Oral problems

Dr Phil Marazzi, a GP in East Horsley, Surrey


This girl developed an annoying lesion on the inside of her cheek after wearing a brace for some time. Given her young age, it was very unlikely to be anything sinister, but it was excised and proved to be a benign fibroepithelial polyp, requiring no other treatment.


Having a tonsillectomy unfortunately does not stop future sore throats, as can be seen in this patient with a nasty pharyngitis many years after a tonsillectomy.

The decision about prescribing antibiotics should be made based on the usual criteria. A swab taken in this case failed to grow a bacterial infection, therefore no antibiotic was prescribed.

Mouth ulcer

This elderly lady was being treated with a COX-2 inhibitor for her osteoarthritis. She developed a series of nasty ulcers.

Despite symptomatic topical treatment with an antiseptic mouthwash and steroid mouth gel, the ulcers only settled when she stopped the drug.

Other treatments that may be used in persistent or severe oral ulcers include oral steroids, tetracycline mouth washes and even oral immunosuppressants.

Pyogenic granuloma

This elderly woman presented with a rather alarming lesion growing from her gum over a period of a few weeks.

She was referred to the maxillo-facial surgeons for excision. The diagnosis was confirmed as a benign pyogenic granuloma, requiring no further treatment. Its appearance is quite similar to other lesions of this type, normally seen growing from the skin.

Geographical tongue

This presentation of geographical tongue is quite a common appearance that this patient seems to develop whenever he is ill. It is not significant and reassurance is all that is required.

Geographical tongue may also be triggered by certain foods, allergies and minor injuries. It should be noted that conditions such as oral candidiasis may have a similar appearance.

A swab may confirm this diagnosis, although in fact the diagnosis is usually made on the history.

Torn palate

This two-year-old girl fell with her mouth open and sustained this nasty tear to her soft palate. In spite of this, she remained calm allowing me to take this photograph.

She was referred for surgical repair and did very well.

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