By Medicover Hospitals / 12 Jan 2021
Leukoplakia appears as thick, white spots on the inner surfaces of the mouth. It has several possible causes, including repeated injury or irritation. It can also be a sign of precancerous changes in mouth or mouth cancer.
- What is leukoplakia or white Patches in the mouth?
- When to visit a Doctor?
What is leukoplakia or white Patches in the mouth?
Leukoplakia is a condition in which thickened white patches form on the gums, the inside of the cheeks, the base of the mouth, and sometimes the tongue. These patches cannot be easily removed. The cause of leukoplakia is unknown, but tobacco, whether smoked, wet, or chewed, is considered being the main culprit in its development. Leukoplakia is not usually dangerous, but it can sometimes be serious. Although most leukoplakia patches are benign, a small percentage show early signs of cancer, and many mouth cancers occur near areas of leukoplakia. For that reason, it is best to see your dentist if you have unusual and persistent changes in your mouth.
There are two main types of leukoplakia:
- Homogeneous: A thin, mostly white, uniform colored spot that may have a smooth, wrinkled, or striated surface that is uniform throughout.
- Non-homogeneous: Mainly white and red patch, irregular that may be flat, nodular (bumpy), or warty (raised). Additional subclassifications, such as ulcerated and nodular (mottled), can also be made, which can help predict the likelihood of a patch becoming cancerous.
Mainly white and red patch, irregular that may be flat, nodular (bumpy), or warty (raised). Additional subclassifications, such as ulcerated and nodular (mottled), can also be made, which can help predict the likelihood of a patch becoming cancerous.
Damage to the mouth can be the result of cheek chewing, excessive tooth brushing, trauma, or dentures that don't fit properly. Both of these can cause inflammation, redness, and probably white patches in the mouth. White patches in the mouth can also be the result of underlying conditions, such as cancer and gum disease.
Hairy leukoplakia: Epstein-Barr virus (EBV) is the leading cause of hairy leukoplakia. Once you contract this virus, it remains in your body permanently. The EBV is usually inactive. However, you can cause patches of hairy leukoplakia to develop at any time. Flare-ups are more common in people with HIV or other immune problems.
Some common causes of white spots in the mouth:
- 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
- Alcohol consumption (prolonged use)
- Bacterial infections
- Mouth ulcers
- Chew the inside of the cheeks
- Dental appliances
Tobacco use puts you at high risk for leukoplakia and oral cancer. Drinking alcohol in combination with smoking raises the risk.
Leukoplakia does not usually cause permanent damage to the tissues of the mouth. Oral cancer is a potentially serious complication of leukoplakia. Oral cancers often form near the 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, on the other hand, is not painful and is not likely to cause cancer. However, it can imply HIV infection or AIDS.
Since white leukoplakia patches do not cause symptoms, they are first noticed by doctors during a routine exam.
Before making a diagnosis of leukoplakia, other possible causes of white spots are investigated. These could include friction inside the mouth (caused by something like false teeth), repeated cheek biting, yeast infection, or lichen planus.
If the biopsy is positive for cancer and your doctor performed an excisional biopsy that removed the entire patch of leukoplakia, you may not need further treatment. You may be referred to an oral surgeon or an ear, nose, and throat (ENT) specialist for care if the patch is large.
- Oral brush biopsy: Consists of removing cells from the surface of the lesion with a small rotating brush. This is a non-invasive procedure, but it does not always result in a definitive diagnosis.
- Excisional biopsy: Consists of surgically removing tissue from the leukoplakia patch or removing the entire patch if it is small. An excisional biopsy is more complete and usually results in a definitive diagnosis.
Diagnosis for Hairy Leukoplakia:
If you have hairy leukoplakia, you may be screened for complications that can lead to a weak immune system.
Treatment of leukoplakia, if necessary, involves removing the source of irritation. For example, if leukoplakia is caused by a rough tooth or an uneven denture or filling surface, the tooth will be smoothed and the braces will be restored. If leukoplakia is caused by smoking, you will be advised to restrict or stop smoking or other tobacco products.
Leukoplakia is typically harmless, and the lesions usually heal within a few weeks or months after the cause of irritation has been eliminated. If the cause of inflammation is not effective in minimizing leukoplakia, the lesion will need to be surgically removed. The lesion can be removed by your general dentist or by an oral surgeon.
Treatment for Hairy Leukoplakia:
You usually 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, that 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, the cause of hairy leukoplakia. Topical treatment can also be used.
- Follow-up visits: After finishing treatments, white patches of hairy leukoplakia may return. Your doctor can prescribe daily follow-up appointments to observe changes in your mouth or continuous treatment to prevent the recurrence of leukoplakia patches.
When to visit a Doctor?
Many cases of white spots in the mouth do not cause concern. However, anyone who develops white oral plaques can see a doctor for a thorough examination. These plaques can sometimes be a symptom of a more serious health complication that requires medical treatment, such as cancer.
While leukoplakia is not cancer, specialists also believe leukoplakia to be precancerous. Sometimes oral tumors develop within persistent, painful, or severe plaques or plaques of leukoplakia.
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
Practicing proper oral hygiene and avoiding practices that harm or stress the lining of your mouth is the best way to monitor and avoid 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
- 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 drinking
- 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
Frequently Asked Questions:
You can rinse your mouth with saltwater at home and avoid spicy or acidic foods to speed up the treatment.
White patches in the back of the throat or on the tonsils are usually signs of infection, particularly strep throat, tonsillitis, or mononucleosis; sometimes they are associated with a syphilitic infection.
White spots on the inner surfaces of the mouth have several possible causes, including repeated injury or irritation. It can also be a sign of precancerous changes in mouth or mouth cancer.
SPRINGER - https://link.springer.com/chapter/10.1007/978-3-030-15432-5_4
Wiley Online Library - https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0528.2004.00171.x
British Dental Journal - https://www.nature.com/articles/4813197