Mouth Conditions

Aphthous ulcer

This is a painful, superficial ulceration of the oral mucosa, which arises spontaneously and heals without scars

Whilst they are usually benign, it is essential to biopsy any ulcer not healing after 3 weeks to exclude malignancy

Symptoms

Appears like it has a grey base with surrounding erythema. Tender to touch and pain when eating

Management

Most self-resolve spontaneously

Can use topical anaesthetic or anti-inflammatory gels (Bongela) for symptomatic relief

Mumps

This is an infection due to the mumps virus that causes swelling of the parotid glands.

The virus is transmitted by respiratory droplets and infects respiratory tract cells before spreading to the parotid glands and other tissues.

The disease is now very rare due to the success of the MMR vaccine.

Symptoms

Fever, muscle pain, headache and malaise

Swelling of the parotid glands

Can affect testes (orchitis), pancreas (pancreatitis), CNS (aseptic meningitis)

Can lead to hearing loss (typically unilateral)

Complications

Orchitis (inflammation of testes)

Pancreatitis

Hearing loss (usually unilateral)

Aseptic meningitis

Key tests

Raised serum amylase due to salivary gland/pancreas involvement

Management

Supportive management as it is a self-limiting condition

Leukoplakia

This is an mucosal white patch in the mouth that does not rub off.

It is usually seen in people who smoke, drink excessive alcohol and use betel nuts.

It is a premalignant lesion which can turn into squamous cell carcinoma.

Squamous cell carcinoma

This is a malignant proliferation of the squamous cells lining the oral mucosa, usually on the floor of the mouth. 

It is associated with tobacco use, alcohol excess, leucoplakia as well as human papilloma virus infections.

Risk factors

Tobacco and alcohol

Human Papillomavirus 16

Leucoplakia and Erythroplakia (red plaque)

Symptoms

An ulcer which does not heal

Mouth pain, progressive dysphagia as the tumour becomes larger

Key tests

Biopsy of lesion is diagnostic

CT/MRI imaging is used to stage the cancer

Management

Surgical removal with chemo/radiotherapy

Although most ulcers are benign, it is important to consider biopsy for any ulcer which does not heal after 3 weeks, as this could be a sign of cancer 

Salivary Gland tumours

This is a group of tumours which arise from the salivary glands. Most occur in the parotid gland but can also occur in the submandibular or sublingual gland.

These are usually benign and more common in women, except Warthin’s tumour, which is more common in men.

Pleomorphic adenomas

These are benign tumours which present as a slow-growing, painless lump.

They occur due to epithelial duct cell proliferation, but these can become malignant and recur after surgery.

Parotid carcinomas present as hard, less mobile, painful lumps which can invade the facial nerve.

Parotid carcinomas

These are malignant tumours which are less common

They present as hard, less mobile, painful lumps which can invade the facial nerve

Warthin’s tumour

This is a type of lymphoma due to lymphocyte infiltration of the parotid gland.

They are benign and are soft, mobile, and usually occur in older males.

Key tests

Ultrasound, followed by fine needle aspiration to assess histology

If malignant, CT/MRI imaging is used for staging

Management

Surgical resection is definitive but involves risk of damage to the facial nerve as it splits within the parotid gland