The roof of the mouth, or the palate, is a sensitive structure composed of the hard palate at the front and the soft palate toward the throat. Red spots on this mucosal tissue are common and have a wide range of potential causes. These spots can manifest as flat lesions, raised bumps, or pinpoint areas of bleeding, and they may or may not be accompanied by pain. While many instances are temporary and harmless, they can occasionally signal an underlying issue that warrants attention.
Immediate and Non-Contagious Causes
Localized injuries or irritations are the most frequent causes of red spots on the palate. A common example is a thermal burn, often called a “pizza burn,” which occurs when hot food or liquid scalds the mucosal lining. The resulting lesion is typically a painful, red area of inflammation that heals within a few days. Mechanical trauma from physical abrasion is another cause, resulting from sharp food edges, aggressive brushing, or friction from ill-fitting dental appliances. Localized allergic reactions may also manifest as redness, triggered by ingredients in dental products or highly acidic foods.
Viral and Fungal Infections
Infectious agents are a significant cause of red spots, often accompanied by pain or systemic symptoms like fever. Oral candidiasis (thrush) is a fungal infection caused by an overgrowth of the Candida species. Thrush typically appears as creamy white lesions that, when wiped away, reveal a red, inflamed base. The Coxsackievirus, which causes Hand-Foot-and-Mouth Disease (HFMD), frequently causes painful, small red spots (herpangina) on the soft palate. These spots often blister and turn into ulcers, usually accompanied by a fever and a rash.
The Herpes Simplex Virus (HSV) causes oral herpes; outbreaks can produce fluid-filled blisters that rupture, leaving painful red-based ulcers on the palate. This progression from blisters to ulcers helps distinguish viral lesions from flat red patches. The bacterial infection Strep throat can also present with tiny red spots (petechiae) on the soft palate.
Vascular Causes and Petechiae
A distinct cause of red spots involves the vascular system, resulting in lesions called petechiae. Petechiae are tiny, pinpoint spots that form when capillaries rupture, causing bleeding beneath the oral mucosa. Unlike inflammatory spots, petechiae are non-blanching, meaning their color does not disappear when pressure is applied. They are frequently caused by a sudden, intense increase in pressure within the head and chest area. Forceful actions such as severe coughing, repeated vomiting, or suction trauma can cause the delicate capillaries in the soft palate to burst.
While most petechiae from trauma are harmless, widespread or unexplained petechiae can sometimes indicate a systemic issue. Conditions affecting blood clotting, such as thrombocytopenia (low platelet count) or certain blood disorders, may present with petechiae on the palate and other parts of the body. Infectious mononucleosis is another condition known to occasionally cause petechiae.
Recognizing When to Seek Medical Attention
While many red spots resolve on their own, certain signs indicate the need for professional medical evaluation. A medical professional should examine any red spots that persist for longer than two weeks without showing signs of healing. Lesions that fail to clear up after removing a suspected irritant, such as an ill-fitting dental device, also warrant concern. Accompanying systemic symptoms include a high or persistent fever, severe swelling in the mouth or throat, or difficulty swallowing. Unexplained, widespread bruising or petechiae appearing elsewhere on the body requires prompt investigation to rule out an underlying blood or clotting disorder.
Rapid worsening of existing spots, or the development of a large, velvety red patch known as erythroplakia, should trigger an immediate visit to a doctor or dentist. Erythroplakia, particularly in individuals with a history of tobacco or alcohol use, requires professional assessment to determine if it represents a precancerous change.