Leukoplakia is a common oral lesion that can be caused by tobacco. Read this article to know more about the symptoms, diagnosis, and treatment.
Leukoplakia is defined as a condition where one or more white patches or spotty lesions are noted to form at the mouth's inner surface. Leukoplakia varies from other oral lesions by their cause. Leukoplakia can progressively develop into oral cancer. Within 15 years from the incidence of leukoplakia, about 3% to 17.5% of the affected individuals are more likely to develop squamous cell carcinoma. It is a slow-growing type of tumor. The likelihood of developing a squamous cell carcinoma from leukoplakia depends primarily on the size, shape, and appearance of abnormal cells.
Leukoplakia has been broadly classified into two different types, and they are as follows.
Homogenous Leukoplakia: In this type of leukoplakia, the lesion is mostly white. The lesion looks like a thin patch that usually has a smooth, wrinkled, or ridged surface.
Non-homogenous Leukoplakia: In this type of leukoplakia, the lesion is white or white-and-red in color. The structure of the patch is irregularly shaped. It may be flat or nodular. Non-homogenous leukoplakia is further sub-classified into ulcerated and nodular types. Classifying them can greatly help in the prediction of whether a patch will become cancerous or not.
Proliferative verrucous leukoplakia (PVL) is the most aggressive form. This condition is also known as florid papillomatosis. It is often associated with the Epstein-Barr virus. Epstein-Barr Virus (EBV) belongs to the herpes virus family. Almost all the affected individuals will eventually acquire cancer at several different sites. Proliferative verrucous leukoplakia is diagnosed as a late event in the development of leukoplakia. This is the reason that it takes a long time to spread to different sites. It has also been noted to have a high rate of recurrence.
Oral hairy leukoplakia is also associated with the Epstein-Barr virus infection. Epstein-Barr infections usually stay in the affected person's body throughout their life. People with weak immune systems, like the Acquired Immunodeficiency Syndrome (AIDS) patients are affected. These people have a higher development of oral hairy leukoplakia when compared to others. The appearance of oral hairy leukoplakia can be explained as black hairy patches, often with folds. This structure makes it appear like the hair is growing out of the folds. These spots are commonly seen on the tongue, but they can develop in other parts of the mouth. Oral hairy leukoplakia does not develop into a squamous cell carcinoma, unlike the other types. This condition is also commonly seen in homosexual males.
The cause of leukoplakia is unknown most of the time. It is very frequently caused by chronic irritation with tobacco. Sometimes long term users of smokeless tobacco products eventually develop leukoplakia at the location they hold the tobacco against their cheeks (buccal skin).
Other causes may include chronic irritation from:
Jagged teeth due to any previous trauma, broken or sharp teeth that rubs on the lateral tongue surfaces.
Broken dentures or dentures that do not fit properly.
Chronic usage of alcohol.
The following are the most frequently seen risk factors that lead to leukoplakia:
Long term tobacco use.
Chronic alcohol use.
Acquired immunodeficiency syndrome.
Ebstein-Barr virus infections.
Inappropriately fitting dentures.
Leukoplakia usually occurs in gums, the inner region of the cheeks, the floor of the mouth below the tongue, and, sometimes, superficially on the tongue. The initial stages of this condition usually do not cause any pain or discomfort. This causes it to go unnoticed for a while.
When symptoms start to appear, they have the following features.
White or grayish in patches that cannot be scrapped from the surface, unlike the thrush of candidiasis.
Irregular or flat in appearance.
Intermittent thickened and hardened areas.
Raised red lesions which are known as speckled leukoplakia or erythroplakia. These are signs that indicate that the lesion is more developing its precancerous changes.
The most commonly used methods in the diagnosis of are leukoplakia by:
Oral examination of patches present in the affected individual’s mouth.
Attempting to scrape off the white patches.
A thorough and focussed medical history and looking for the presence of risk factors.
Ruling out other possible causes such as candidiasis.
A biopsy is a very useful diagnostic tool in identifying the condition of leukoplakia.
Oral brush biopsy. This procedure involves the removal of cells from the superficial surface of the lesion with the help of a small, spinning brush. This is a non-invasive procedure but does not always help in achieving a definitive diagnosis.
Excisional biopsy. This procedure involves the surgical removal of tissue from the leukoplakia patch, or the entire patch can also be removed if the lesion is small. An excision biopsy is more effective when compared to the oral brush biopsy, and it results in an appropriate diagnosis.
Treatment is very successful only when the lesion is found and treated early. A small lesion can be treated quickly. Regular follow-up visits with the doctor are needed. This is to routinely inspect the person's oral cavity to look for any signs of progression.
All the affected people would be required to quit habits such as stopping tobacco or alcohol to prevent progression. If the disease has already progressed to a cancerous stage, then the patient would require surgical removal of the lesion. Recent advances have led to the development of cryotherapy aided removal of leukoplakia. If there is the presence of infection with Epstein-Barr virus, antivirals are also usually prescribed to eradicate the virus. Supplementation with vitaminA- Retinoids will be an excellent preventive measure for leukoplakia.
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Leukoplakia is usually a benign condition and is non-cancerous; however, few may show signs of cancer. It is also reported that areas next to leukoplakia are more prone to the appearance of cancer. Further, speckled leukoplakia increases the risk of cancer.
Mild cases of leukoplakia usually require no treatment and will resolve in two weeks, whereas severe cases can have an interconnection with oral cancer, and prompt treatment is needed. Routine dental checkups help in preventing recurrence.
Leukoplakia usually resolves by itself in a period of two weeks if the trigger is removed. Else, it should be evaluated by the dentist with the help of a biopsy for other conditions.
Avoiding the triggers, taking vitamin A, Isotretinoin, and beta carotene supplements followed by surgical removal of the lesion with the help of a surgical scalpel, laser therapy, or cryoprobe, if it exhibits early cancer symptoms, is needed along with regular dental follow-ups.
Depending on the clinical and pathological progression, the spreading rate of oral verrucous leukoplakia is similar to progressive verrucous leukoplakia, which is about 7.8 years for turning into a malignant condition.
If leukoplakia shows signs of early cancer, it can be surgically removed; however, recurrence is common in leukoplakia, so regular follow-up is necessary.
Non-scrapable whitish or grayish patches that appear irregular or flat in texture and hardened suggest leukoplakia. Red lesions indicate speckled leukoplakia or erythroplakia that are more prone to cancerous developments.
A study has reported that Aspirin mouthwash can be used to treat oral leukoplakia, as it hampers the growth of cancer cells by inhibiting certain enzymes necessary for cell growth.
Leukoplakia is caused by tobacco usage, chronic alcoholism, profound cheek biting, and ill-fitting dentures, whereas canker sores are induced by stress.
Dentists can diagnose leukoplakia clinically, but to detect the cancerous changes, a biopsy is needed.
Leukoplakia will heal on its own in the absence of triggering factors in a span of two weeks. If it does not heal, then it needs biopsy and surgical intervention.
- Rise of nodules.
- White or red lesions with a pebble-like appearance.
- Ulcerated lesion.
- Firm in texture.
Leukoplakia of the tongue presents the same symptoms as in any other area of the oral cavity. It is usually present on the lateral borders of the tongue and may also occur on the dorsal and ventral surfaces.
Treatment for tongue leukoplakia is similar to that of any leukoplakia of the oral cavity. It involves avoiding alcohol and tobacco usage, taking vitamin A, Isotretinoin, and beta carotene supplements, followed by surgical management if needed.
Last reviewed at:
17 Mar 2022 - 4 min read
Query: Hello doctor, I am seeing white stuff in my mouth. I see more in quantity in inner cheeks and gums when I wake up in the morning. It has been four weeks. It can be scraped off using the finger. I consulted a dentist nearby and she told me it might be leukoplakia and it goes away by itself in a few d... Read Full »
Query: Hi doctor, I am 56 year old and having problem of white scaling on side of tongue and also on top of the tongue. I got tested for fungal growth and it was negative. This problem is there since one year. I have consulted many doctors in regard to the same. They asked me to take extra care of hyg... Read Full »
Query: Hi doctor, What are the everyday habits that could affect our teeth? I want to get some insight on how certain practices such as smoking, biting nail, opening things with the mouth, etc., affect the teeth. Read Full »
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