Over the course of time, we notice several white lesions in the mouth. Ulcers, fungal and bacterial infections and injuries are some causes for these lesions. Leukoplakia is one such white lesion which has the potential to be fatal.

It is a pre-cancerous condition, which means that if the etiological factors remain, the situation can become malignant. (1) The disease is a reaction of the mucous membrane to chronic irritation. It can affect your tongue, palate, gums and cheek lining.

What causes leukoplakia?

This question has no definite answer because the exact cause of leukoplakia is still unknown. Though one specific cause cannot be zeroed down on, many pre-disposing factors and habits are linked to it.

Habits

The strongest aetiology linked to this condition is the use of tobacco. Continuous tobacco use irritates the mucous lining and causes white patches in areas where you keep tobacco in the mouth.

Smoking and drinking alcohol are habits that can aggravate the condition, if not cause it.

Irritation from Dentures

People who have been wearing dentures for a long time may develop chronic irritation in some parts of the mouth. The acrylic from the dentures can rub against the floor of the mouth or the cheek lining, and over time it develops into a white patch. Ill-fitting dentures that come off frequently or impinge on soft tissues require replacement.

Sharp tooth

Sometimes, the cusps of the teeth are sharper than usual, making it a source of irritation to the skin around it. A sharp cusp of a molar impinges on the cheek lining, and it will cause pain every time you eat or talk. Over time, this develops into leukoplakia.

Systemic conditions

Some inflammatory conditions of the body also cause leukoplakia secondarily in the mouth and oesophagus.

Ultraviolet Radiation

Harmful ultraviolet radiation is an etiological factor for leukoplakia of the lower lip and is most often in combination with angular cheilitis.

Virus

Hairy leukoplakia is a peculiar form of leukoplakia that occurs due to a virus, Epstein Barr Virus (EBV). (1) The virus does not leave your body once you acquire it.

Under normal conditions, it remains dormant. If you have an immunocompromised state because of diseases like HIV, then the virus causes oral hairy leukoplakia.

Signs and Symptoms

The characteristic oral appearance of leukoplakia is of a white patch. It can be greyish to yellowish.

Common sites in the mouth are the inner cheek lining, the floor of the mouth and the under surface of the tongue. These patches are not usually painful. But they are sensitive to heat, cold and irritation.

These white patches are non-scrapable, this means that they will not fade away if use an instrument to scrape it off. They do not have any particular shape and are rough textured.

Sometimes the patches are in combination with red spots, in a condition called erythroplakia. This condition is more susceptible to develop into malignancy.

Diagnosis

Leukoplakia diagnosis basis itself on the exclusion criteria. The definition of the condition clearly states that it is a white patch which cannot be diagnosed as any other condition.

Since an exact cause does not accompany leukoplakia, the doctor will first eliminate all other clinically similar conditions before reaching this diagnosis.

The dentist will first examine the affected areas and obtain a thorough history of your habits and illness. You should tell your doctor about any past illness, surgery, a medication that you have taken.

Also, inform your clinician about symptoms associated with the white patches-pain, bleeding, sensitivity, burning, etc.

If you take tobacco, are a smoker, or you drink alcohol, your dentist will note details about the amount and frequency of intake. This forms an integral part of the diagnosis.

Leukoplakia can be diagnosed based on clinical examination and history, but to rule out cancer, your dentist will have to run some investigations. The investigations will also tell you the sub-type of leukoplakia that you are suffering from. (2)

A biopsy of a lesion is a microscopic analysis to determine the nature of it. The technician removes a small portion of the white patch using special instruments and then examines it for malignancy.

This takes a few days, and in the meanwhile, the dentist can give you palliative care.

Other conditions that resemble Leukoplakia

Many other conditions in the mouth manifest as white patches. Leukoplakia is just one of them, and when a diagnosis is underway, these conditions are ruled out based on symptoms and history.

Oral Thrush is a fungal infection caused by Candida Albicans. The fungus also creates the appearance of white patches on the tongue, palate and gums. However, the lesions of candidiasis are scrapable.

Lichen planus is an immunological condition that leads to white patches in the oral cavity. (3) Chemical burns caused due to some strong food or ingestion also cause white patches. Another condition where the patient has white patches is keratosis caused due to smoking.

Treatment

The treatment of leukoplakia is to care for the patches. Most white patches resolve if the underlying cause moves out. For example, tobacco cessation is essential if tobacco is the underlying cause. Similarly, you should quit smoking and drinking alcohol too.

If a denture has caused chronic irritation, the dentist will advise you to get a new one made. For a while, avoid wearing any prosthesis till the irritation subsides. The sharp cusps of a tooth are smoothened to stop them from impinging on the mucosa.

If the patches are painful or they give you a burning sensation, you can apply topical numbing ointments or retinoic acid gel. (4)

Hairy leukoplakia is a condition in which antiviral drugs can help subside the patches.

If the biopsy shows a malignant transformation, oral cancer has to be treated either by surgery, radiation, or cryotherapy. In a surgical procedure, the entire cancerous tissue is excised.

For safety purposes, some healthy tissue is also removed. Cryotherapy is a process where extremely low temperatures are used to kill the malignant cells.

Prevention

There are some small measures which will prevent leukoplakia due to mechanical causes. Keep your dentures clean, and if you feel any sharp edges, get them smoothened by your dentist.

Remember that no prosthesis lasts forever, so change your dentures when the fitting becomes poor.

Quit harmful habits like tobacco chewing, smoking and drinking alcohol. They have other deleterious effects on different parts of our body. If you have any mechanical injury or trauma in the mouth, don’t eat something that is very hot or spicy. This will irritate the area more.

Maintain good oral hygiene, to avoid any infections in the mouth. An unhealthy mouth is more susceptible to diseases, and this makes the treatment complex.

To Wrap Up

Leukoplakia is a potentially dangerous condition. It is advisable to identify the risk factors and seek medical help to treat the patches. You may not be dealing with malignancy, but we would all rather be safe than sorry.

Oral appearance of leukoplakia is of a white patch. Common sites in the mouth are the inner cheek lining, mouth floor & under tongue surafce