Erythematous Macule and Erosion
Mechanical trauma to the oral lining can produce a variety of clinical
lesions, depending upon the nature and circumstances of the insult. Three
common red, flat lesions in the mouth are (1) the erythematous macule and
erosion, (2) the purpuric macule, and (3) the granulomatous stage of the
The causes and the course of the disease
Traumatic erythematous macules are produced by a low-grade, chronic physical
insult. If the trauma is intensified, the lesions may become ulcerated. Common
causes include sharp margins of teeth, defective restoration, and ill-fitted
dentures. Self-inflicted trauma such as cheek biting or other habits may also
cause traumatic erythematous macules.
The red color of the lesion is usually the result of increase blood circulation
in the underlying tissue. The loss of part or all of the covering skin also
contributes to the measures of color developed; a thick membrane obscures the
underlying red color, whereas more color is transmitted through a thin one. The
degree of redness is also, in part, a function of the amount of the pigment
hemoglobin present in the area and the extent of its oxygenation. Red lesions
frequently have a thin skin that covers numerous dilated and engorged vessels,
and as a consequence, they bleed heavily after minimal trauma.
A red color can also be imparted to the tissues by another pigment, melanin.
This color may vary from light brown to a reddish brown to a bluish black. The
reddish brown color is seen infrequently in melanin-producing lesions.
The usual sites for erythematous macules are on the front and the side of the
tongue, the floor of the mouth, the back of the palate, the cheek, and the wet
surfaces of the lips. The macules may show considerable variation in the
intensity of its red color. The size of the red zone corresponds closely to the
size of the traumatic agent. The edges of the lesions are not usually well
defined. Symptoms may vary from mild tenderness to considerable pain. The
causative agent is usually identified, either through the history of the oral
examination. The lesion generally resolves quickly after the cause is removed;
however, if the lesion is located on the tongue, it may persist for several
weeks and heal as a bald pink area. Because this lesion is basically
inflammatory, it may blanch when digital pressure is applied.
The differential diagnosis
There are many lesions in the mouth that have the similar clinical
presentations. Therefore, when a red lesion occurs in the mouth, you need to
see your dentist. Your dentist will help you to determine whether the lesion is
a (1) traumatic erythematous macule, (2) purpuric macule of oral sex, (3)
palatal bruising because of severe coughing or severe vomiting, (4) macular
hemangioma, (5) atropic candidiasis, (6) mononucleosis and histoplasmosis, (7)
herpangina, (8) erythroplakia, and (9) squamous cell carcinoma.
The recommended treatment
Once you are diagnosed with erythematous macule, your dentist should identify
and remove the mechanical irritant immediately. The procedures may involve
smoothing the sharp edges of broken teeth, replacing defective restorations,
straigtening teeth with braces, and adjusting ill-fitted dentures. Your lesion
is then kept under close observation until it disappears. Healing normally
takes place in 3 or 4 days. If the lesion does not disappear in 10 days,
additional workup should be done. A biopsy may be performed then to rule out
more serious conditions such as erythroplakia, squamous cell carcinoma, and
fungal diseases such as candidiasis and histoplasmosis.