Sores, Lumps and Bumps 3

Sores, Bumps, Lumps and abnormalities in the mouth that are commonly mistaken for cancer but are NOT

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Stenson's Duct

The opening of the duct of the parotid saliva gland is called Stenson's Duct.  these structures are NOT abnormal. Everyone has two of them.  They are located on the inside of each cheek beside the upper molars (back teeth).  They can be felt with the tip of the tongue as small "flaps" of cheek mucosa ("skin") running from the back to the front of the mouth, about a half inch long and about even with the chewing surfaces of the top back teeth.  While you can feel them with your tongue, they are difficult to photograph. Unless they become infected they are difficult to see, so I have provided two images.  They tend to have a bluish tint which is sometimes more easily seen than the actual tissue flap.  One, or upon rare occasion, both of these can become infected, in which case they may manifest as  swollen, red and sore bumps in the same location.  This is most likely to happen when saliva flow is reduced from its normal levels, often due to prolonged usage of decongestants and antihistamines or other drugs which cause dry mouth.  Infection of Stenson's duct is another example of a retrograde infection in which normal oral bacterial flora ascends up the duct because too little saliva is descending from the parotid glands into the mouth.  The usual treatment is a course of antibiotics (generally penicillin or Zithromax).

Herpes Labialis

Better known as "Cold sores", These sores are the result of an infection with a common virus known as Herpes Labialis.  The virus is very contagious, and if one member of a family comes down with this lesion, others in the family may be prone to get it as well.  They most usually occur on the corners of the lips, however they can occur inside the mouth in young children (as a primary, or first infection), or in individuals with compromised immune systems.  This condition is well covered on my page on AIDS, however, the presence of this sore does NOT imply the presence of HIV!   A typical cold sore lasts from 7 to 14 days if left untreated.  It may be treated using acyclovir cream (Zovirax®) or penciclovir cream (Denavir®).  Herpes simplex is a very contagious virus.  If one person in a family gets a cold sore, then others in the family may get one also.

Contact dermatitis

(To see a larger image, click on the image to the right.)  Anyone can develop an allergy to nearly anything at any time of life.  You can suddenly develop an allergy to an ingredient in a toothpaste you have been using for months, or even to a fruit that you have eaten before without any ill effects.  Contact dermatitis begins as redness and burning on the lips tongue or palate, and can progress to a rash and small papules (blisters).  Many people are familiar with contact dermatitis through their own contact with poison oak or poison ivy.  Symptoms around the oral cavity can look and feel like this, except that the blisters generally remain quite small.  You may be surprised to learn that mangos (the tropical fruit) are in the same family as poison oak, poison ivy and poison sumac.  The peel contains the oil, urushiol, which can elicit a skin rash called “Urushiol-Induced Contact Dermatitis".  This oil is also found in the shells of cashews and in Ginko Biloba.  The good news is that the rash generally subsides after a few days or weeks.  The bad news is that it can return when you come into contact with your allergen. (Image above is compliments of www.skinsite.com)

Angular Cheilitis

This lesion presents as dry, scaly, red skin at the corners of the lips. It frequently occurs in cold, dry weather.  People who produce a lot of saliva or tend to have moist corners of the lips due to poorly fitting dentures are especially prone to this problem.  It is also frequent in persons who have reduced immune function.  It is caused by a persistent yeast infection, and is easily treated with daily applications of an antibiotic specific for yeast like nystatin cream, or a cream that contains both a yeast specific antibiotic and a steroid, such as Mycolog II®,.  This condition is also covered on my page on AIDS, but the presence of these lesions does NOT imply the presence of HIV.  Angular cheilitis is not contagious. 

Mucocele

A mucocele (pronounced "muco-seel") is a mucous filled sac that forms, generally on the soft, pink mucosa on the inside of the lips or cheeks as the result of a traumatic incident that causes the patient to lacerate the tissue.  If you gently bite the inside of your lower lip, you will notice that the tissue, held between the teeth, is sort of bumpy.  Each of those little bumps represents a mucous or saliva gland, and each of these glands has a tiny duct that empties the mucous produced by that gland inside the mouth on the surface of the mucosa.  If, due to a traumatic incident one or more of these ducts are severed, the mucous produced by the gland may not be able to reach the surface of the mucosa and it may produce a bluish blister filled with mucous.  The blister breaks every so often, heals up and then refills with mucous, only to burst again later.  These lesions are generally removed by an oral surgeon.  They are not dangerous.

Fordyce Granules

These are tiny yellowish flecks that appear on the inside of the cheek mucosa and on the lips.  They are actually misplaced sebaceous glands. Sebaceous glands normally occur in the skin outside of the mouth, and their function is to keep the skin moist and lubricated.  Since the mouth is always moist anyway, they have no real function there, but their presence is considered normal. 

Lichen Planus

Lichen Planus is actually a dermatological autoimmune disease that is often first diagnosed by a dentist due to its characteristic appearance in the mouth. In the mouth it appears as a series of filamentous, white, lacy lines (Striae of Wickham) on the inside of the cheeks or on nearly any other oral tissue.   Lesions can occur on other parts of the body as well, most notably on the skin of the anticubital space (inside of the elbows). 

Most of these lesions are painless, but sometimes they occur on attached tissue such as the palate where they can be quite painful.  They can also cause quite a bit of burning in the mouth when eating sharp foods.  The image above is a fairly common presentation, and an obvious diagnosis.  The image on the right below shows a more subtle presentation under the tongue.  Click on either image to see it full size.  This condition is thought to be an autoimmune condition associated with exposure to drugs to which the patient may be sensitive.   Liken planus is usually found in patients older than 40 and is frequently associated with stress and anxiety. It is especially associated with certain antihypertensive drugs (especially HTCZ), NSAIDs, tetracycline and several sulfonamides, as well as a number of "recreational" drugs.  The condition often improves with the cessation of the offending drug.  The condition is more of a nuisance than a disability.  The oral symptoms are often treated with steroid mouth rinses.  If the symptoms are not severe, it is not treated at all.  Lichen planus is not a contagious condition. Chronic lichen planus has been known to (very rarely) morph into squamous cell oral cancer and it is recommended that patients be followed regularly as long as the condition exists.

Treatment of the more painful lesions is generally accomplished with topical steroid creams, ointments, gels or rinses. Click here to read about the drugs prescribed to treat this condition.

 

Fibroma

Fibromas are overgrowths of connective tissue.  In the oral cavity they occur as firm, well defined "lumps" of uniformly pink tissue.  They are generally not bound down to any underlying tissue, so their movement is limited only by the overlying tissue.  They generally grow to a particular size (most commonly a centimeter across or less) and then stop growing.  They can remain unchanged for many, many years.  They are either ignored or removed by an oral surgeon.  They are totally harmless unless they interfere with normal functioning.   They are not contagious.

 

Snuff Pouch

Snuff pouches are a form of hyperkeratosis (leukoplakia) that develops on the mucosal surfaces in the oral cavity where the patient keeps snuff.  These areas are generally located in the vestibule, which is the fold where the lips or cheeks curve as they approach the teeth.  These lesions take the form of verrucous (wart-like), linear folds which develop a white thickening of the mucosa over a period of years.  The longer the snuff habit remains active, the thicker and whiter the leukoplakia, and the more likely the lesion is to transform into an aggressive form of squamous cell carcinoma (cancer) known as verrucous carcinoma.  In most cases, cessation of the habit prior to the development of the cancer results in the disappearance of the lesion and a return to normal mucosa.  The lesion pictured here is is a very early lesion with a very thin coating of leukoplakia, and should regress with cessation of the snuff habit.

Nicotinic Stomatitis

Nicotinic Stomatitis is a condition characterized by inflammation of the soft palate due to the irritation of excessive amounts of cigarette smoke.  It appears as red, raised bumps on the soft palate.  In and of itself, this is not a dangerous condition, and it resolves when the smoking habit stops.  However, it is often associated with the condition called leukoplakia, described above.  Leukoplakia is considered a pre cancerous lesion which can transform into squamous cell carcinoma.  Nicotinic stomatitis is caused almost exclusively by pipe smoking and is not contagious.  It should be noted, however, that the development of this condition is an indication that the patient may be prone to the development of smoking related cancers.  Click on the image for much more on nicotinic stomatitis.

Amalgam Tattoo

An Amalgam Tattoo is exactly what the name implies.  Most cavities in back teeth are filled with silver amalgam.  Silver Amalgam is NOT poisonous, or in any way harmful to the human body, but when a small amount of it is introduced into an open wound in the mouth, it remains under the mucosa and causes a characteristic blue-gray tattoo.  This occurs most frequently when a tooth is extracted and some of the amalgam that was part of the filling in the original tooth breaks off and falls into the open socket.  It also happens frequently during the removal of old amalgam fillings if the dentist accidentally nicks the gums introducing some of the amalgam "flash" into the wound.  This is a totally harmless condition.  However the characteristic appearance of an amalgam tattoo can look a lot like a very dangerous cancer called "melanoma".  Melanoma is characterized by painless lesions that appear tan to dark brown to black in appearance with diffuse edges while amalgam tattoos appear blue-gray and have more well defined edges.  Melanoma is a very rare cancer in the oral cavity, and if you see a lesion like this in your mouth, it is MUCH more likely to be an amalgam tattoo that you never noticed before than a melanoma.   Amalgam tattoos appear suddenly after a dental procedure and remain the same size throughout life.  Melanoma tends to grow and change shape within a matter of a week or two. 

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