Leukoplakia (White Patches): Symptoms & Causes

Leukoplakia is not usually dangerous but can sometimes be severe. Although most leukoplakia patches are benign, a small percentage show early signs of cancer, and many mouth cancers occur near areas of leukoplakia. Therefore, it is best to see your dentist if you have unusual and persistent changes in your mouth.

What is Hairy Leukoplakia?

Epstein-Barr virus (EBV) is the leading cause of hairy leukoplakia. Once you contract this virus, it remains in your body permanently.

EBV is usually inactive. However, it can cause patches of hairy leukoplakia to develop at any time. Flare-ups are more common in people with HIV or other immune problems.

Types of White Patches in the Mouth

There are two main types of leukoplakia:

• Homogeneous: A thin, primarily white, uniform-colored spot that may have a smooth, wrinkled or striated surface, which is uniform throughout.
• Non-homogeneous: Mainly a white and red patch, irregular, that may be flat, nodular (bumpy) or warty (raised).

Leukoplakia Stages

• Early Stage: You might notice small white spots in your mouth.
• Intermediate: These spots can get thicker or start to spread.
• Advanced: These spots can show early signs of abnormal changes that could lead to health issues.
• Malignant Transformation: In rare cases, it can become oral cancer.

Causes of Leukoplakia

Damage to the mouth can result from cheek chewing, excessive tooth brushing, trauma, or dentures that don't fit properly. Both can cause inflammation, redness, and probably white patches in the mouth.

White patches in the mouth can also result from other conditions, such as cancer and gum disease.

• Injury to the inside of the cheek, such as from biting
• Uneven and rough teeth
• Dentures, especially if they don't fit properly
• Inflammatory conditions of the body
• Prolonged alcohol use can contribute to these symptoms

The Risk Factors for Leukoplakia?

• Tobacco Use: Smoking or chewing tobacco significantly raises the risk.
• Alcohol Use: Drinking alcohol, especially in combination with smoking, increases the likelihood of leukoplakia and oral cancer.
• Weakened Immune System: Conditions like HIV and medications that suppress the immune system can increase susceptibility.
• Poor Oral Hygiene: Not maintaining good oral hygiene can lead to oral issues, including leukoplakia.

Complications of Leukoplakia

Leukoplakia does not usually cause permanent damage to the mouth's tissues. However, oral cancer is a potentially serious complication of leukoplakia. Oral cancers often form near leukoplakia patches, and the patches themselves can show cancerous changes. Even after the leukoplakia patches are removed, the risk of oral cancer remains high.

Hairy leukoplakia, conversely, is not painful and is not likely to cause cancer. However, it can imply HIV infection or AIDS.

When to Visit a Doctor?

Many cases of white spots in the mouth do not cause concern. However, anyone who develops white oral plaques should see a doctor for a thorough examination. These plaques can sometimes be a symptom of a more serious health complication, such as cancer, that requires medical treatment.

People should see a doctor for oral cancer if they notice the following symptoms:

• Mottled white patches with raised red regions
• White bumps with dark or red spots
• Patches with an uneven texture
• Pain or difficulty eating
• Swallowing, or moving the jaw
• Sores that last more than 2 weeks without healing
• Changes in the surrounding tissues in the mouth, earache

Diagnostic Method for Leukoplakia

Since white leukoplakia patches do not cause symptoms, doctors first notice them during a routine exam. Before diagnosing leukoplakia, doctors investigate other possible causes of white spots. These could include friction inside the mouth (caused by false teeth), repeated cheek biting, yeast infections, or lichen planus.

Cancer Tests

• Oral Brush Biopsy: Removes cells from the lesion's surface with a small rotating brush. This is a noninvasive procedure; however, it does not always result in a definitive diagnosis.
• Excisional Biopsy: Involves surgically removing tissue from the leukoplakia patch or removing the entire patch if it is small. An excisional biopsy is more comprehensive and usually results in a definitive diagnosis.

If the biopsy is positive for cancer and your doctor has performed an excisional biopsy that removed the entire leukoplakia patch, you may not need further treatment. If the patch is large, you may be referred to an oral surgeon or an ear, nose, and throat (ENT) specialist.

Treatments for Leukoplakia

In most cases, leukoplakia does not require treatment if the cause is removed. Some standard treatment approaches include:

• Eliminating Irritation: If a rough tooth or improperly fitted denture is causing irritation, smoothing the tooth or adjusting the denture can help.
• Smoking Cessation: If tobacco use is a contributing factor, quitting smoking and using tobacco products is essential.
• Surgical Removal: If the leukoplakia patches do not resolve after irritation is eliminated, a dentist or oral surgeon may need to remove them surgically.
• Follow-Up Care: Regular follow-up visits to monitor the area and check for any changes that may indicate cancer.

Treatment for Hairy Leukoplakia

Usually, you don't need treatment for hairy leukoplakia. The condition often causes no symptoms and is not likely to lead to mouth cancer. If your doctor prescribes medication, it may include:

• Medicine: You can take a pill that affects your entire system (systemic medication), such as antiviral drugs. These drugs can suppress the Epstein-Barr virus, which causes hairy leukoplakia. Topical treatment can also be used.
• Follow-up visits: White patches of hairy leukoplakia may return after finishing treatments. Your doctor can prescribe daily follow-up appointments to observe changes in your mouth or continuous treatment to prevent the recurrence of leukoplakia patches.

Leukoplakia Home Remedies

These remedies may relieve discomfort but are not cures:

• Aloe vera gel to reduce irritation
• Turmeric or saltwater rinses for inflammation
• Clove oil for antiseptic properties
• Maintaining good oral hygiene
• Avoiding hot, spicy and acidic foods

Prevention of Leukoplakia

Practicing proper oral hygiene and avoiding practices that harm or stress the lining of your mouth are the best ways to monitor and prevent leukoplakia.

Recommended ways to prevent leukoplakia include:

• Avoid tobacco products of any kind
• Avoid inhaled or smoked products, including cannabis, cloves, and resin
• Reduce or stop drinking alcohol
• Conduct routine self-exams and checkups with a doctor
• Attend routine dental exams and maintain dental hygiene
• Avoid abrasive dental hygiene products, such as bleaches and rinses
• File teeth properly to ensure cavities are not rough or uneven
• Make sure dental devices, such as dentures and braces, fit well without rough or exposed edges
• Keep mouth wounds clean
• Wait for hot drinks or food to cool before consuming
• Avoid candy or chews that have rough edges or cause mouth irritation
• Eat a healthy and balanced diet to avoid nutrient imbalances or deficiencies
• Practice safe sex to reduce the risk of HPV transmission, including the use of a condom or dental dam during oral intercourse