Lump inside the lip, on the cheek or on the palate: mucocele, fibroma, papilloma and other lesions

Lump in the mouth: which lesions are the most common?

A lump in the mouth usually has a benign cause: a mucous cyst after injury to a minor salivary gland, a fibroma from long-term irritation, a papilloma caused by a virus, or bony growths that some people live with for years. Cancer Research UK points out that most people with a lump, ulcer or patch in the mouth do not have mouth cancer.

These lesions differ in location, colour and firmness, which helps the dentist make a first distinction between them. A definite diagnosis of a lesion removed from the lining of the mouth, however, comes only from a histopathological examination, which is why the tissue is usually sent to a pathology laboratory after the procedure. Lumps on the gum often have other, tooth-related causes and are described in a separate article.

Lip mucocele: what does it look like, and will it go away by itself?

A mucocele, also called a mucous cyst, is a mucus-filled blister in the lining of the mouth that forms when a damaged minor salivary gland or its duct stops draining saliva. Cleveland Clinic reports that it appears most often on the inside of the lower lip, as a soft, dome-shaped lump, clear or bluish, 1 mm to 2 cm across.

The most common cause is biting the lip while eating, and also a habit of sucking the lip or cheek. Mucoceles mainly affect people under 30: according to Cleveland Clinic, 70% of cases occur between the ages of 3 and 20, with a peak between 10 and 20. They usually do not hurt, but large ones can get in the way of speaking and eating.

A mucocele often bursts and disappears by itself, but it can come back in the same place. A mucocele should not be pierced at home because of the risk of infection and tissue damage; when it keeps returning or is large, a doctor removes it surgically, often together with the minor salivary gland, or uses a laser or freezing.

A similar cyst on the floor of the mouth, under the tongue, is called a ranula. A mucocele can also form on the inside of the cheek, on the tongue and on the gum.

Fibroma in the mouth: what causes a lump on the inside of the cheek?

A lump on the inside of the cheek that is smooth and the colour of the surrounding mucosa is often an irritation fibroma, also called a traumatic fibroma. Cleveland Clinic reports that such fibromas appear most often on the inside of the cheek, where the upper and lower teeth meet, and that they result from irritation or injury.

A fibroma is a benign lesion. When it gets in the way, grows or keeps being bitten, it is removed surgically. Cleveland Clinic warns that fibromas tend to come back if the source of irritation remains, so smoothing a sharp tooth or filling, adjusting a denture or breaking the habit of cheek biting is as important as the procedure itself.

Other lesions, for example a pyogenic granuloma, can look similar to a fibroma, which is why the removed tissue is examined under a microscope. Cleveland Clinic also suggests two simple ways of prevention: avoiding biting the cheeks and lips, and regular dental visits.

Papilloma in the mouth: is it HPV?

An oral squamous papilloma is a benign growth of epithelial cells, usually caused by human papillomavirus (HPV) types 6 or 11. DermNet reports that these virus types are not linked to cancer or precancerous lesions, unlike the high-risk types described in the article on mouth cancer.

A papilloma usually looks like a soft lump on a stalk with finger-like projections: when it is heavily keratinised it is white and resembles a cauliflower, and when less so it is pink, like a raspberry. It appears most often on the tongue, the inside of the cheeks and the lips, and is usually diagnosed in people aged about 30 to 50.

A papilloma does not hurt and, according to DermNet, may be left untreated; if it gets in the way, it is removed by conservative excision, and recurrence in the mouth is unlikely. Because some other lesions have a similar, wart-like surface, the decision to leave a lump without treatment is made by a doctor after an examination.

A hard lump on the palate or under the tongue: what are bony growths?

A hard, fixed lump in the middle of the palate is most often a bony growth called a palatal torus (torus palatinus). Cleveland Clinic describes it as a harmless, usually painless overgrowth of bone of the hard palate and reports that 20 to 30% of people have one, more often women and people over 30. A tendency to such growths can run in families, and clenching and grinding the teeth may increase the risk.

Similar growths on the inner side of the lower jaw, under the tongue, are called mandibular tori (torus mandibularis); according to Cleveland Clinic, in about 80% of people they occur on both sides. Neither type of growth is a tumour or a precancerous lesion. They can make it harder to fit a denture, a splint or a brace, and food debris collects around them.

Bony growths are usually not treated. A surgeon removes them when they get in the way of speaking, eating or daily life, for example by making it difficult to wear a denture; Cleveland Clinic reports that surgery on the palate is done under local anaesthesia and that full healing can take up to a month. Show a dentist any bony growth that grows, changes colour, hurts or bleeds.

A red lump that bleeds easily: what is a pyogenic granuloma?

A pyogenic granuloma is a benign red lump made of overgrown blood vessels, which bleeds easily when touched or brushed. Its name is misleading because, as the review by Lomeli Martinez et al. (2023) stresses, the lesion contains no pus and is not a true granuloma.

According to that review, the gum accounts for 75% of sites, but a granuloma also appears on the lips, tongue and cheeks. It is more common in women, and its development is encouraged by injury, tartar, plaque and long-term irritation, as well as hormonal changes; in pregnancy it is called a pregnancy granuloma.

The treatment of choice is surgical excision combined with removal of the irritating factors. The review reports that a granuloma comes back in about 15% of cases, most often after incomplete removal or when the source of irritation remained.

When does a lump in the mouth need an urgent appointment?

A lump in the mouth that does not go away needs to be shown to a dentist or doctor, even if it does not hurt. The NHS advises seeing someone about any lump that grows, is hard and fixed, lasts longer than 2 weeks or grows back after removal, and the UK’s NICE guideline recommends that a lump on the lip or in the mouth be assessed by a dentist urgently.

Assessment starts with looking at and feeling the lump. When its nature is not obvious or the lump needs to be removed, the doctor cuts it out under local anaesthesia or takes a sample, and sends the tissue for histopathological examination. The result of this examination settles the diagnosis and whether check-ups are needed.

• A lump that grows, is hard and does not move against the tissue beneath it.
• A lump or thickening that lasts longer than 2 weeks or grows back after removal.
• A lump with an ulcer that has not healed for more than 3 weeks, or one that bleeds for no obvious reason.
• A red or red and white patch around the lump or on another part of the mouth lining.
• Numbness of the lip, tongue or another part of the mouth, or a loose tooth for no obvious reason.
• A lump in the neck that does not go away, or difficulty swallowing or speaking.

How it works at DentalBlue

At DentalBlue in Białystok, a lump in the mouth is assessed by a dentist during a “Wizyta bez bólu” (visit without pain), which includes a panoramic X-ray, a consultation, an examination and a written treatment plan; in the clinic’s price list it costs 300 zł. If the lump needs to be removed, the price list includes “Usunięcie zmiany na błonie śluzowej” (removal of a mucosal lesion, 500 zł) and “Badanie histopatologiczne” (histopathological examination, 100 zł). Surgical procedures are carried out under local anaesthesia or, for patients who qualify, under general anaesthesia. The final scope and cost are set by the dentist, and prices may change. When the test result requires it, further treatment is provided by a specialist clinic.