White and red lesions

What are white and red lesions of the mouth?

White and red lesions in the mouth are very common. They can represent a wide variety of conditions. These include benign lesions such as reactive keratosis (thickening of the skin of the mouth), to more serious patches that are precancerous. Other common red and white lesions include inflammatory or immune medicated skin conditions which can involve other body organs. It’s very important that the correct diagnosis is made so effective treatment is given.

Signs and symptoms:

  • Normal soft tissues in the mouth are pink in colour, so any changes away from that (typically white or red changes) can signal developing pathology.
  • White changes in the mouth can represent thickening of the skin caused by biting, rubbing, or other trauma, regularly termed reactive keratosis. These changes are not worrisome.
  • Other white changes in the mouth can be more worrisome as they can be precancerous (known as leukoplakia). These require a biopsy to check the presence of any abnormal cells on histopathology.
  • Other white changes in the mouth can include lesions that are caused by inflammation or an aberrant immune system. One of the most common lesions in this category is oral lichen planus.
  • Purely red patches (erythroplakia) are often precancerous, but these can also be caused by infections such as thrush, so correct diagnosis is imperative.
  • Many of the lesions noted here can take on mixed red and white colour changes, and they often present with soreness, ulceration or pain.

Causes:

  • Some white patches are caused by trauma to the oral soft tissues such as biting, grinding, rubbing, or form hard/crunchy foods, or broken-down/sharp teeth.
  • Red patches can be caused by a fungus called Candida.
  • Leukoplakia is of unknown cause but mostly associated with a history of smoking and alcohol consumption.
  • Immune mediated conditions are caused by an over-active immune system that attacks the skin cells in the mouth and can cause red and white patches, but also blisters and ulcers, depending on the specific condition.

Diagnosis:

The specialists at Perth Oral Medicine & Dental Sleep Centre are experts at examining, diagnosing and treating the full variety of oral lesions that present as white or red patches. Our specialists will be able to provide you with the correct diagnosis and then commence the most appropriate treatment. They are also proficient in monitoring long term changes to avoid development of more sinister pathology such as oral cancer.

  • Most red and white patches require biopsy for diagnosis as clinical examination is not sufficient for definitive diagnosis.
  • Special tests such as blood tests may also be required depending on the type of condition.

Treatment:

  • Treatment depends on the type of lesion.
  • Keratosis does not need any treatment beyond removing the irritating factor and resolution of the keratosis occurs in most cases.
  • Leukoplakia and erythroplakia require surgical excision with clear margins to reduce the likelihood of developing oral cancer.
  • Immune mediated conditions require topical or systemic steroids or other immunosuppressive treatments, depending on the severity of the condition and the particular patient factors.

Recovery:

Many white and red lesions of the mouth are chronic conditions and require long-term review and monitoring. This can be required to prevent any of these lesions changing or becoming cancerous, or because they require long-term treatment with medications which also need to be reviewed, adjusted or changed over time. Most patients will have good long-term outcomes with appropriate management.

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