IRRITATION fibromas are caused by lip, tongue, or cheek biting or sucking. Frequently, the growth occurs opposite the small space between the teeth where the tissue can be sucked in. On the other hand, a papilloma is a benign growth that occurs on its own accord. The patient first becomes aware of the fibroma or papilloma by feeling or observing the irregularity or by frequent, accidental biting of the overgrowth of tissue.

Some people may observe a fleshy growth on either the gums or tongue or even a scaly lesion anywhere on the soft tissues of the mouth. Fortunately, most tumours of the gums and tongue are benign (non-cancerous). The most common growth is an irritation fibroma, which appears as a smooth-surfaced, pink mushroom, suspended by a small stalk attached to the lip, tongue, or inner cheek. The papilloma is also mushroom-shaped but with an irregular, white surface.

Treatment by excision (cutting out) is the usual cure. Since the diagnosis is obvious and the entire growth is removed without difficulty, a biopsy to check for cancer is not necessary. Avoidance of lip or tongue “doodling” usually prevents recurrence. If recurrence is due to a space between the teeth, then closure of the space with a small, fixed bridge may be indicated. However, once the growth is removed, it seldom recurs, and no further treatment is necessary.

Then there are bony growths, quite common in adults, in the middle of the palate or on the inside lateral or tongue side of the lower jaw. They are called tori and consist of a normal bone substance that, in the palate, appears as an irregular oval protuberance and in the mandible more or less as small single or multiple marbles beneath the mucosa. The cause is unknown and completely symptomless. Occasionally, they grow large as to be traumatized by chewing or interfering with the wearing of dentures. Most people are unaware of their presence until a dentist or dentex points them out. Unless tori cause a problem, there is no reason to have them removed. If their size becomes annoying or interferes with the placement of a denture, they are removed by simple surgery. Once removed, tori does not recur.

A hairy tongue is a harmless elongation of the hairlike filiform papillae on the tongue’s top surface. The surface usually appears white but may be stained brown or black by tobacco or pigments in food. The condition occurs only in adults. A white-coated tongue is common during a dehydration illness, but what causes a hairy tongue in the absence of systemic illness is unknown. The condition is painless and noted only for its abnormal colour. Since food particles can collect in the hairy filaments, the tongue may emit an unpleasant smell. Both treatment and prevention consist of daily brushing or scraping of the tongue to keep its surface clean.

Leukoplakia, meanwhile, should be considered more seriously. This is observed more frequently among older males, and in persons using tobacco. Although most lesions remain benign, the condition can be viewed as pre-cancerous. Lesions vary in size from a few millimetres to many centimetres (an inch or more) across. It may be flat, fissured, or ulcerated with a somewhat rough and scaly surface, and whitish yellow, pearly white, or grayish-white in colour. Leukoplakia is usually found behind and to the outside of the lower molars, on the inside of the cheeks, and the floor of the mouth or the side of the tongue.

Leukoplakia occurs spontaneously or may be caused by irritation from heavy smoking, chewing tobacco, jagged teeth, ill-fitting dentures, and poor oral hygiene. The disease develops slowly and painlessly and a dentist discovers most times with the patient unaware of the condition.

When leukoplakia appears on the tongue or floor of the mouth, there is a very high risk of it developing into invasive cancer, so complete excision is recommended with mandatory biopsy. Constant monitoring by the dentist is required.