The oral cavity can play host to a wide variety of pathology. Many lesions are self-limiting, others may indicate underlying systemic disease, and some will be pre-malignant or malignant in nature. Consider the following common presentations:-
Oral swellings or lumps:
A mass on the soft palate has a 30% risk of being malignant. A mass on the hard palate is more likely to be malignant than benign, even if it looks and feels benign (eg adenoid-cystic carcinoma).
Remember benign long-standing swellings such as torus palatinus, (developmental bony outgrowth of the hard palate, always located in the midline and typically presenting in young adulthood).
Sore tongue:
Discomfort in the tongue is common and often difficult to manage. Exclude local irritation from dentures or regular use of mouthwashes, as well as side effects from medication (eg OTC, antidepressants). Look for focal lesions and generalised inflammation such as Candida. Consider anaemia (Hb/Folate/B12).
Review by a general dental practitioner, ENT or oral surgeon may be appropriate.
Coated tongue:
White coating of the tongue is almost never pathological but is a source of distress for some individuals. It is usually due to a lower roughage diet resulting in less normal abrasion of the tongue and a build up of the normal dorsal mucosa. Advice on diet or cleaning the tongue with a stiff toothbrush is often helpful. Don’t forget the rare hairy leukoplakia of the tongue in HIV infection.
White patches:
Leukoplakia is a clinical diagnosis. Oral Leukoplakia needs a biopsy to exclude dysplasia or frank neoplasia. Lichen planus may look similar.
Red patches:
Erythroplasia also requires biopsy as the malignant potential is greater than in leukoplakia.
Ulceration:
Any ulcer on the tongue should be observed carefully for no longer than three weeks. Refer urgently if persistent. 80% of tongue cancers are on the lateral borders. Risk factors for oral squamous cell carcinoma include Betel nut/tobacco chewing, alcohol, smoking and poor oral hygiene.
Aphthous ulcers:
These can be very demoralising if frequently recurrent. They are usually multiple and small, but maay occasionally present as a solitary giant aphthous ulcer masquerading as a malignant ulcer. Refer to the BNF for use of mouthwashes to manage recurrent aphthous ulceration.
Bad breath:
Halitosis can be demoralising and socially isolating. THe most common causes are chronic low-grade gum disease or poor oral hygiene. Refer to a dental hygienist. The most common ENT cause is foul debris building up in the crypts of the tonsils. The treatment is either to gargle with the frothy water in the mouth after cleaning the teeth (and not strong mouthwashes), or if this fails, the only recourse is tonsillectomy.
ENT Doctor London is one of UK’s leading Rhinoplasty London clinics, and can be contacted on 0207 580 6970.