Causes of Geographic Tongue
Causes of Geographic Tongue (Diseases Database):
The follow list shows some of the possible medical causes of Geographic Tongue
that are listed by the Diseases Database:
Source: Diseases Database
Geographic Tongue Causes: Book Excerpts
Related information on causes of Geographic Tongue:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Geographic Tongue may be found in:
Causes of Geographic Tongue: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Geographic Tongue.
Stomatitis:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Aphthous stomatitis is the most common cause of recurrent oral lesions
–Presents as gray-yellow tender ulcer in anterior part of oral cavity
–Major, minor, and herpetiform subtypes
–Herpetiform ulcers: Multiple vesicles on tip
or sides of tongue
- Infectious stomatitis
–Herpes simplex virus may present as a primary infection (herpetic gingivostomatitis) with ulcers/vesicles in anterior oropharynx or as a secondary infection with “fever blisters” on lips
–Herpangina: Caused by coxsackievirus; results in 1–2 mm vesicles on soft palate that rupture to become white ulcers; seen primarily in children, may be associated with palmar and plantar lesions in hand-foot-and-mouth disease
–Syphilis (condyloma lata) results in painless oral chancres on lips, buccal mucosa, gingival
–Varicella or chicken pox
–Condylomata acuminata (warts) and molluscum contagiosum lesions resemble their characteristic genital lesions
–Primary HIV infection
–Candidiasis
- Stomatitis in immunocompromised patients
–Breakdown in epithelium results in superinfection by Candida, HSV, VZV, or CMV
–May occur secondary to chemotherapy - Stevens-Johnson syndrome
- Gangrenous stomatitis (acute necrotizing ulcerative gingivitis)
–Also known as “trench mouth”
–Primarily affects children with severe
malnourishment or debilitation
–Causative agent is most commonly a spirochete (e.g., Borrelia vincentii)
–Presents as painful, red vesicle on gingiva; progresses to necrotic ulcer, then cellulitis
-
Chronic granulomatous disease
-
Behçet syndrome (presents as recurrent oral and genital ulcers)
-
Lichen planus
-
Vitamin C deficiency
-
Cancers (e.g., mouth cancer, leukemia, mucositis following chemotherapy)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Stomatitis:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Aphthous ulcers (idiopathic)
–May be due to alteration of T-cell immune function
–Triggers include dietary substances, stress, and illness
–Nutritional deficiencies (iron, B vitamins) may play a role
–May run in families, thus making it more difficult to distinguish from herpetic lesions that have been shared among family members
–May be small or large, may be singular or grouped
- Infectious stomatitis
–Coxsackievirus: Also known as hand-footand-mouth disease; all locations of lesions may not be present; usually seen in the summer and fall
–Herpetic gingivostomatitis: Common in toddlers; may last a week or longer; generally accompanied by fever, lymphadenopathy; painful lesions may cause reduction in oral intake and resultant dehydration
–Herpangina: Caused by an enterovirus rather than human herpesvirus; lesions are present primarily on the soft palate, anterior tonsillar pillars, and posterior pharynx
–Trench mouth: also known as Vincent angina; caused by fusiform bacteria or spirochetes; causes necrotizing gingivostomatitis with pseudomembrane formation; found in developing nations and malnourished patients
-
Hematologic disorders
–Associated with leukemia
–Associated with neutropenia secondary to
chemotherapy for malignancy
–Associated with cyclic neutropenia
-
Behçet disease
-
Stevens-Johnson syndrome
-
Inflammatory bowel disease: May be found in Crohn disease or ulcerative colitis
-
HIV
–Alterations in T-cell immunity can lead to aphthous ulcers
–HIV patients are more susceptible to herpetic infections
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Mouth lesions:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Acquired immunodeficiency syndrome (AIDS)
Oral lesions may be an early indication of the immunosuppression that’s characteristic of AIDS. Fungal infections can occur, with oral candidiasis being the most common. Bacterial or viral infections of the oral mucosa, tongue, gingivae, and periodontal tissue may also occur.
The primary oral neoplasm associated with AIDS is Kaposi’s sarcoma. The tumor is usually found on the hard palate and may appear initially as an asymptomatic, flat or raised lesion, ranging in color from red to blue to purple. As these tumors grow, they may ulcerate and become painful.
Actinomycosis (cervicofacial)
Actinomycosis is a chronic fungal infection that typically produces small, firm, flat, and usually painless swellings on the oral mucosa and under the skin of the jaw and neck. Swellings may indurate and abscess, producing fistulas and sinus tracts with a characteristic purulent yellow discharge.
Behçet’s syndrome
Behçet’s syndrome is a chronic, progressive syndrome that generally affects young males and produces small, painful ulcers on the lips, gums, buccal mucosa, and tongue. In severe cases, the ulcers also develop on the palate, pharynx, and esophagus. The ulcers typically have a reddened border and are covered with a gray or yellow exudate. Similar lesions appear on the scrotum and penis or labia majora; small pustules or papules on the trunk and limbs; and painful erythematous nodules on the shins. Ocular lesions may also develop.
Candidiasis
Candidiasis is a common fungal infection that characteristically produces soft, elevated plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; the plaques may be wiped away. The lesions of acute atrophic candidiasis are red and painful. The lesions of chronic hyperplastic candidiasis are white and firm. Localized areas of redness, pruritus, and a foul odor may be present.
Discoid lupus erythematosus
Oral lesions are common, typically appearing on the tongue, buccal mucosa, and palate as erythematous areas with white spots and radiating white striae. Associated findings include skin lesions on the face, possibly extending to the neck, ears, and scalp; if the scalp is involved, alopecia may result. Hair follicles are enlarged and filled with scale.
Gender Cue:This chronic, recurrent disease is most common in women ages 30 to 40.
Erythema multiforme
Erythema multiforme is an acute inflammatory skin disease that produces a sudden onset of vesicles and bullae on the lips and buccal mucosa. Also, erythematous macules and papules form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia. Lymphadenopathy may also occur. With visceral involvement, other findings include a fever, malaise, a cough, throat and chest pain, vomiting, diarrhea, myalgia, arthralgia, fingernail loss, blindness, hematuria, and signs of renal failure.
Gingivitis (acute necrotizing ulcerative)
Gingivitis is a recurring periodontal condition that causes a sudden onset of gingival ulcers covered with a grayish white pseudomembrane. Other findings include tender or painful gingivae, intermittent gingival bleeding, halitosis, enlarged lymph nodes in the neck, and a fever.
Herpes simplex I
With primary infection, a brief period of prodromal tingling and itching, which is accompanied by a fever and pharyngitis, is followed by eruption of small and irritating vesicles on part of the oral mucosa, especially the tongue, gums, and cheeks. Vesicles form on an erythematous base and then rupture, leaving a painful ulcer, followed by a yellowish crust. Other findings include submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and keratoconjunctivitis.
Herpes zoster
Herpes zoster is a common viral infection that may produce painful vesicles on the buccal mucosa, tongue, uvula, pharynx, and larynx. Small red nodules typically erupt unilaterally around the thorax or vertically on the arms and legs, and rapidly become vesicles filled with clear fluid or pus; vesicles dry and form scabs about 10 days after eruption. A fever and general malaise accompany pruritus, paresthesia or hyperesthesia, and tenderness along the course of the involved sensory nerve.
Inflammatory fibrous hyperplasia
Inflammatory fibrous hyperplasia is a painless nodular swelling of the buccal mucosa that typically results from cheek trauma or irritation and is characterized by pink, smooth, pedunculated areas of soft tissue.
Leukoplakia, erythroplakia
Leukoplakia is a white lesion that can’t be removed simply by rubbing the mucosal surface — unlike candidiasis. It may occur in response to chronic irritation from dentures or from tobacco or pipe smoking, or it may represent dysplasia or early squamous cell carcinoma.
Erythroplakia is red and edematous and has a velvety surface. About 90% of all cases of erythroplakia are either dysplasia or cancer.
Pemphigoid (benign mucosal)
Pemphigoid is a rare autoimmune disease that’s characterized by thick-walled vesicles on the oral mucous membranes, the conjunctiva and, less commonly, the skin. Mouth lesions typically develop months or even years before other manifestations and may occur as desquamative patchy gingivitis or as a vesicobullous eruption. Secondary fibrous bands may lead to dysphagia, hoarseness, and blindness. Recurrent skin lesions include vesicobullous eruptions, usually on the inguinal area and extremities, and an erythematous, vesicobullous plaque on the scalp and face near the affected mucous membranes.
Pemphigus
Pemphigus is a chronic skin disease that’s characterized by thin-walled vesicles and bullae that appear in cycles on skin or mucous membranes that otherwise appear normal. On the oral mucosa, bullae rupture, leaving painful lesions and raw patches that bleed easily. Associated findings include bullae anywhere on the body, denudation of the skin, and pruritus.
Pyogenic granuloma
Typically the result of injury, trauma, or irritation, pyogenic granuloma — a soft, tender nodule, papule, or polypoid mass of excessive granulated tissue — usually appears on the gingivae, but can also erupt on the lips, tongue, or buccal mucosa. The lesions bleed easily because they contain many capillaries. The affected area may be smooth or have a warty surface; erythema develops in the surrounding mucosa. The lesions may ulcerate, producing a purulent exudate.
Squamous cell carcinoma
Squamous cell carcinoma is typically a painless ulcer with an elevated, indurated border. It may erupt in areas of leukoplakia and is most common on the lower lip, but it may also occur on the edge of the tongue or floor of the mouth. High risk factors include chronic smoking and alcohol intake.
Stomatitis (aphthous)
Stomatitis, a common disease, is characterized by painful ulcerations of the oral mucosa, usually on the dorsum of the tongue, gingivae, and hard palate.
With recurrent aphthous stomatitis minor, the ulcer begins as one or more erosions covered by a gray membrane and surrounded by a red halo. It’s commonly found on the buccal and lip mucosa and junction, tongue, soft palate, pharynx, gingivae, and all places not bound to the periosteum.
With recurrent aphthous stomatitis major, large, painful ulcers commonly occur on the lips, cheek, tongue, and soft palate; they may last up to 6 weeks and leave a scar.
Syphilis
Primarysyphilis typically produces a solitary painless, red ulcer (chancre) on the lip, tongue, palate, tonsil, or gingivae. The ulcer appears as a crater with undulated, raised edges and a shiny center; lip chancres may develop a crust. Similar lesions may appear on the fingers, breasts, or genitals, and regional lymph nodes may become enlarged and tender.
During the secondary stage, multiple painless ulcers covered by a grayish white plaque may erupt on the tongue, gingivae, or buccal mucosa. A macular, papular, pustular, or nodular rash appears, usually on the arms, trunk, palms, soles, face, and scalp; genital lesions usually subside. Other findings include generalized lymphadenopathy, a headache, malaise, anorexia, weight loss, nausea, vomiting, a sore throat, a low-grade fever, metrorrhagia, and postcoital bleeding.
At the tertiarystage, lesions (usually gummas — chronic, painless, superficial nodules or deep granulomatous lesions) develop on the skin and mucous membranes, especially the tongue and palate.
Systemic lupus erythematosus
Oral lesions are common and appear as erythematous areas associated with edema, petechiae, and superficial ulcers with a red halo and a tendency to bleed. Primary effects include nondeforming arthritis, a butterfly rash across the nose and cheeks, and photosensitivity.
Other causes
Drugs
Various chemotherapeutic agents can directly produce stomatitis. Also, allergic reactions to penicillin, sulfonamides, gold, quinine, streptomycin, phenytoin, aspirin, and barbiturates commonly cause lesions to develop and erupt. Inhaled steroids used for pulmonary disorders can also cause oral lesions.
Radiation therapy
Radiation therapy may cause oral lesions.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Stomatitis and other oral infections:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Acute herpetic stomatitis results from the herpes simplex virus. It’s common in children ages 1 to 3. The cause of aphthous stomatitis is unknown, but predisposing factors include stress, fatigue, anxiety, febrile states, trauma, and solar overexposure. This type is common in girls and female adolescents.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Mouth lesions:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acquired immunodeficiency syndrome (AIDS)
Oral lesions may be an early indication of the immunosuppression that’s characteristic of this disease. Fungal infections can occur, with oral candidiasis being the most common. Bacterial or viral infections of oral mucosa, tongue, gingivae, and periodontal tissue may also occur.
The primary oral neoplasm associated with AIDS is Kaposi’s sarcoma. The tumor is usually found on the hard palate and may appear initially as an asymptomatic, flat or raised lesion, ranging in color from red to blue to purple. As these tumors grow, they may ulcerate and become painful.
Actinomycosis (cervicofacial)
This chronic fungal infection typically produces small, firm, flat, usually painless swellings on the oral mucosa and under the skin of the jaw and neck. Swellings may indurate and abscess, producing fistulas and sinus tracts with a characteristic purulent yellow discharge.
Behçet’s syndrome
This chronic, progressive syndrome that generally affects young males produces small, painful ulcers on the lips, gums, buccal mucosa, and tongue. In severe cases, the ulcers also develop on the palate, pharynx, and esophagus. The ulcers typically have a reddened border and are covered with a gray or yellow exudate. Similar lesions appear on the scrotum and penis or labia majora; small pustules or papules on the trunk and limbs; and painful erythematous nodules on the shins. Ocular lesions may also develop.
Candidiasis
This common fungal infection characteristically produces soft, elevated plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; the plaques may be wiped away. The lesions of acute atrophic candidiasis are red and painful. The lesions of chronic hyperplastic candidiasis are white and firm. Localized areas of redness, pruritus, and foul odor may be present.
Discoid lupus erythematosus
Oral lesions are common, typically appearing on the tongue, buccal mucosa, and palate as erythematous areas with white spots and radiating white striae. Associated findings include skin lesions on the face, possibly extending to the neck, ears, and scalp; if the scalp is involved, alopecia may result. Hair follicles are enlarged and filled with scale.
Gender Cue: This chronic, recurrent disease is most common in women ages 30 to 40.
Epulis (giant cell)
This rare tumor or growth occurs on the gingival or alveolar process, anterior to the molars. Dark red, pedunculated or sessile, and 0.5 to 1.5 cm in diameter, it commonly ulcerates to produce a concave defect in the underlying bone. Gingivae bleed easily with slight trauma.
Erythema multiforme
This acute inflammatory skin disease produces sudden onset of vesicles and bullae on the lips and buccal mucosa. Also, erythematous macules and papules form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia. Lymphadenopathy may also occur. With visceral involvement, other findings include fever, malaise, cough, throat and chest pain, vomiting, diarrhea, myalgias, arthralgias, fingernail loss, blindness, hematuria, and signs of renal failure.
Gingivitis (acute necrotizing ulcerative)
This recurring periodontal condition causes a sudden onset of gingival ulcers covered with a grayish white pseudomembrane. Other findings include tender or painful gingivae, intermittent gingival bleeding, halitosis, enlarged lymph nodes in the neck, and fever.
Gonorrhea
Painful lip ulcerations may occur, along with rough, reddened, bleeding gingivae (possibly necrotic and covered by a yellowish pseudomembrane), and a swollen, ulcerated tongue. Related effects vary. Most men develop dysuria, purulent urethral discharge, and a reddened, edematous urinary meatus. Most women remain asymptomatic, but others develop inflammation and a greenish yellow cervical discharge.
Herpes simplex 1
With primary infection, a brief period of prodromal tingling and itching, which is accompanied by fever and pharyngitis, is followed by eruption of small and irritating vesicles on any part of the oral mucosa, especially the tongue, gums, and cheeks. Vesicles form on an erythematous base and then rupture, leaving a painful ulcer, followed by a yellowish crust. Other findings include submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and keratoconjunctivitis.
Herpes zoster
This common viral infection may produce painful vesicles on the buccal mucosa, tongue, uvula, pharynx, and larynx. Small red nodules often erupt unilaterally around the thorax or vertically on the arms and legs, and rapidly become vesicles filled with clear fluid or pus; vesicles dry and form scabs about 10 days after eruption. Fever and general malaise accompany pruritus, paresthesia or hyperesthesia, and tenderness along the course of the involved sensory nerve.
Inflammatory fibrous hyperplasia
This painless nodular swelling of the buccal mucosa typically results from cheek trauma or irritation and is characterized by pink, smooth, pedunculated areas of soft tissue.
Leukoplakia, erythroplakia
Leukoplakia is a white lesion that cannot be removed simply by rubbing the mucosal surface—unlike candidiasis. It may occur in response to chronic irritation from dentures or tobacco or pipe smoking, or it may represent dysplasia or early squamous cell carcinoma.
Erythroplakia is red and edematous and has a velvety surface. About 90% of all cases of erythroplakia are either dysplasia or cancer.
Lichen planus
Oral lesions develop on the buccal mucosa or, less commonly, on the tongue as painless, white or gray, velvety, threadlike papules. These precede the eruption of violet papules with white lines or spots, usually on the genitalia, lower back, ankles, and anterior lower legs; pruritus; nails with longitudinal ridges; and alopecia.
Mucous duct obstruction
Obstruction produces a ranula—a painless, slow-growing mucocele on the floor of the mouth near the ducts of the submandibular and sublingual glands.
Pemphigoid (benign mucosal)
This rare autoimmune disease is characterized by thick-walled vesicles on the oral mucous membranes, the conjunctiva and, less often, the skin. Mouth lesions typically develop months or even years before other manifestations and may occur as desquamative patchy gingivitis or as a vesicobullous eruption. Secondary fibrous bands may lead to dysphagia, hoarseness, and blindness. Recurrent skin lesions include vesicobullous eruptions, usually on the inguinal area and extremities, and an erythematous, vesicobullous plaque on the scalp and face near the affected mucous membranes.
Pemphigus
This chronic skin disease is characterized by thin-walled vesicles and bullae that appear in cycles on skin or mucous membranes that otherwise appear normal. On the oral mucosa, bullae rupture, leaving painful lesions and raw patches that bleed easily. Associated findings include bullae anywhere on the body, denudation of the skin, and pruritus.
Pyogenic granuloma
Commonly the result of injury, trauma, or irritation, this soft, tender nodule, papule, or polypoid mass of excessive granulation tissue usually appears on the gingivae but can also erupt on the lips, tongue, or buccal mucosa. The lesions bleed easily because they contain many capillaries. The affected area may be smooth or have a warty surface; erythema develops in the surrounding mucosa. The lesions may ulcerate, producing a purulent exudate.
Squamous cell carcinoma
This is typically a painless ulcer with an elevated, indurated border. It may erupt in areas of leukoplakia and is most common on the lower lip, but it may also occur on the edge of the tongue or the floor of the mouth. High risk factors include chronic smoking and alcohol intake.
Stomatitis (aphthous)
This common disease is characterized by painful ulcerations of the oral mucosa, usually on the dorsum of the tongue, gingivae, and hard palate.
With recurrent aphthous stomatitis minor, the ulcer begins as one or more erosions covered by a gray membrane and surrounded by a red halo. It’s commonly found on the buccal and lip mucosa and junction, tongue, soft palate, pharynx, gingivae, and all places not bound to the periosteum.
With recurrent aphthous stomatitis major, large, painful ulcers commonly occur on the lips, cheek, tongue, and soft palate; they may last up to 6 weeks and leave a scar.
Syphilis
Primary syphilis typically produces a solitary painless, red ulcer (chancre) on the lip, tongue, palate, tonsil, or gingivae. The ulcer appears as a crater with undulated, raised edges and a shiny center; lip chancres may develop a crust. Similar lesions may appear on the fingers, breasts, or genitals, and regional lymph nodes may become enlarged and tender.
During the secondary stage, multiple painless ulcers covered by a grayish white plaque may erupt on the tongue, gingivae, or buccal mucosa. A macular, papular, pustular, or nodular rash appears, usually on the arms, trunk, palms, soles, face, and scalp; genital lesions usually subside. Other findings include generalized lymphadenopathy, headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, low fever, metrorrhagia, and postcoital bleeding.
At the tertiarystage, lesions (often chronic, painless, superficial nodules or deep granulomatous lesions, called gummas) develop on the skin and mucous membranes, especially the tongue and palate.
Systemic lupus erythematosus
Oral lesions are common and appear as erythematous areas associated with edema, petechiae, and superficial ulcers with a red halo and a tendency to bleed. Primary effects include nondeforming arthritis, butterfly rash across the nose and cheeks, and photosensitivity.
Trauma
The most common cause of oral lesions, trauma can produce ulcers anywhere in the mouth, especially on the tongue and buccal mucosa.
Tuberculosis (oral mucosal)
This rare disorder produces a painless ulcer (usually on the tongue) and, sometimes, caseation. Other findings include lymphadenopathy, fatigue, weakness, anorexia, weight loss, cough, low fever, and night sweats.
Other causes
Drugs
Various chemotherapeutic agents can directly produce stomatitis. Also, allergic reactions to penicillin, sulfonamides, gold, quinine, streptomycin, phenytoin, aspirin, and barbiturates commonly cause lesions to develop and erupt. Inhaled steroids used for pulmonary disorders can also cause oral lesions.
Orthodontics
The rubbing of orthodontic equipment or prosthesis on the buccal mucosa may cause eroded, tender areas.
Radiation therapy
Radiation therapy may cause oral lesions.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Stomatitis and other oral infections:
Causes
(Handbook of Diseases)
Acute herpetic stomatitis results from herpes simplex virus. The cause of aphthous stomatitis is unclear.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Mouth lesions:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acquired immunodeficiency syndrome
Oral lesions may be an early indication of the immunosuppression that’s characteristic of acquired immunodeficiency syndrome (AIDS). Fungal infections can occur, with oral candidiasis being the most common. Bacterial or viral infections of oral mucosa, tongue, gingivae, and periodontal tissue may also occur.
The primary oral neoplasm associated with AIDS is Kaposi’s sarcoma. The tumor is usually found on the hard palate. Initially producing no symptoms, it may appear as a flat or raised lesion, ranging in color from red to blue to purple. As these tumors grow, they may ulcerate and become painful.
Candidiasis
Candidiasis, a common fungal infection, characteristically produces soft, elevated plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; the plaques may be wiped away. The lesions of acute atrophic candidiasis are red and painful. The lesions of chronic hyperplastic candidiasis are white and firm. Localized areas of redness, pruritus, and foul odor may be present.
Discoid lupus erythematosus
Oral lesions are common in discoid lupus erythematosus. They typically appear on the tongue, buccal mucosa, and palate as erythematous areas with white spots and radiating white striae. Associated findings include skin lesions on the face, possibly extending to the neck, ears, and scalp; if the scalp is involved, alopecia may result. Hair follicles are enlarged and filled with scale.
Erythema multiforme
Erythema multiforme, an acute inflammatory skin disease, produces sudden onset of vesicles and bullae on the lips and buccal mucosa. Also, erythematous macules and papules form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia. Lymphadenopathy may also occur. With visceral involvement, other findings include fever, malaise, cough, throat and chest pain, vomiting, diarrhea, myalgia, arthralgia, fingernail loss, blindness, hematuria, and signs of renal failure.
Gingivitis (acute necrotizing ulcerative)
Gingivitis, a recurring periodontal condition, causes a sudden onset of gingival ulcers covered with a grayish white pseudomembrane. Other findings include tender or painful gingivae, intermittent gingival bleeding, halitosis, enlarged lymph nodes in the neck, and fever.
Gonorrhea
With gonorrhea, painful lip ulcerations may occur, along with rough, reddened, bleeding gingivae (possibly necrotic and covered by a yellowish pseudomembrane), and a swollen, ulcerated tongue. Related effects vary. Most men develop dysuria, purulent urethral discharge, and a reddened, edematous urinary meatus. Most women remain asymptomatic, but others develop inflammation and a greenish yellow cervical discharge.
Herpes simplex 1
With primary herpes simplex infection, a brief period of prodromal tingling and itching, which is accompanied by fever and pharyngitis, is followed by eruption of small and irritating vesicles on any part of the oral mucosa, especially the tongue, gums, and cheeks. Vesicles form on an erythematous base and then rupture, leaving a painful ulcer, followed by a yellowish crust. Other findings include submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and keratoconjunctivitis.
Herpes zoster
Herpes zoster is a common viral infection that may produce painful vesicles on the buccal mucosa, tongue, uvula, pharynx, and larynx. Small, red nodules usually erupt unilaterally around the thorax or vertically on the arms and legs and rapidly become vesicles filled with clear fluid or pus; vesicles dry and form scabs about 10 days after eruption. Fever and general malaise accompany pruritus, paresthesia or hyperesthesia, and tenderness along the course of the involved sensory nerve.
Leukoplakia, erythroplakia
Leukoplakia is a white lesion that can’t be removed simply by rubbing the mucosal surface — unlike candidiasis. It may occur in response to chronic irritation from dentures or tobacco or pipe smoking, or it may represent dysplasia or early squamous cell carcinoma.
Erythroplakia is red and edematous and has a velvety surface. About 90% of erythroplakia cases are either dysplasia or cancer.
Lichen planus
With lichen planus, oral lesions develop on the buccal mucosa or, less commonly, on the tongue as painless, white or gray, velvety, threadlike papules. These precede the eruption of violet papules with white lines or spots, usually on the genitalia, lower back, ankles, and anterior lower legs; pruritus; nails with longitudinal ridges; and alopecia.
Squamous cell carcinoma
A squamous cell carcinoma is typically a painless ulcer with an elevated, indurated border. It may erupt in areas of leukoplakia and is most common on the lower lip, but it may also occur on the edge of the tongue or the floor of the mouth. High risk factors include chronic smoking and alcohol intake.
Stomatitis (aphthous)
Aphthous stomatitis is a common disease characterized by painful ulcerations of the oral mucosa, usually on the dorsum of the tongue, gingivae, and hard palate.
With recurrent aphthous stomatitis minor, the ulcer begins as one or more erosions covered by a gray membrane and surrounded by a red halo. It’s commonly found on the buccal and lip mucosa and junction, tongue, soft palate, pharynx, gingivae, and all places not bound to the periosteum.
With recurrent aphthous stomatitis major, large, painful ulcers commonly occur on the lips, cheek, tongue, and soft palate; they may last up to 6 weeks and leave a scar.
Syphilis
Primarysyphilis typically produces a solitary painless, red ulcer (chancre) on the lip, tongue, palate, tonsil, or gingivae. The ulcer appears as a crater with undulated, raised edges and a shiny center; lip chancres may develop a crust. Similar lesions may appear on the fingers, breasts, or genitals, and regional lymph nodes may become enlarged and tender.
During the secondary stage, multiple painless ulcers covered by a grayish white plaque may erupt on the tongue, gingivae, or buccal mucosa. A macular, papular, pustular, or nodular rash appears, usually on the arms, trunk, palms, soles, face, and scalp; genital lesions usually subside. Other findings include generalized lymphadenopathy, headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, low fever, metrorrhagia, and postcoital bleeding.
At the tertiarystage, lesions (usually gummas — chronic, painless, superficial nodules or deep granulomatous lesions) develop on the skin and mucous membranes, especially the tongue and palate.
Systemic lupus erythematosus
Oral lesions are common with systemic lupus erythematosus (SLE) and appear as erythematous areas associated with edema, petechiae, and superficial ulcers with a red halo and a tendency to bleed. Primary effects include nondeforming arthritis, butterfly rash across the nose and cheeks, and photosensitivity.
Other causes
Drugs
Various chemotherapeutic agents can directly produce stomatitis. Also, allergic reactions to penicillin, sulfonamides, gold, quinine, streptomycin, phenytoin, aspirin, and barbiturates commonly cause lesions to develop and erupt. Inhaled steroids used for pulmonary disorders can also cause oral lesions.
Treatments
Radiation therapy may cause oral lesions.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Mouth lesions:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acquired immunodeficiency syndrome (AIDS).Oral lesions may be an early indication of the immunosuppression that's characteristic of AIDS. Fungal infections can occur, with oral candidiasis being the most common. Bacterial or viral infections of the oral mucosa, tongue, gingivae, and periodontal tissue may also occur.
The primary oral neoplasm associated with AIDS is Kaposi's sarcoma. The tumor is usually found on the hard palate and may appear initially as a flat or raised lesion that produces no symptoms and ranges from red to blue to purple. As these tumors grow, they may ulcerate and become painful.
Actinomycosis (cervicofacial).Actinomycosisis a chronic fungal infection that typically produces small, firm, flat, and usually painless swellings on the oral mucosa and under the skin of the jaw and neck. Swellings may indurate and abscess, producing fistulas and sinus tracts with a characteristic purulent yellow discharge.
Behçet's syndrome.Behçet's syndrome produces small, painful ulcers on the lips, gums, buccal mucosa, and tongue. In severe cases, the ulcers also develop on the palate, pharynx, and esophagus. The ulcers typically have a reddened border and are covered with a gray or yellow exudate. Similar lesions appear on the scrotum and penis or labia majora; small pustules or papules on the trunk and limbs; and painful erythematous nodules on the shins. Ocular lesions may also develop.
Candidiasis.Candidiasis characteristically produces soft, elevated plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; the plaques may be wiped away. The lesions of acute atrophic candidiasis are red and painful. The lesions of chronic hyperplastic candidiasis are white and firm. Localized areas of redness, pruritus, and a foul odor may be present.
Discoid lupus erythematosus.Oral lesions are common with discoid lupus erythematosus, typically appearing on the tongue, buccal mucosa, and palate as erythematous areas with white spots and radiating white striae. Associated findings include skin lesions on the face, possibly extending to the neck, ears, and scalp; if the scalp is involved, alopecia may result. Hair follicles are enlarged and filled with scales.
Erythema multiforme.Erythema multiforme produces a sudden onset of vesicles and bullae on the lips and buccal mucosa. Also, erythematous macules and papules form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia. Lymphadenopathy may also occur. With visceral involvement, other findings include fever, malaise, cough, throat and chest pain, vomiting, diarrhea, myalgia, arthralgia, fingernail loss, blindness, hematuria, and signs of renal failure.
Gingivitis (acute necrotizing ulcerative).Gingivitiscauses a sudden onset of gingival ulcers covered with a grayish white pseudomembrane. Other findings include tender or painful gingivae, intermittent gingival bleeding, halitosis, enlarged lymph nodes in the neck, and fever.
Herpes simplex I.With primary herpes simplex I infection, a brief period of prodromal tingling and itching, which is accompanied by fever and pharyngitis, is followed by eruption of small and irritating vesicles on part of the oral mucosa, especially the tongue, gums, and cheeks. Vesicles form on an erythematous base and then rupture, leaving a painful ulcer, followed by a yellowish crust. Other findings include submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and keratoconjunctivitis.
Herpes zoster.Herpes zoster may produce painful vesicles on the buccal mucosa, tongue, uvula, pharynx, and larynx. Small red nodules typically erupt unilaterally around the thorax or vertically on the arms and legs, and rapidly become vesicles filled with clear fluid or pus; vesicles dry and form scabs about 10 days after eruption. Fever and general malaise accompany pruritus, paresthesia or hyperesthesia, and tenderness along the course of the involved sensory nerve.
Inflammatory fibrous hyperplasia.Inflammatory fibrous hyperplasia is a painless nodular swelling of the buccal mucosa characterized by pink, smooth, pedunculated areas of soft tissue.
Leukoplakia, erythroplakia.Leukoplakia is a white lesion that can't be removed simply by rubbing the mucosal surface—unlike candidiasis. It may occur in response to chronic irritation from dentures or from tobacco use or pipe smoking, or it may represent dysplasia or early squamous cell carcinoma.
Erythroplakia is red and edematous and has a velvety surface. About 90% of all cases of erythroplakia are either dysplasia or cancer.
Pemphigoid (benign mucosal).Pemphigoid is characterized by thick-walled vesicles on the oral mucous membranes, the conjunctiva and, less commonly, the skin. Mouth lesions typically develop months or even years before other manifestations and may occur as desquamative patchy gingivitis or as a vesicobullous eruption. Secondary fibrous bands may lead to dysphagia, hoarseness, and blindness. Recurrent skin lesions include vesicobullous eruptions, usually on the inguinal area and extremities, and an erythematous, vesicobullous plaque on the scalp and face near the affected mucous membranes.
Pemphigus.Pemphigus is characterized by thin-walled vesicles and bullae that appear in cycles on skin or mucous membranes that otherwise appear normal. On the oral mucosa, bullae rupture, leaving painful lesions and raw patches that bleed easily. Associated findings include bullae anywhere on the body, denudation of the skin, and pruritus.
Pyogenic granuloma.Pyogenic granuloma is a soft, tender nodule, papule, or polypoid mass of excessive granulated tissue that usually appears on the gingivae, but can also erupt on the lips, tongue, or buccal mucosa. The lesions bleed easily because they contain many capillaries. The affected area may be smooth or have a warty surface; erythema develops in the surrounding mucosa. The lesions may ulcerate, producing a purulent exudate.
Squamous cell carcinoma.Squamous cell carcinoma is typically a painless ulcer with an elevated, indurated border. It may erupt in areas of leukoplakia and is most common on the lower lip, but it may also occur on the edge of the tongue or floor of the mouth. High risk factors include chronic tobacco use and alcohol intake.
Stomatitis (aphthous).Stomatitis is characterized by painful ulcerations of the oral mucosa, usually on the dorsum of the tongue, gingivae, and hard palate.
With recurrent aphthous stomatitis minor, the ulcer begins as one or more erosions covered by a gray membrane and surrounded by a red halo. It's commonly found on the buccal and lip mucosa and junction, tongue, soft palate, pharynx, gingivae, and all places not bound to the periosteum.
With recurrent aphthous stomatitis major, large, painful ulcers commonly occur on the lips, cheek, tongue, and soft palate; they may last up to 6 weeks and leave ascar.
Syphilis.Primary syphilis typically produces a solitary painless, red ulcer (chancre) on the lip, tongue, palate, tonsil, or gingivae. The ulcer appears as a crater with undulated, raised edges and a shiny center; lip chancres may develop a crust. Similar lesions may appear on the fingers, breasts, or genitals, and regional lymph nodes may become enlarged and tender.
During the secondarystage, multiple painless ulcers covered by a grayish white plaque may erupt on the tongue, gingivae, or buccal mucosa. A macular, papular, pustular, or nodular rash appears, usually on the arms, trunk, palms, soles, face, and scalp; genital lesions usually subside. Other findings include generalized lymphadenopathy, headache, malaise, anorexia, weight loss, nausea, vomiting, a sore throat, low-grade fever, metrorrhagia, and postcoital bleeding.
At the tertiarystage, lesions (usually gummas—chronic, painless, superficial nodules or deep granulomatous lesions) develop on the skin and mucous membranes, especially the tongue and palate.
Systemic lupus erythematosus (SLE).Oral lesions are common with SLE and appear as erythematous areas associated with edema, petechiae, and superficial ulcers with a red halo and a tendency to bleed. Primary effects include nondeforming arthritis, a butterfly rash across the nose and cheeks, and photosensitivity.
Other causes
Drugs.Various chemotherapeutic agents can directly produce stomatitis. Also, allergic reactions to penicillin, sulfonamides, gold, quinine, streptomycin, phenytoin, aspirin, and barbiturates commonly cause lesions to develop and erupt. Inhaled steroids used for pulmonary disorders can also cause oral lesions.
Radiation therapy.Radiation therapy may cause oral lesions.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
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