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|1. Is the person an infant or child?||See "Mouth Problems in Infants and Children."|
|2. Do you have pain in your mouth?||o to Question 6.*|
|3. Do you have painless white or gray sores that may have a hard, raised coating on the tongue or the inside of the cheeks?||This lesion may be a precancerous LEUKOPLAKIA, more common in those who use tobacco.||See your doctor. Stop smoking or using other tobacco products to help prevent oral cancers. See your dentist if sharp or rough teeth or dental work are causing irritation.|
|4. Do you have a painless lesion, growth or lump on the lip or face?||This may be SQUAMOUS CELL SKIN CANCER.||CELL SKIN CANCER. See your doctor. When there is any change in the color, size, texture or appearance of the skin, or if there is pain, itching or bleeding from a lesion, lump or mole, see your doctor.|
|5. Do you have a painless, fluid-filled sac that may be bluish in color on the inner lips, gums, palate or under the tongue?||This may be a MUCOCELE, a harmless cyst that may be caused by sucking mouth tissue between the teeth.||These cysts usually go away on their own. To avoid infection, only a doctor should open these cysts.|
|*6. Do you have pain or swelling under your tongue or in your cheek, especially while eating or drinking?||This may be a blockage in a salivary duct, possibly caused by a SALIVARY DUCT STONE.||See your doctor.|
|7. Do you have small open and painful sores that are white or yellowish with a red border on the inner lips or cheek, gums or tongue?||These may be CANKER SORES. They may be caused by viral infections.||Canker sores usually heal on their own. To relieve discomfort, rinse with salt water or diluted hydrogen peroxide, or apply an over-the-counter oral gel. You may also use an analgesic such as acetaminophen or ibuprofen to relieve pain. See your doctor if your symptoms don't improve.|
|8. Do you have a sore that is red and crusted on your lip or on the outer edge of your lips?||This may be a COLD SORE, caused by a type of HERPES VIRUS.||Cold sores usually go away on their own. Analgesics, such as acetaminophen, and cold sore ointments can help relieve the discomfort.|
|9. Do you have a red, swollen tongue or lips?||This may be an ALLERGIC REACTION to a medicine or another ALLERGEN.||URGENT See your doctor or go to the nearest emergency room right away if you have any trouble breathing. An antihistamine may help relieve other allergy symptoms.|
|10. Do you wear dentures that seem to rub your gums or irritate your mouth?||MISFITTING DENTURES can cause mouth pain.||See your dentist.|
|11. Do you have red and swollen gums that may bleed when you brush or floss?||You may have GUM DISEASE such as GINGIVITIS or PERIODONTITIS, or a CAVITY, usually caused by poor ORAL HYGIENE.||See your dentist. Good oral hygiene, such as regular brushing, flossing and dental checkups, and eating a healthy diet can help prevent gum diseases.|
|12. Do you have small, painful bumps on your tongue?||These bumps are probably INFLAMED PAPILLAE (where the taste buds are) due to an injury from a burn caused by hot food or drink, or a self-inflicted bite.||The inflammation and bump will usually go away on its own. Avoid hot, spicy and acidic foods. Use an analgesic, such acetaminophen or ibuprofen, to relieve pain.|
|13. Do you have creamy white patches on the tongue, inner cheek or gums that are painful when scraped?||This may be CANDIDIASIS (ORAL THRUSH) caused by a fungus growing out of control.||This condition usually goes away on its own. Eat unsweetened yogurt with live cultures to restore the natural balance of bacteria in your body. Gargle with salt water or use analgesics, such as acetaminophen, to relieve discomfort. If your symptoms get worse or don't improve, see your doctor. He or she may prescribe an antifungal medicine.|
|14. Do you have raised patches of white lines or bumps that may also include red open sores on the inside of your cheeks or sides of the tongue?||You may have ORAL LICHEN PLANUS, an inflammatory condition that may have many causes.||This condition may go away without treatment. Practice good oral hygiene, such as regular brushing and flossing, don't eat foods that irritate your mouth, limit alcohol consumption, and stop smoking. See your doctor if your symptoms get worse or don't improve.|
|15. Do you have a burning sensation in your mouth that may involve several areas?||You may have BURNING MOUTH SYNDROME (BMS).||See your doctor. Treatment often depends on underlying causes. Stop smoking or using other tobacco products. Their use may be the cause or may make the problem worse.|
|16. Do you have cracking or open sores in the corners of your mouth?||These tender sores may result from a vitamin deficiency or from chapped lips.||Use a soothing ointment on these cracked areas. Take riboflavin and/or a multivitamin if you think your diet isn't adequate. See your doctor if your symptoms don't improve.|
White patches in the mouth |
What is a white patch in the mouth?
A white patch is an area of thickening in the lining of the mouth (mucosa) and has a white appearance (also called leukoplakia).
Why do people get white patches?
Your mouth (and tongue) are lined with a special type of skin (mucosa), which looks (mostly) pink because it is thinner than your other skin (eg on your arms and legs). Some changes to your mouth lining can change its color to white:
•It is common for people to have a line of white along the inside of their cheeks, this is where their teeth rub against the cheek (and is quite normal).
•If you burn your mouth (eg after hot drinks or food) you can get white blisters, which usually peel off soon afterwards.
•If you have been ill for a while or haven't moved your tongue around much, you can get a furry white tongue. This is because the skin on the taste buds has not been rubbed off normally. You can usually gently rub/scrape this off with a toothbrush.
•Mouth ulcers can be white because of thicker layers of skin cells forming that are trying to heal the injury.
•If people have poorly fitting dentures they can get ulcers or sometimes white patches forming.
Dentists and doctors are most concerned about the white patches that can't be rubbed or scraped away. These show areas of thicker mouth lining, which can be signs of mouth conditions.
Where are white patches found?
A white patch can be situated anywhere in the mouth.
How big are white patches?
A white patch can be of any size.
What causes mouth white patches?
White patches in the mouth result from infections caused by bacteria, viruses and fungi. Infections of the skin around the mouth, mucous membranes inside the mouth, gums, and tongue are common causes of mouth white patches.
White patches are almost always due to some form of irritation including infection:
Alcohol use (long-term use)
Behcet’s syndrome (disease characterized by widespread inflammation of blood vessels)
Candidiasis (fungal infection)
Celiac disease (severe sensitivity to gluten from wheat and other grains that causes intestinal damage)
Chemical irritation: eg aspirin burns, smoking (smoker's keratosis);
Chewing on the inside of cheeks
Crohn’s disease (inflammatory bowel disease that can affect any part of the intestine)
Herpes simplex virus
Human Papilloma Virus infections
Immune system diseases, such as systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues)
Infection: eg fungal (candida)
Leukoplakia (precancerous condition of the mouth)
Salivary duct stone
Trauma and friction: eg poorly fitting dentures, cheek biting, sharp teeth or fillings (frictional keratosis)
Tobacco use (chewing or smoking)
Questions for diagnosing the cause of mouth white patches
To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your mouth white patches including:
How long have you had the mouth white patches?
Why: to determine if acute or chronic.
Where exactly are the mouth white patches?
Why: e.g. lips, gums, tongue, lining of the mouth, tonsils.
What medications has the patient been taking for the past week?
What medication is the patient taking every day in recent months?
Why: some medications increase the risk of oral Candida infection including steroids (including inhaled steroids), broad spectrum antibiotics and tumor chemotherapy; some medications may induce a lichen planus like eruption including ACE inhibitors, gold, streptomycin, tetracycline, quinine, penicillamine, hydrochlorothiazide and chlorpropamide.
Does the patient have a fever?
Do You Have Pain?
Where is the Pain?
Is there more than one site?
When did your pain start?
How often does it occur?
Has its intensity changed?
How long does it last?
What makes your pain worse?
What makes your pain better?
What previous treatment have you tried to relieve your pain?
Were they effective?
What does your pain feel like?
What words would you use to describe your pain?
Does the pain move anywhere?
On a scale of 0 to 10 with O being no pain and 10 being the worst pain you can imagine, how much does it hurt right now?
How much does it hurt at it’s worst?
How much does it hurt at it’s best?
If your medicine helps with the pain, how many hours of relief do you get?
Is this acute or chronic pain?
Pain Evaluation and Treatment
Here are further guidelines.
Do you have dentures?
Why: Poorly fitting dentures may cause white, raised folds of tissue in the mouth.
Symptoms of lichen planus?
Why: e.g. raised flat topped purple colored shiny itchy patches on the skin and milky white raised patches in the mouth. Mouth lesions may be painful if ulcers are present. Mouth lesions may occur on the lining of the mouth, lips, tongue or gums.
Symptoms of measles?
Why: e.g. fever, malaise, red watery eyes, runny nose, blotchy bright red rash, cough, Koplik's spots ( bluish white spots on a red base opposite the premolars inside the mouth).
Symptoms of tonsillitis?
Why: e.g. fever, sore throat, difficulty with swallowing due to pain, malaise, white pus spots on tonsils, enlarged neck lymph nodes.
Symptoms of Chronic mucocutaneous candidiasis?
Why: a distinct syndrome usually occurring in children comprising of recurrent or persistent oral thrush, finger or toe bed infection and skin infection.
Symptoms of diabetes
Why: e.g. frequent urination, excessive thirst, weight loss, fatigue - can cause recurrent mouth infections especially Candida (thrush).
Symptoms of oral candidiasis?
Why: e.g. creamy white curd-like patches in the mouth which are removed only with difficulty and leave a bleeding surface. If the infection spreads to the esophagus it may cause pain with swallowing.
Are you currently receiving care for other health problems?
Do you smoke or use smokeless tobacco products?
When did you first notice the white patches in your mouth?
Have you recently been on antibiotic therapy?
Do you have any other symptoms?
What medications are you taking?
How are white patches diagnosed?
Often an experienced dentist or doctor can tell what kind of white patch you have by its appearance, position and by asking you questions about how long you have had it etc.
Sometimes they will wish to take a biopsy of a white patch to make sure it is not something that requires more involved treatment.
What will a biopsy involve?
A biopsy is a sample of mouth tissue (eg lip, cheek, gum, tongue) that enables us to look at it under a microscope. We will use local anaesthetic to numb the area and sew it up afterwards using dissolvable stitches (sutures).
The biopsy area might be a little sore for a couple of days afterwards and you should rinse your mouth with warm salted water for a week to keep the area clean.
What can be done to help white patches heal?
As described above, there are many causes of white patches. Your dentist (or doctor) might offer you the following advice:
•Stop (or greatly reduce) smoking (smoker's keratosis);
Or will offer you the following treatment to help it heal up (or prevent it forming):
•Smoothing sharp edges on teeth (frictional keratosis);
•Remaking or relining dentures;
•Eradicating infection (such as fungal infections: candida);
I have a sore white patch, what can I do to make it more comfortable?
Occasionally, white patches can become sore. If this is the case, it is important to avoid anything that might make it worse, such as spicy or abrasive foods and alcohol.
If it remains a problem, your dentist or doctor can prescribe special mouthwashes or ointments.
Should I be worried about white patches?
Most white patches are a reaction to an irritation and are not a cause for concern. Very rarely, they can be an early sign of more serious mouth conditions (including mouth cancer). This is why it is important to seek advice from an experienced professional (your dentist or doctor) so they can help you remove possible reasons for them forming and follow up on any unusual ones.
I have a white patch that is being 'watched', how often will I need to return and what should I do between appointments?
Some people have white patches that we have some concerns about and are not sure if they will repair on their own (or after we have removed some of the possible causes of irritation).
We will explain that we are 'watching' the patch and would like you to return for a follow-up appointment (usually after 3-12 months).
It is important that you attend these appointments so we can check that the white patch has not changed.
Do heed any advice you are given about stopping smoking, and reducing a heavy alcohol intake, or cleaning the area.
Do keep an eye on the patch yourself and if you think that it has changed, or if it becomes painful or forms an ulcer or lump, please ring the dentist or doctor who is caring for you. Explain to them what you have noticed and they might decide to bring your appointment forwards. It is better that they take a look at it to stop you worrying about it.
What is leukoplakia?
Leukoplakia just means white patch in Greek. It is a term used for white patches that do not fit into any of the above categories, most of which have causes that can be avoided or treated.
If we are not sure of the cause and type of white patch we will often want to find out what is happening in the mouth or skin by taking a biopsy.
Depending on the biopsy result, we might recommend that the white patch is completely removed or carefully watched by an experienced professional to make sure that it doesn't develop into anything more serious. These options will be discussed with you carefully. .
What Is the Treatment for Leukoplakia?
Treatment for leukoplakia, if needed, involves removing the source of irritation. For example, if leukoplakia is caused by a rough tooth or an irregular surface on a denture or a filling, the tooth will be smoothed and dental appliances repaired. If leukoplakia is caused by smoking, you will be asked to minimize or stop smoking or using other tobacco products.
Leukoplakia is usually harmless, and lesions usually clear in a few weeks or months after the source of irritation is removed. If eliminating the source of irritation is ineffective in reducing leukoplakia, the lesion may need to be surgically removed. The lesion can be removed either by your general dentist or by an oral surgeon.
Hairy leukoplakia requires treatment with an antiviral medication.