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White, Red & Reactive Lesions Chapter: White, Red and Reactive Mucosal Lesions
🖨 Print or save as PDF Updated 2026-10-20
White lesions Lesion Clues Leukoedema Filmy gray-white buccal mucosa that fades when stretched; harmless Linea alba, frictional keratosis, cheek biting Along the occlusal line or a source of rubbing; resolves when the cause stops Nicotine stomatitis White palate with red dots (inflamed minor salivary duct openings) in pipe or cigar smokers; reversible Smokeless tobacco keratosis Wrinkled white mucosa where the tobacco is held (vestibule) White sponge nevus Thick, folded white buccal mucosa from childhood, family history (keratin 4/13 genes); benign Leukoplakia White plaque that cannot be characterized as any other condition: a clinical term requiring biopsy
Red and pigmented lesions Lesion Clues Erythroplakia Red patch not explained by other causes; most likely of all lesions to already be severe dysplasia or carcinoma at biopsy Geographic tongue (erythema migrans) Red patches with white borders that move over days; often with fissured tongue Median rhomboid glossitis Red rhomboid area in the midline dorsal tongue in front of the circumvallate papillae; associated with Candida Vascular lesions (hemangioma, vascular malformation, varix) Blanch with pressure (diascopy) Amalgam tattoo Most common oral pigmentation; blue-gray, next to restorations or old extraction sites; may show radiopaque particles Melanotic macule Small, flat, brown, stable, often the lower lip; biopsy if changing to rule out melanoma
Reactive growths Lesion Site and features Irritation (traumatic) fibroma Most common soft tissue mass; firm, smooth, along the bite line of the buccal mucosa Pyogenic granuloma Bleeds easily, red, often ulcerated; gingiva most often; 'pregnancy tumor' when hormones contribute Peripheral giant cell granuloma Gingiva or alveolar ridge only; purple-red; can cup the underlying bone Peripheral ossifying fibroma Gingiva only, often interdental papilla, teens and young adults; calcifications; recurs if not removed to periosteum Epulis fissuratum Folds of tissue around an ill-fitting denture flange Mucocele Lower lip most often; bluish, fluctuant; from a ruptured minor salivary duct (extravasation) Ranula Mucocele of the floor of the mouth from the sublingual gland; 'plunging' ranula passes through the mylohyoid into the neck
⚠️ Common traps Leaving leukoplakia undiagnosed because it looks benign: leukoplakia needs a biopsy. Calling a red patch 'irritation' without a plan: erythroplakia must be biopsied. Diagnosing a peripheral giant cell granuloma outside the gingiva or alveolar ridge. Removing a mucocele without the feeding minor gland (it recurs). Mini-quiz Pick an answer to see right away whether it is correct and why.
A gray-white film on both buccal mucosae disappears when the cheek is stretched. Diagnosis?
A. Leukoplakia B. White sponge nevus C. Leukoedema D. Lichen planus
A pregnant patient has a bleeding red gingival growth between the maxillary incisors. Most likely:
A. Peripheral ossifying fibroma B. Irritation fibroma C. Amalgam tattoo D. Pyogenic granuloma
Which reactive lesion occurs ONLY on the gingiva or alveolar ridge?
A. Pyogenic granuloma B. Irritation fibroma C. Mucocele D. Peripheral giant cell granuloma
A fluctuant blue swelling in the floor of the mouth lateral to the midline is most likely a:
A. Mucocele of the lower lip B. Ranula C. Dermoid cyst D. Pleomorphic adenoma
Which red lesion is most likely to show severe dysplasia or carcinoma when biopsied?
A. Geographic tongue B. Median rhomboid glossitis C. Hemangioma D. Erythroplakia
0 of 5 answered
Answer key: 1 C · 2 D · 3 D · 4 B · 5 D
