Intra-oral Swellings and Abnormal Appearance
Brief description of condition
Swellings in the oral cavity can vary in speed of onset, position and extent/size. Small lumps are common and are almost always benign especially in patients under 50 years. Angioedema is an uncommon rapid onset swelling that can affect the face and may be the result of an allergic reaction (see Angioedema).
Red, white, or mixed speckled red and white patches or pigmented areas can develop in the oral cavity, varying in size, position and extent.
Key signs and symptoms
- A firm or soft lump
- Swelling may be static or increase over hours
- Swelling due to sepsis or oedema around or in the tongue or pharynx
- Ulcerated swelling
- A change in normal appearance to a red, white, or mixed red and white patch
- A pigmented area on the soft tissues or tongue e.g. black/grey/blue
Determine if the airway is compromised: speech, swallowing or breathing are restricted, the patient is unable to swallow their own saliva or they are unable to push their tongue forward out of their mouth.
If the airway is compromised
Send the patient immediately to emergency care via NHS 24 or call 999.
If the airway is not compromised
- Determine how long the altered appearance has been present.
- If a red, white or mixed speckled red and white patch or a pigmented area has been present for more than 3 weeks, refer the patient via the local rapid access pathway to investigate potential dysplasia or malignancy.
- If a red, white or mixed speckled red and white patch or a pigmented area has been present for less than 3 weeks, advise the patient to seek non-urgent dental care.
- If a lump or swelling is ulcerated or has begun to increase in size rapidly, advise the patient to seek urgent care.
Monitor symptoms at follow-up appointments.
Record altered appearance on a mouth map or with a digital camera.
Consider referral to an oral and maxillofacial surgeon or an oral medicine specialist.
For red and white patches and pigmented areas, if the lesion does not resolve in 3 weeks, refer the patient via the local rapid access pathway to investigate potential dysplasia or malignancy..