Tele Oral Medicine

White and Red Lesions

White and red lesions in the mouth are common. Diagnosis can range from benign lesions including reactive keratosis caused by irritation to more dangerous precancerous lesions. Inflammatory or immune-mediated skin conditions can present as red and white lesions in the mouth.

The diagnosis of a mucosal lesion will review colour, size, texture, thickness, bleeding and ulceration. The appearance of oral premalignant lesions and early oral cancers will require review of clinical history and image examination. A biopsy is often necessary for definitive diagnosis.  A non-healing ulcer that is firm and painful also likely requires urgent biopsy and treatment.  

Signs and Symptoms:

  • Normal soft tissues in the mouth are pink in colour so any white or red changes may indicate mouth pathology. 
  • White changes in the mouth can represent irritation and thickening of the skin caused by biting, rubbing, or other trauma regularly termed reactive keratosis. These changes are not typically concerning. 
  • White lesions in the mouth may be sinister as they can be precancerous white plaques (Leukoplakia). 
  • White lesions in the mouth can also include lesions that are caused by inflammation or an aberrant immune system. One of the most common mouth lesions in this category is an ongoing inflammatory condition that affects mucous membranes inside your mouth (oral lichen planus). 
  • Red patches (Erythroplakia) are often precancerous and requires immediate diagnosis and treatment.
  • Red areas of the mouth may also indicate infections such as oral thrush.
  • Many oral lesions can present as mixed red and white colour changes of the normal pink soft tissue of the mouth. These may present with ulceration and pain. 


There are many causes of red and white mouth lesions.  

White Lesions:-
The most common causes of white mouth lesions is chronic irritation friction such as cheek chewing, sun damage and smoking. Other factors include dental treatments like ill-fitting dentures and rough dental fillings. In rare cases, it may present as leukoplakia and can be precancerous.

Red Lesions:-

Red lesions in mouth can appear in the oral cavity due to an allergic reaction to medications, food or ordental products, including fillings, denture adhesive, mouthwashes, and toothpastes. Fungal infections can also present red patches of the mouth. Immune mediated and autoimmune conditions can present as red lesions of the mouth. A velvet like red plaque (erythroplakia) of the mouth is concerning as it may represent a precancerous lesion or oral cancer. 


A definitive diagnosis of red and white lesions is established based on your history, clinical findings, and diagnostic tests such as blood tests, mouth swabs and biopsy.  


Certain benign red and white lesions in mouth may be treated by general dentists and general medical practitioner. However, often treatment is complex requiring specialist care and ongoing follow-up.  

When to see a doctor?

If you note white and red lesions or spots in your mouth or tongue, it is critical to consult a doctor or dentist for assessment and treatment.


To consult an Oral Medicine Specialist regarding any red or white lesions of your mouth, ask your doctor or dentist to refer you to TeleOralMedicine. 

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