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Section Questions and Answers

Growths and Tumours

"The mouth is a mirror of health or disease, a sentinel or early warning system...a potential source of pathology affecting other systems and organs...less common, but very serious, are oral and pharyngeal (throat) cancers" - U.S. Surgeon General's Report

  • This section deals with only some of the more common tumours and growths that can occur in the mouth.
    • Tumours and growths are called hard or soft depending on their origin and consistency.
    • Examples are hard bone and soft gum tumours.

The information will be presented under three headings:

  • A. Growths

  • These are also called swellings or lumps.
  • They result from infections or irritations of the tissues.
  • B. Non-cancerous Tumours

  • These are caused by an increase in the number of cells, leading to an enlargement of an area of the body.
  • C. Cancerous Tumours

  • These are made up of cells that are abnormal in shape, size and number.
  • They multiply uncontrollably and spread to other parts of the body.
  • These tumours destroy normal body function.

A. Growths

  1. What is an abscess?
  2. What is a cyst?
  3. What is an epulis?
  4. What is a granuloma?
  5. What is an irritation (denture) hyperplasia?
  6. What is a mucocoele?
  7. What is a haemangioma?

 
1. What is an Abscess?

  • This is a soft, pus containing swelling.The causes can be:
  • The symptoms of an abscess are:
    • It will be a red swollen area that is tender to touch.
    • The tooth over or around it may be painful to chew or bite on.
    • It can cause a severe throbbing pain.

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Abscess

See Abscess, Toothache and Gum Disease

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2. What is a Cyst?

  • A cyst is a soft swelling that contains fluid.
    • It occurs in the gums near or around the teeth.
    • It is not tender or painful, unless it becomes infected.
    • A radicular cyst forms around the apex of a root of a permanent tooth, in which the nerves and blood vessels have died.
    • There are many types of cysts.
    • They can be accurately diagnosed and treated by the dentist.

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Cyst
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Cyst (dark area)

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3. What is an Epulis?

  • This is a growth consisting of irregular nodules that project out from the gum.
    • It is connected to the gum by a narrower stem, near the tooth.
    • It varies in colour from pink to red, and is associated with chronic irritation.
    • It may start during pregnancy, and may eventually disappear slowly.
    • There are several different types of epulis.
    • They are usually removed surgically.

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Epulis

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4. What is a Granuloma?

  • This is a nodular, fleshy swelling occurring in the gingiva (gums), close to the tooth.
    • It can be tender to the touch, but is usually not very painful.
    • It results from chronic irritation or injury, but may also appear during pregnancy.
    • It can be treated by surgery.

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Granuloma

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5. What is an irritation hyperplasia?

  • This is also called denture hyperplasia.
  • It is an overgrowth of tissue caused by repeated, ongoing injury and ulceration.
    • The problem is caused by an ill-fitting denture.
    • It is treated by the removal of the growth, and adjustment or renewal of the denture.

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6. What is Mucocoele?

  • This is a small cyst that mostly occurs in the lower lip.
    It removed by surgery.

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Mucocoele

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7. What is a haemangioma?

  • This is a blood vessel lesion that is caused by an abnormality during development.
    • It usually occurs on the lip or tongue.
    • It is a bluish-coloured swelling that may increase in size or remain unchanged.

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Haemangioma

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B. Non-cancerous Tumours

Soft non-cancerous tumours

These tumours are caused by an increase in the number of cells in the growth. It leads to an enlargement of the area.

  1. What is a neoplasm?
  2. What is a papilloma?
  3. What is a fibroma?
  4. What is a lipoma?

 
1. What is a neoplasm?

  • A neoplasm is another name for a tumour.

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2. What is a papilloma?

  • It is also called a squamous cell papilloma.
    • It is a small, firm, pink, wart-like, cauliflower-shaped swelling which occurs almost anywhere in the mouth.
    • It does not usually become cancerous.
    • Treatment is by surgical removal.

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Papilloma

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3. What is a fibroma?

  • This is a pink, firm tumour that may be connected to the gum by a narrow stem.
  • It is also found in the palate and cheeks.
  • The treatment is surgical removal.

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Fibroma

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4. What is a lipoma?

  • This is a soft, smooth, yellowish, slow-growing lump that is composed of fat cells.

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Hard non-cancerous tumours

Hard tissue tumours may arise from the bone or even the teeth. They may be seen in the mouth as bumps or lumps or may only be found after routine x-ray.

  1. What is an osteoma?
  2. What is an ossifying fibroma?
  3. Can tumours develop from teeth or parts of teeth?
  4. What is a torus?
  5. Can Paget's Disease affect the jaw bones?

 
1. What is an osteoma?

  • This is a smooth, hard bone tumour, and is usually solitary.

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2. What is an ossifying fibroma?

  • This is a hard tumour which is similar to a fibroma (previously described), except that bone has grown in it.

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3. Can tumours develop from the teeth or parts of the teeth?

  • There is quite a variety of tumours that develop from certain tooth structures.
    Some of these are called Ameloblastoma and various Odontomas.

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4. What is a torus?

  • This is hard overgrowth of jawbone that takes place during the development of the jaws.
    • It can occur in the midline of the palate (torus palatinus) or on the inside of the lower jaw next to the premolar teeth (torus mandibularis).
    • It is usually harmless and rarely needs to be removed.

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Torus (lower jaw)
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Torus (palate)

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5. Can Paget's Disease affect the jaw-bones?

  • In this condition the jaws slowly grow larger and soften.
    • The upper jaw is often the first place for it to be seen.
    • Paget's disease affects the skull, long bones, the pelvis and the jaws.
    • It is more common in the upper jaw, which can become quite large.
    • It is more common in women.

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"In particular, tobacco use is a risk factor for oral cavity and pharangeal( throat) cancers, periodontal diseases, candidiasis, and dental caries, among other diseases."
"Oral cancers occur in sites that lend themselves to early detection by most primary health care providers and, to a lesser extent, by self-examination." - U.S. Surgeon General's Report.

The purpose of this section is to alert the public to the causes and risks of cancer of the mouth. It is purely introductory.

Cancerous tumours

  • These are made up of cells that are abnormal in shape, size and number.
    • They multiply uncontrollably and spread to other parts of the body.
    • These tumours destroy normal body function.
  • Tumours and growths are called hard or soft, depending on their origin and consistency.
  • Examples are hard bone and soft gum tumours.

Soft cancerous tumours

  1. How common is soft tissue cancer?
  2. At what age can it occur?
  3. What does cancer look like?
  4. What are the main causes of mouth cancer?
  5. Is there a direct connection between smoking and oral cancer?
  6. How does smoking cause mouth cancer?
  7. Does cigar or pipe smoking also cause oral cancer?
  8. Does the use of alcohol aggravate the effects of smoking?
  9. Is chewing tobacco or taking snuff a safe form of tobacco use?
  10. What is the most common type of mouth cancer?
  11. Where does it usually occur?
  12. Can one survive oral cancer?
  13. What other type of oral cancer is there?
  14. Can the salivary glands become cancerous?

 
1. How common is soft tissue cancer?

  • Cancer of the mouth makes up about 2% of all cancers in Europe and the USA.
  • Oral cancers are diagnosed in about 30,000 Americans annually. 8,000 die from this disease each year.

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2. At what age can it occur?

  • It usually occurs after the age of 48.

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3. What does cancer look like?

  • It looks like an ulcer, which is firm and raised.
    • It may also look like a white patch of leukoplakia.
    • It is painless.

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Cancer of the lip
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Cancer of the mouth

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4. What are the main causes of mouth cancer?

  • Smoking is the cause of most mouth and lung cancers.
    • Smokers are the most likely to get mouth cancer.
    • The risk of getting cancer will increase with the use of any tobacco product.

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5. Is there a direct connection between smoking and oral cancer?

  • The connection has been proved beyond any doubt.
    • Smoking can cause cancer in the mouth, the respiratory system or anywhere else in the body.
    • Smoking is the main cause of cancer of the mouth and pharynx (throat).

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6. How does smoking cause mouth cancer?

  • Leukoplakia and erythroplakia are mouth lesions caused by smoking.
    • These are pre-cancerous conditions.
    • Cancer is likely to develop from these smoking-induced mouth sores.
    • The immune system can normally attack and destroy cancer cells in the early stages.
    • Smoking depresses the immune system, and hampers this defence against cancer.
    • Tobacco contains carcinogenic (cancer-forming) substances.
    • The most damaging substance is in tobacco tar.

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Leukoplakia

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7. Does cigar or pipe smoking also cause oral cancer?

  • Smoking any type of tobacco can cause cancer.
    • This includes cigarettes, cigars and pipes.
    • The tobacco tars are the main problem as they are carcinogenic.
    • Because the hot pipe stem rests on the lower lip, this is often where cancer afflicts pipe smokers.

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8. Does the use of alcohol aggravate the effects of smoking?

  • Alcohol helps the carcinogenic substances in tobacco smoke to penetrate the tissues.
    • A combination of smoking and alcohol appears to be potentially life threatening.
    • Alcohol and tobacco in combination cause leukoplakia and erythroplakia which are pre-cancerous sores.
    • The combined use of alcohol and tobacco is thought to account for up to 75% of oral cancers.

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9. Is chewing tobacco or taking snuff a safe form of tobacco use?

  • Tobacco use in any form, smoking, chewing or sniffing is carginogenic.
  • Chewing tobacco (spit tobacco) and snuff can also cause cancer.

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Chewing Tobacco Lesion

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10. What is the most common type of mouth cancer?

  • Squamous cell carcinoma is the most common form of mouth cancer.

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Cancer

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11. Where does it usually occur?

  • It is most commonly found on the floor of the mouth, and under the tongue, or on the borders of the tongue. It can also occur on the lips.

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12. Can one survive oral cancer?

  • Survival after treatment depends on many factors. It is important to detect and treat cancer as early as possible.
    • If a cancer can be treated before it has spread to other areas, the chances of controlling it will improve.
    • Smokers have a lower survival rate than non-smokers.
    • The outlook is nevertheless poor. Only about 30-50% of cancer victims survive for five years.
    • The rate improves for those higher up on the socio-economic scale.
    • This is possibly due to factors relating to the accessibility of treatment.

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13. What other type of oral cancer is there?

  • The veruccous carcinoma is a small wart-like lesion, which is more slow growing than the squamous cell carcinoma.
    The slower growth should improve the chances of successful early treatment.

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14. Can the salivary glands become cancerous?

  • Though very rare, this can happen.

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Hard Cancerous Tumours


  • Hard tissue tumours may arise from the bone or even from the teeth.
    • They may appear in the mouth as visible bumps or lumps.
    • Sometimes they are only found by routine x-ray examinations.
    • All hard lumps that can be seen or felt must be shown to a dentist or medical specialist.
  1. How common is cancer of the jaws?
  2. At what age can hard tissue cancer occur?
  3. What are the most common hard tissue cancers?
  4. Can one survive hard tissue cancer of the jaw?

 
1. How common is cancer of the jaws?

  • Though this does occur, it is rare.

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2. At what age can hard tissue cancer occur?

  • Some rare tumours can occur in children, others in adults.

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3. What are the most common hard tissue cancers?

  • The most common are the sarcoma tumours.

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Kaposi's sarcoma

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4. Can one survive hard tissue cancer of the jaw?

  • Survival after treatment depends on many factors, not the least of which is how early it is treated.

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