There are various lesions that appear as white patches in the oral cavity. Most of these lesions are noncancerous and do not require any treatment. Read the article to know more about such lesions.
The oral cavity is an overlapping area among different medical specialties, such as otolaryngology (ENT), maxillofacial surgery, dentistry, and oncology. The oral cavity overlaps so many specialties because of its role as a shared pathway for food, liquids, and even air in some cases. The oral cavity is the door for the gastrointestinal system. Any oral lesion, even a small lesion, can affect our ability to eat, speak, and our appearance. All the diseases of the oral cavity cannot be covered in a single article because a single oral disease can be discussed from multiple points of view according to the specialty of the writer himself. In this article, I have discussed white oral lesions from an otolaryngology point of view.
Clinically, oral lesions can be classified according to the color into:
The importance of discussing white oral lesions is not only due to its rate but also the susceptibility for malignant transformation of some lesions, such as lichen planus and leukoplakia. Oral white lesions can also be classified into:
Congenital lesions are lesions that are present at birth and may be noticed later during life like leucoderma, white sponge nevus, dyskeratosis congenita, and hereditary benign intraepithelial dyskeratosis.
1) Leucoderma - presents as a grey or white patch most commonly on the oral cavity mucosa. Wrinkles of the white patch disappear while stretching the oral mucosa. The most affected oral part is the buccal mucosa.
2) White Sponge Nevus - is presented after birth or in early childhood and even in adolescence. It takes the shape of raised, corrugated, white spongy plaques, which affect most commonly the oral mucosa, bilaterally. It can also affect the soft palate, the floor of the mouth, and alveolar mucosa. White sponge nevus can cause difficulty in swallowing when it affects the esophagus.
3) Dyskeratosis Congenita - is a bone marrow failure syndrome. So, it is a disease that affects many systems of the body. The most important oral manifestation here is bullae formation, followed by eruptions. Dyskeratosis congenita is also presented by developmental delay, liver failure, hypothyroidism, microcephaly, and many other manifestations.
4) Hereditary Benign Intraepithelial Dyskeratosis - is presented in childhood by the same manifestation of white sponge nevus, which is described before. It has raised corrugated white plaques and in addition to an ocular involvement in the form of white thick opaque gelatinous plaques on the mucous membrane lining the inner surface of the eyelids and the eyeball adjacent to the cornea. The lesion can also affect the cornea, producing blindness which needs an ophthalmology interference.
All the above-mentioned congenital lesions do not require any medical interference and are not premalignant except dyskeratosis congenita, which requires a bone marrow transplantation. Moreover, it has a thirty percent potential of malignant transformation into leukoplakia.
The acquired white oral lesions are classified into two groups:
Acquired lesions that can be scraped off.
Acquired lesions that cannot be scraped off.
Acquired Lesions That Can Be Scraped Off:
They are superficial oral burn, oral candidiasis, materia alba, and morsicatio.
1) Superficial Oral Burn - can be thermal or chemical.
Thermal Burns - are caused by hot food, liquids, and iatrogenic from hot dental instruments. The most affected oral parts are the tip of the tongue, posterior buccal mucosa, and palatal mucosa. Superficial thermal burns are increased after the use of microwave ovens in our homes.
Chemical Burns - are caused by chemical materials, such as Aspirin, hydrogen peroxide, and battery acid. Superficial oral burns present mostly as small areas of the yellowish-white necrotic epithelium. All the superficial oral burns are not dangerous and improve without treatment. In some severe cases, medical treatment with antibiotics, analgesics, and anti-inflammatory drugs is needed.
2) Oral Candidiasis - is the most common lesion of the oral lesions that we are discussing now. The causative organism is Candida Albicans, which are normally present in the oral cavity. Candida Albicans, an opportunistic fungus in nature, turns into a pathological agent when the patient’s immunity falls. Oral candidiasis are commonly seen in infants because of their underdeveloped immune system, elderly patients who have chronic diseases that affect the immunity, such as diabetes mellitus, patients under severe psychological stress, and patients taking broad-spectrum antibiotics for a long period. Oral candidiasis appears as creamy white plaques that can be removed, leaving a blood oozing surface. Although oral candidiasis treatment is just local antifungal drops or gel, the chronicity of oral candidiasis can be an important sign of human immunodeficiency virus (HIV) infection.
3) Materia Alba - is not a pathological condition, but an accumulation of food remnants in the form of white or grey patches on the oral mucosa and tongue that can be easily removed. Materia alba is a matter of lack of oral hygiene. The treatment is mainly mouth gargling and brushing.
4) Morsicatio - is a Latin word that means “bite.” A lot of people can bite their own oral mucosa subconsciously, leaving a white bite lesion on their inner buccal mucosa. The difficulty in diagnosing morsicatio is the denial of the patient himself. Most of the cases are under severe psychological stress or have a mental illness. The most affected parts are the sides of the tongue, buccal mucosa, and the inner surface of the lips. If the patient confesses that he actually bites his own oral mucosa, the diagnosis would be easy. If the patient denies, a biopsy should be taken from the lesion to be histologically examined to exclude any malignancy.
Acquired White Oral Lesions That Cannot Be Scraped off:
They can be classified into two groups:
The first group is acquired lesions with a specific pattern.
The second group is acquired lesions that do not have a specific pattern.
I will be addressing acquired white oral lesions in my next article.
White lesions in the mouth are caused by smoking and chronic irritation from dentures or dental restorations. Exposure to tobacco products for a very long time can also cause white lesions in the mouth.
Oral lesions appear as white thickenings. The surrounding area of this thickening is almost red. If it occurs as erosion or ulcer, then it is painful. If it occurs only as a white lesion, then it is not painful.
When the oral cavity is concerned, a certain degree of keratinization happens all the time. It involves the formation of keratin. When keratinization happens in an abnormal manner, the lesion begins to appear white.
The common oral lesions of the mouth are:
- Oral candidiasis.
- Herpes labialis.
- Recurrent aphthous stomatitis.
- Erythema migrans.
- Hairy tongue.
- Lichen planus.
The causes of white lesions on the tongue:
- Chronic irritation.
- Vitamin or nutrient deficiency.
- Hypersensitivity reactions.
- Hormonal imbalance.
- Aphthous ulcers.
- Canker sores.
The oral lesions are treated based on the cause. If a particular medication or allergic agent is causing a lesion, then the exposure to that particular medication or allergic substance should be stopped. Topical corticosteroids should be applied to the lesions. It will reduce the pain and size of the lesion. The rate of recurrence of the condition cannot be reduced.
All the lesions in the mouth are not cancerous. Many lesions are just benign ones. There are many laboratory diagnosis procedures to identify cancerous conditions. In the majority of the benign conditions, the pain would not be noticed in the lesion.
The white lesion that appears on the gingiva is leukoplakia. It can occur on the cheeks and tongue also. It might become hard after a particular period of time. Most of the cases of leukoplakia are benign. It cannot be scraped off with cotton or gauze.
Topical application of steroid ointments are recommended. Regular mouth gargling is recommended. You can use mouthwashes for this purpose. Spicy and oily food items should be avoided as it can aggravate the white spots.
Oral thrush can be identified by the following symptoms.
- Yellow or white patches on the inner cheeks, tonsils, tongue, gums, or lips.
- Bleeding if the bumps are scraped.
- Cracked skin at the corners of the lips.
- Difficulty in swallowing.
- Altered taste in your mouth.
Last reviewed at:
05 Oct 2020 - 4 min read
Query: Hello doctor,I am a 26-year-old female. The signs and symptoms of my health are headache, nausea, sore throat, with pain and rashes on my tongue, and gums. Also, I see something white in my tongue. Read Full »
Query: Hi doctor, My son is 14 months old and a normal baby. He has developed white patches or spot behind ear and back of the neck. According to my knowledge, it is present since birth or from the time he was three months old. My father has eczema in his leg. The patches do not spread but with time, they... Read Full »
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