There are many benign oral soft tissue lesions. Those included below are the lesions where specialist advice is most often sought.
PLEASE SEE PRIMARY CARE MANAGEMENT FOR DETAILS OF ASSESSMENT AND TREATMENT.
Geographic Tongue
This is a common condition that affects the surface of the tongue and is normally asymptomatic. It appears as red areas, usually surrounded by a white border. The red areas can move around the tongue. It is generally considered to be a variation of normal and it is not contagious or associated with infection. There is an association with coeliac disease and psoriasis, but these are not common co-diagnoses. If there is a family history or GI symptoms, then testing for Coeliac disease would be indicated.
Oral pigmentation
Oral pigmentation in children is commonly due to racial (physiological) pigmentation and is often seen in children with darker skin. Rarer causes of oral pigmentation are Peutz-Jeghers Syndrome ((PJS) which usually presents with peri-oral freckling in addition), Addison’s disease and oral melanoma.
Refer for Specialist review (Paediatric Gastroenterology): where oral pigmentation presents with associated systemic symptoms or positive family history of Peutz-Jeghers Syndrome. NB. Spontaneous mutations can happen i.e. with no family history.
Refer for review with Paediatric Dental Team in Lothian Oral Health Service: where there is oral pigmentation only and a second opinion is deemed necessary. Clinical photographs attached to the referral are valuable.
C.M & P.G, H.C 22-01-24
Who to refer:
GPs/primary care team should refer:
- to General Paediatrics any patient with red flags (struggling to maintain oral intake, involuntary weight loss, faltering growth, or repeated attendances at practice or A&E etc.)
- to Paediatric Gastroenterology where there is a strong suggestion of organic disease (including PJS – see above).
Those with suspected benign oral lesions needing further initial assessment should be referred to their dentist – including all referrals from health visitors and school nurses.
Who not to refer:
- Where no red flags exist, primary care assessment and reassurance is likely to be sufficient, in conjunction with signposting to patient websites (See Resources and Links).
How to refer:
- Please refer via SCI Gateway as outlined above to the relevant speciality where there are additional or concerning features.
Geographic Tongue
Assessment
- Ask about duration, if the lesion moves, any discomfort when eating sore/spicy foods.
- Examine the patient’s skin as psoriasis may also be present
- Consider if there are relevant GI symptoms.
- Clinical photographs, if appropriate, are useful (include a sizer if available) and can be attached if an onward referral is necessary.
Treatment
- No treatment required apart from avoidance of spicy/citrus foods if need be.
- Refer patients with suspected benign oral lesions to their dentist for assessment if it is felt their input is necessary.
Oral Pigmentation
Assessment
- Lesion: ask about location, duration, change in size, pain, family history
- General: ask about lethargy, faltering growth/weight, abdominal pain, additional new skin lesions/peri-oral pigmentation.
No treatment: where no systemic problems and the clinical picture is that of racial pigmentation.
The British and Irish Society for Oral Medicine – patient information and PILS
Sore or white tongue – information for patients
Association between geographic tongue and psoriasis: A systematic review and meta-analyses
Crighton AJ. Oral medicine in children. Br Dent J. 2017 Dec;223(9):706-712. doi: 10.1038/sj.bdj.2017.892. Epub 2017 Nov 3. PMID: 29097798.
