ORAL MEDICINE : Managing Patients with Red or Red-White Oral Lesions

1. Common causes of mucosal redness (erythema) include: 
  • Vasodilation: increased blood vessel diameter commonly occurring with inflammation, but also possible with neoplasia 
  • Vascular proliferation: increased number of blood vessels due to release of growth factors, such as vascular endothelial growth factor (VEGF), during inflammation and as part of neoplasia 
  • Leaky blood vessels (bleeding into tissue): due to trauma, occasionally due to an immune response 
  • Epithelial thinning (atrophy and/or reduced epithelial keratinization): due to abnormal cell turnover during normal healing, in response to trauma, or as part of dysplasia 
2. A mixture of red and white lesions suggests an irregular epithelial surface that may be caused by a variety of processes, including chronic trauma, inflammation and neoplasia. 




Any age, but more common in adults 


1. Signs of potential precancerous or malignant processes include: 

2. Colour: homogeneous red (erythroplakia) or mixed red and white (erythroleukoplakia); may appear lacy 
  • Surface anatomy: flat, elevated, mass, ulceration 
  • Surface texture: smooth, velvety, verrucous or ulcerated 
  • Consistency: indurated or non-indurated 
  • Tissue fragility 
  • Paresthesia, numbness, discomfort, sensitivity to spicy/acidic foods 
  • Nonhealing ulcer present for more than 2 weeks 
3. Highest intraoral risk sites for neoplasia are lateral and ventral surfaces of the tongue, floor of mouth and retromolar area. Waldeyer tonsillar ring (tonsils, base of tongue) at increased risk. 

4. Location: single site, multiple sites, bilateral or unilateral presentation. Malignancies are less commonly bilateral.

Canadian Dental Association 
Joel B. Epstein, DMD, MSD, FRCD, FDS RCSE; Sara Gordon, DDS, MSc, FRDC


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