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Mouth Diseases

Blood blisters in mouth

02/02/2009

Question:

I submitted a question yesterday evening regarding blood blisters in my mouth. As it turns out, a person with an identical problem submitted the question on 01/07/09 @ 12:08PM. It reads "I have a raised blister that appears to be a blood blister on the inside of my right cheek. There is also a small red blood fleck above it that is not raised...." Let me elaborate more. These blisters appear spontaneously(sp). It`s as if something has triggered a blood vessel to break. There is no trama involved. No pain. I`ve had 6 or 7 of these in the last few months. I visited my primary care physician today and he stated that, "he had never seen anything like this in his life". By that, he meant that the sheer appearance of it is that unusual. It`s so unusual that the doctor wouldn`t even break it for a biopsy. He wants an ENT physician to be able to look at it in it`s present state.

I`ve googled this topic to death in the last couple of days and have determined that, whatever it is, it`s rare. Before I close, I would like to give you a bit more information: 1) I`m a fit, athletic, 53 year old male who runs regularly in 5K and 10K races. 2) I quit smoking cigarettes and dropped 50 pounds five or six years ago 3) I have gall stones, severe case of hypertension (under control), occular histoplasmosis, slight bradycardia, and had a benign mass removed from my neck 4) negative for HIV, AIDS, and STD`s.

Answer:

Without having the opportunity to see your “blisters” personally, there are a few possiblities that I would consider. First, and certainly most commonly, would be result of trauma so minor that you don’t recall or didn’t notice it.

Much less commonly, but possibly the most important consideration would be mucous membrane pemphigoid, also known as cicatricial pemphigoid. This is a form of autoimmune disease where the body starts producing antibodies against the skin “connectors” in the mouth and possibly other areas such as the eyes.

This condition can be progressive in some patients, leading to blisters throughout the mouth and the gum tissues, and involvement of the eyes can be serious as well.

Lastly, there is the tongue-twister known as angina bullosa hemorrhagica. This is a rare, poorly understood condition that exhibits blood-filled blisters, usually on the back of the roof of the mouth (soft palate).

Because this problem has been persistent, I would recommend that you consider excluding the possibility of mucous membrane pemphigoid. This will require a biopsy and I would recommend this be performed by an oral and maxillofacial surgeon. A small piece of your cheek near the edge of the blister will be removed, then split into two pieces before being placed into two separate solutions. This permits routine processing as well as special processing that can examine your cheek tissues for the presence of antibodies and substances related to an autoimmune disease.

Once a diagnosis is made, proper management and follow-up can be provided. Good luck!

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Response by:

John R Kalmar, DMD, PhD John R Kalmar, DMD, PhD
Clinical Professor of Pathology
College of Dentistry
The Ohio State University