches in the mouth. Thrush sticks tightly to the mucus membranes and when the material is wiped away, leaves a red patch. Thrush is most common among people with diabetes or a suppressed immune system and in those who are taking antibiotics.

A torus , which is a slow-growing, rounded projection of bone, may form in the middle of the roof of the mouth (torus palatinus) or on the lower jaw by the side of the tongue (torus mandibularis). This hard growth is both common and harmless. Even a large growth can be left alone unless it gets scraped during eating or the person needs a denture that covers the area. Multiple bony growths in the mouth may indicate familial adenomatous polyposis, a hereditary disorder of the digestive tract where the person has numerous polyps in the colon that often become cancerous (see Familial Adenomatous Polyposis).

Keratoacanthomas (see Keratoacanthomas) are growths that form on the lips and other sun-exposed areas, such as the face, forearms, and hands. A keratoacanthoma usually reaches its full size of ½ to 1 inch (about 1 to 3 centimeters) or more in diameter within 1 or 2 months, then begins to shrink after another few months and may eventually disappear without treatment. Once, all keratoacanthomas were considered to be noncancerous, but some experts now consider those that do not diminish in size to be slow-growing cancerous tumors.

Many kinds of cysts (hollow, fluid-filled swellings) cause jaw pain and swelling. Often they are next to an impacted wisdom tooth and can destroy considerable areas of the jawbone as they expand. Certain types of cysts are more likely to recur after surgical removal. Various types of cysts may also develop in the floor of the mouth. Often, these cysts are surgically removed because they make swallowing uncomfortable or because they are unattractive. By far the most common cyst occurs in the lip and is called a mucocele or mucus retention cyst. It is usually the result of accidentally biting the (lower) lip and occurs when saliva draining into the mouth from a minor salivary gland is blocked. Most mucoceles disappear in a week or two but can be surgically removed if annoying.

Odontomas are overgrowths of tooth-forming cells that look like small, misshapen extra teeth. In children, they may get in the way of normal teeth coming in. In adults, they may push teeth out of alignment. They are usually removed surgically.

Most (75 to 80%) salivary gland tumors are noncancerous, slow-growing, and painless. They usually occur as a single, soft, movable lump beneath normal-looking skin or under the lining (mucosa) of the inside of the cheek. Occasionally, when hollow and fluid-filled, they are firm. The most common type (called a mixed tumor or pleomorphic adenoma) occurs mainly in women older than 40. This type can become cancerous and is removed surgically. Unless completely removed, this type of tumor is likely to grow back. Other types of noncancerous tumors are also removed surgically but are much less likely to become cancerous or to grow back once removed.


Precancerous changes

White, red, or mixed white-red areas that are not easily wiped away, persist for more than 2 weeks, and are not definable as some other condition may be precancerous. The same risk factors are involved in precancerous changes as in cancerous growths, and precancerous changes may become cancerous if not removed.

Leukoplakia is a flat white spot that may develop when the moist lining of the mouth (oral mucosa) is irritated for a long period. The irritated spot appears white because it has a thickened layer of keratin—the same material that covers the skin and normally is less abundant in the lining of the mouth.

Erythroplakia is a red and flat or worn away area that results when the lining of the mouth 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 white-red areas contain both leukoplakia and erythroplakia and also may become cancer over time.


Oral cancer

People who use tobacco, alcohol, or both are at much greater risk (up to 15 times) of oral cancer (see Mouth and Throat Cancer). For those who use chewing tobacco and snuff, the insides of the cheeks and lips are common sites of oral cancer. In other people, the most common sites for oral cancer include the sides of the tongue, the floor of the mouth, and the throat. Rarely, cancers found in the mouth region have spread there from other parts of the body, such as the lungs, breast, or prostate.

Oral cancer can have many different appearances but typically resembles precancerous lesions. For example, white, red, or mixed white-red areas that are not easily wiped away.


Evaluation

The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.

Warning signs

Certain symptoms and characteristics are cause for concern. They include

  • Weight loss

  • Firm lump in the neck


When to see a doctor

People with a mouth growth that does not go away in a week or two should see their doctor or dentist when convenient. Warning signs suggest a higher risk of cancer, and although evaluation is not urgent, people with warning signs (particularly those who use tobacco) should not put off being evaluated.

Because oral cancer often causes no symptoms early on, it is important for people to have a yearly examination of the mouth. Such an examination can be done during an annual dental check-up.


What the doctor does

Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination can help suggest a cause of the mouth growth.

Doctors ask people about how long the growth has been present, whether it is painful, and whether there was any injury to the area (for example, biting a cheek or scraping by a sharp tooth edge or dental restoration). Other things they ask about include

  • The amount and duration of use of alcohol and tobacco

  • Risk factors for thrush (caused by the fungus Candida albicans), including use of antibiotics and a history of diabetes or HIV infection

  • Whether the person has lost weight or been feeling generally ill

The physical examination focuses on the mouth and neck. Doctors look carefully at all areas of the mouth and throat, including under the tongue. They feel the sides of the neck for swollen glands (lymph nodes), which indicate possible cancer or chronic infection.


Testing

If a growth has the appearance of thrush, doctors examine scrapings under a microscope. For other growths that have lasted longer than a few weeks, most doctors recommend removing all or part of the growth for examination in a laboratory (biopsy). Biopsy is often necessary to make sure a growth is noncancerous.


Treatment

  • Treatment depends on the cause

Treatment differs depending on the cause of the growth.

Key Points

  • Most mouth growths are noncancerous.

  • Warts, yeast infections, and repeated trauma (such as biting or rubbing against a sharp tooth edge) are common causes of noncancerous growths.

  • Use of alcohol and tobacco is a risk factor for oral cancer.

  • Because cancerous growths are difficult to recognize by their appearance, doctors frequently recommend a biopsy.

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