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Dark Spots in Mouth: Causes, Treatment, and When to Seek Medical Attention

What causes dark spots in the mouth. How to identify different types of oral discoloration. When should you be concerned about black spots inside your cheek. What treatments are available for oral pigmentation.

Common Causes of Dark Spots in the Mouth

Discovering a dark spot inside your mouth can be unsettling, but it’s often harmless. Several benign conditions can lead to oral discoloration. Let’s explore some of the most common causes:

Oral Nevi: Moles Inside the Mouth

Oral nevi are essentially moles that appear inside the oral cavity. They typically present as small, slightly raised dots in shades of brown, bluish-gray, or nearly black. While they can form on the cheeks, they’re more commonly found on the roof of the mouth or inner lip.

Are oral nevi dangerous. Generally, no. There are no reported cases of oral nevi becoming cancerous. However, to err on the side of caution, your dentist or doctor may recommend a biopsy to confirm the diagnosis and rule out melanoma.

Blood Blisters: Temporary Discoloration

Blood blisters can form when the soft tissue inside your mouth gets pinched or injured. These fluid-filled sacs appear as dark purple to deep red spots, often large enough to feel with your tongue. They typically develop on the softer parts of the mouth, such as the cheeks or inner lips.

Do blood blisters require treatment. In most cases, no. Blood blisters usually resolve on their own within a couple of weeks. However, if a blood blister persists for more than two weeks or becomes a recurring issue, it’s advisable to consult your doctor.

Melanotic Macules: Harmless Hyperpigmentation

Oral melanotic macules are areas of hyperpigmentation in the mouth. These flat spots have well-defined borders and average about a quarter of an inch in diameter, though they can be as small as 0.04 inches. While melanotic macules are non-cancerous, your doctor may still recommend a biopsy to definitively rule out melanoma.

Dental-Related Causes of Oral Discoloration

Sometimes, dental procedures or habits can lead to dark spots in the mouth. Here are two common dental-related causes:

Amalgam Tattoos: Leakage from Dental Fillings

Amalgam tattoos are a relatively common occurrence resulting from leakage of dental filling material. These spots appear dark blue, gray, or black and are typically located adjacent to a filling. Amalgam, a material composed of mercury, tin, zinc, silver, and copper, has been used for dental fillings for over 150 years.

Do amalgam tattoos require treatment. No, these tattoos don’t cause any symptoms and don’t necessitate treatment. They’re permanent unless removed through laser surgery.

Smoker’s Melanosis: Stains from Tobacco Use

Smoking can leave behind blotchy stains inside the cheeks and gums, a condition known as smoker’s melanosis. Approximately 22% of smokers develop this type of staining. While these stains don’t cause symptoms or require treatment, your doctor may recommend a biopsy to rule out other conditions.

Can smoker’s melanosis be removed. Yes, these stains can be eliminated through laser treatment or electrosurgery if desired.

Rare but Serious Causes of Oral Dark Spots

While most dark spots in the mouth are benign, there are some rare but serious conditions that can cause oral discoloration. It’s crucial to be aware of these possibilities:

Oral Melanoma: A Rare Form of Cancer

In extremely rare cases, a dark spot inside the cheek may indicate oral melanoma, a type of cancer affecting pigmented cells called melanocytes. Oral melanoma accounts for about 1.6% of head and neck cancers and less than 1% of all melanomas.

What are the symptoms of oral melanoma. In its early stages, oral melanoma often has minimal symptoms. It typically appears as a dark brown to blue-black spot, but can also be unpigmented or white. As it progresses, the spot may be accompanied by pain, ulcers, and bleeding.

How is oral melanoma treated. Treatment options for oral melanoma may include surgery, immunotherapy, radiation, and drug therapy. Early detection and treatment are crucial for the best outcomes.

Peutz-Jeghers Syndrome: A Genetic Condition

Peutz-Jeghers syndrome is a genetic condition that causes non-cancerous growths called polyps in the intestines and stomach. Children with this condition often develop dark spots on their lips, inside their mouth, near their eyes and nose, and around their anus. These spots usually fade with age.

What are the complications of Peutz-Jeghers syndrome. People with this condition may experience complications such as pain, bleeding, or bowel obstruction. While there’s no cure, surgery can remove the polyps in the digestive tract.

Systemic Conditions That Can Cause Oral Discoloration

Some systemic health conditions can manifest with symptoms in the mouth, including dark spots or discoloration:

Addison’s Disease: Hormonal Imbalance

Addison’s disease, also known as adrenal insufficiency, is a deficiency of hormones produced by the adrenal glands. One of the symptoms of this condition is hyperpigmented blotches of skin inside the mouth.

What are other symptoms of Addison’s disease. Other signs include extreme fatigue, weight loss, salt cravings, low blood sugar, and hyperpigmentation of the skin. Treatment typically involves hormone replacement therapy.

When to Seek Medical Attention for Oral Dark Spots

While many dark spots in the mouth are harmless, it’s important to know when to consult a healthcare professional:

  • If the spot changes in size, shape, or color
  • If you experience pain, bleeding, or ulceration associated with the spot
  • If the spot persists for more than two weeks
  • If you have a family history of oral cancer or melanoma
  • If you have other concerning symptoms along with the dark spot

Your dentist or doctor can perform a thorough examination and, if necessary, order additional tests to determine the cause of the discoloration.

Diagnostic Procedures for Oral Dark Spots

When investigating dark spots in the mouth, healthcare professionals may use various diagnostic procedures:

Visual Examination

The first step in diagnosing oral dark spots is a thorough visual examination. Your dentist or doctor will carefully inspect the affected area, noting the size, shape, color, and location of the spot.

Biopsy

In many cases, a biopsy may be recommended to definitively diagnose the cause of the dark spot. This involves removing a small sample of tissue from the affected area for microscopic examination.

What types of biopsies are used for oral lesions. There are several types of biopsies that may be used, including incisional biopsy (removing a portion of the lesion), excisional biopsy (removing the entire lesion), and brush biopsy (collecting cells from the surface of the lesion).

Imaging Studies

In some cases, imaging studies such as X-rays, CT scans, or MRI may be used to get a more detailed look at the affected area and surrounding structures.

Treatment Options for Oral Dark Spots

The treatment for oral dark spots depends on their underlying cause. Here are some common approaches:

Observation

For benign conditions like oral nevi or amalgam tattoos, no treatment may be necessary. Your healthcare provider may recommend regular monitoring to ensure the spot doesn’t change over time.

Laser Treatment

Laser therapy can be used to remove certain types of oral pigmentation, such as amalgam tattoos or smoker’s melanosis.

Surgical Removal

In cases where a lesion is suspicious or causing discomfort, surgical removal may be recommended. This can be done through traditional surgery or newer techniques like electrosurgery.

Medical Management

For systemic conditions like Addison’s disease that cause oral discoloration, treatment focuses on managing the underlying condition. This often involves medication to address hormonal imbalances.

Cancer Treatment

In the rare case of oral melanoma, treatment may involve a combination of surgery, radiation therapy, immunotherapy, and targeted drug therapies.

Preventing Oral Dark Spots

While not all causes of oral dark spots are preventable, there are steps you can take to reduce your risk:

  • Practice good oral hygiene
  • Avoid tobacco use
  • Limit alcohol consumption
  • Eat a balanced diet rich in fruits and vegetables
  • Protect your lips from sun exposure
  • Attend regular dental check-ups

By maintaining good oral health and addressing any changes in your mouth promptly, you can help ensure early detection and treatment of any potential issues.

Living with Oral Pigmentation

For many people, living with benign oral pigmentation is simply a matter of acceptance. However, if the appearance of dark spots in your mouth causes you distress, there are options to consider:

Cosmetic Treatments

In some cases, cosmetic treatments may be available to reduce the appearance of oral pigmentation. These might include professional teeth whitening or the use of special makeup designed for oral use.

Psychological Support

If you’re struggling with the psychological impact of oral pigmentation, don’t hesitate to seek support. A mental health professional can help you develop coping strategies and improve your self-image.

Patient Support Groups

For those dealing with more serious conditions like oral cancer or genetic syndromes, patient support groups can provide valuable emotional support and practical advice.

Remember, most oral dark spots are harmless. However, it’s always best to have any new or changing spots in your mouth evaluated by a healthcare professional. With proper care and attention, you can maintain good oral health and address any concerns promptly.

Causes and What Needs to Be Treated

Finding a black spot or dot on the inside of your cheek can be alarming, but it’s not necessarily a sign of something serious.

A variety of harmless conditions can cause discoloration in your mouth, such as moles, hyperpigmentation, and leakage from your dental fillings.

In extremely rare cases, a black spot may be a sign of a type of cancer called oral melanoma. Oral melanoma accounts for about 1.6 percent of cancers of the head or neck, and less than 1 percent of all melanomas, according to The Oral Cancer Foundation.

Keep reading to find out what may be causing a black spot on the inside your cheek and when you should see your doctor.

The following conditions may cause a black dot, a small, circular mark, to form on the inside of your cheek.

Oral nevi

Oral nevi are small brown, bluish gray, or almost black dots that can appear inside your mouth. Nevi is a medical term for moles (nevus is singular).

Oral nevi are usually slightly raised. They’re more common on the roof of the mouth or inner lip, but they can also form on the cheeks. They usually don’t cause any symptoms.

No treatment is usually necessary for an oral nevus, and there are no reports of an oral nevus becoming cancerous. However, your doctor or dentist may still recommend getting a biopsy to make sure it’s indeed a nevus and not melanoma.

Blood blister

Blood blisters are sacs of fluid that fill with blood. They can range in color from purple to dark red. They commonly form when the skin in your mouth gets pinched.

Blood blisters are often big enough that you can feel them with your tongue. They most often form on the soft parts of your mouth, like your cheek or inner lips. They’re typically painful when touched, or if you eat spicy food.

The majority of blood blisters don’t last long and don’t need treatment if you leave them alone. But if the blood blister lasts for more than 2 weeks or becomes a reoccurring problem, it’s a good idea to visit your doctor.

Melanotic macules

Oral melanotic macules are areas of hyperpigmentation that average about a quarter of an inch in diameter. They can be as small as 0.04 of an inch. These spots are typically flat and have a well-defined border.

Oral melanotic macules are noncancerous, but your doctor may recommend a biopsy to rule out melanoma.

The following are potential causes of dark spots on the inside of your cheek. Spots can vary in size but they are larger than a dot.

Leakage from a dental filling

Amalgam is a material made of mercury, tin, zinc, silver, and copper. It’s been used for more than 150 years for dental fillings.

Amalgam tattoos are leakages from these dental fillings. They’re relatively common and usually appear dark blue, gray, or black. They’re most often located next to a filling.

Amalgam tattoos don’t cause any symptoms and don’t need treatment. They’re permanent unless removed with laser surgery.

Smoker’s melanosis

Smoking can leave blotchy stains called smoker’s melanosis inside your cheeks and gums. About 22 percent of people who smoke have this staining.

These stains don’t cause symptoms and don’t need treatment. However, your doctor will likely recommend a biopsy to rule out other conditions. The stains can be removed with laser treatment or electrosurgery.

Oral cancer

Melanoma is a type of skin cancer that affects pigmented cells called melanocytes.

Melanoma is most common on parts of your skin frequently exposed to sunlight, but it can also form in your mouth and nose. In extremely rare cases, a dark spot inside your cheek may be a sign of oral melanoma.

In its early stages, oral melanoma often has minimal symptoms. It usually manifests as a dark brown to blue-black spot. It can also be unpigmented or white. In its late stages, the spot may be accompanied by pain, ulcers, and bleeding.

The average age of diagnosis of oral melanoma is 56. Oral cancer is twice as common in men as women.

Treatment for oral melanoma may include:

  • surgery
  • immunotherapy
  • radiation
  • drug therapy

Peutz-Jeghers syndrome

Peutz-Jeghers syndrome is a condition that causes noncancerous growths called polyps in the intestines and stomach.

Children who develop this condition also commonly develop dark spots on their lips, inside their mouth, near their eyes and nose, and around their anus. The spots usually fade with age.

People with Peutz-Jeghers syndrome also often develop complications such as pain, bleeding, or bowel obstruction.

There’s no current cure for Peutz-Jeghers syndrome, but surgery can remove the polyps in the digestive tract.

Addison’s disease

Addison’s disease, or adrenal insufficiency, is a deficiency of the hormones produced by your adrenal glands. One of the symptoms of Addison’s disease is hyperpigmented blotches of skin inside your mouth.

Other symptoms include:

  • extreme fatigue
  • weight loss
  • salt cravings
  • low blood sugar
  • hyperpigmentation

You can take medication to replace the hormones your adrenal glands can’t produce by themselves.

Even though the chances of developing oral melanoma is very low, it’s good practice to see your doctor whenever you notice an abnormally colored spot or dot in your mouth.

It’s especially important to get the spot checked if you’re older than 55 years. Older adults have a higher risk for developing oral cancer.

Your doctor may use the following tests to help confirm a diagnosis of the dark spot inside your cheek:

  • Physical inspection. Your doctor may be able to identify the spot during a physical examination simply based on its appearance.
  • Biopsy. During a biopsy, your doctor will cut away a small piece of the spot and send it to a lab for analysis.
  • Blood test. Your doctor may administer a blood test measuring your potassium, cortisol, and ACTH hormone levels if they suspect Addison’s disease.

Finding a dark spot or dot in your mouth is unlikely to be a sign of cancer. However, it’s still a good idea to show it to your doctor or dentist. If it does turn out to be cancerous, getting an early diagnosis and treatment can improve your outlook.

Pictures, causes, treatment, and when to seek help

Black spots inside the cheek can have several causes, such as blisters or hyperpigmentation. In rare cases, they may indicate something more serious, such as mouth cancer.

Many harmless conditions can cause a black spot to develop inside the cheek. Often, there will be no other symptoms, and it will improve without treatment.

Rarely, however, a black spot inside the cheek may be a symptom of oral melanoma. This is a rare type of cancer.

The American Cancer Society estimate that just over 54,000 people will develop mouth or throat cancer in 2021. Melanoma usually accounts for 0.5% of all oral cancers.

This article will examine some potential causes of a black spot inside the cheek. It will also look at some treatment options and when a person should contact their doctor.

Blisters are raised bubbles on the skin with fluid inside. They can occur anywhere on the body, including in the mouth.

Blood blisters contain blood and appear dark red or purple. They may develop in the mouth due to accidentally biting the cheek or as a result of an allergic reaction.

Learn more about blood blisters in the mouth here.

Treatment

Blood blisters are not typically harmful, and they will often heal without treatment.

Sometimes, however, they may cause pain or discomfort. In these cases, a person can use over-the-counter (OTC) pain relief medication.

Amalgam tattoos occur when metal fillings leak, causing dark marks to appear inside the mouth.

These marks can appear when a dentist places or removes a filling and tiny metal fragments fall between the teeth.

They most commonly appear on the gum or cheek, near the amalgam filling. However, they can appear anywhere in the mouth.

Treatment

Amalgam tattoos do not cause any symptoms or require any form of treatment.

Smoking can cause smoker’s melanosis. This is a condition wherein brown or black pigmentation develops inside the mouth and throat.

Treatment

This condition is not harmful, and it does not require treatment.

However, the tobacco smoke that causes these spots is harmful to various areas of the body. For example, smoking can cause gum disease, tooth loss, and mouth cancer, as well as several other conditions.

Melanoma is a cancer of the pigment-making cells, or melanocytes, that typically affects the skin. However, these cancers can also occur on mucosal membranes, such as in the mouth.

Oral melanoma usually appears as a raised area that has a black, brown, or dark blue appearance. These marks can be asymmetric with an irregular border.

There may also be swelling, if inflammation is present.

One 2020 article notes that oral melanoma is not related to sun exposure. Healthcare professionals are unsure about what the risk factors may be, but they may include:

  • dental irritation
  • cigarette smoking
  • alcohol consumption

Treatment

The main treatment option for oral melanoma is surgery. A healthcare professional may also recommend radiation therapy.

Addison’s disease is an endocrine disorder that occurs when the adrenal glands, which are the glands on the top of the kidneys, do not make enough of certain hormones. These include cortisol and aldosterone.

The National Institute of Diabetes and Digestive and Kidney Diseases note that Addison’s disease can cause the development of darker areas on the skin and inside the mouth.

Other symptoms can include:

  • chronic fatigue
  • muscle weakness
  • abdominal pain
  • weight loss
  • appetite loss

Treatment

Treatment for Addison’s disease will include hormone replacement medications. People can take a corticosteroid, such as hydrocortisone, to replace missing cortisol. They will take an oral tablet two or three times per day.

To replace aldosterone, a person can take fludrocortisone to help balance the amount of fluid and sodium in the body.

Peutz-Jeghers syndrome is a rare genetic condition that causes dark freckles to appear around the face and inside the mouth. It may also cause mushroom-shaped tissue growths called polyps to develop throughout the gastrointestinal tract.

Peutz-Jeghers syndrome can also cause other symptoms, including:

  • nausea
  • vomiting
  • stomach pain
  • rectal bleeding
  • digestive issues

Treatment

There is currently no cure for Peutz-Jeghers syndrome. However, treatments may involve surgically removing any polyps that are causing gastrointestinal problems.

A doctor or dentist will perform a physical examination of the black spots to determine the cause. Also, they will likely ask the person whether or not the spots are painful or have any accompanying symptoms.

A doctor may also check a person’s medical history for any signs of genetic conditions, such as Peutz-Jeghers syndrome, that could be the cause. They might also review the person’s dental records for the presence of metal fillings.

Depending on their assessment, a doctor may also order additional tests to make a firm diagnosis. For example, they might require a blood test or skin sample for further analysis.

Many causes of black spots inside the cheek, such as amalgam tattoos, are harmless.

Although no medical treatment is necessary for some causes of a black spot in the cheek, a person should contact a doctor about any sore or spot that lasts for longer than 3 weeks.

If the black areas develop sores or ulcers, these could be symptoms of mouth cancer. Early detection of mouth cancer is crucial for successful treatment.

There are many possible causes of black spots inside the cheek. For most people, these spots will cause no additional symptoms and will not require treatment.

Some people may require OTC treatments for causes that cause pain, such as blood blisters. Other causes, such as mouth cancer, will require medical treatment.

Although black spots inside the mouth may be harmless, it is worth contacting a doctor about persistent cases. They can help determine whether the spot is harmless or requires further care.

Spots in the mouth: what are the causes

Spots in the mouth: what are the causes | Moscow
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