Kenneth Cheng, D.D.S.
Leukoplakia is a condition that develops when cells within the mucous membrane change. This often occurs in response to chronic irritation and causes white lesions within the mouth. These may develop on the inner cheeks, lips, gums, tongue and roof or floor of the mouth.
Many different factors can irritate the lining of the mouth. The primary cause is tobacco use, and includes tobacco products that are smoked, chewed or held in the mouth. Alcohol consumption is another common cause of the irritation that can lead to leukoplakia. When combined, tobacco and alcohol consumption can significantly raise the risk for a person developing leukoplakia. Vitamin deficiency, syphilis and endocrine disturbances can also cause leukoplakia.
In a small number of cases (about 3 percent), leukoplakia may lead to oral cancer. Patients should consult their dentist if they have a mouth sore or area of discoloration that lasts a week or longer. If red lesions (erythroplakia) occur in or near the leukoplakia, it may indicate the development of cancer.
A different type of leukoplakia, called hairy leukoplakia, is also characterized by white lesions inside the mouth. However, these areas appear fuzzy and ridged. Hairy leukoplakia most often occurs on the tongue and is due to a viral infection (Epstein-Barr virus). This virus becomes activated by an immune system deficiency. It is most common in people infected with human immunodeficiency virus (HIV) who have been previously exposed to the Epstein-Barr virus. Unlike leukoplakia, hairy leukoplakia does not increase the risk of oral cancer.
A dentist can usually diagnose leukoplakia based on its appearance and location within the mouth. An examination of the entire mouth is usually performed, including inspection of all sides of the tongue. A dental history and medical history may be obtained, and patients may be asked whether they have a family history of leukoplakia or oral cancer. An oral brush biopsy, a quick and painless procedure, may be performed as a screening test to determine whether signs of cancer exist within the lesion. This may be followed with a scalpel biopsy, which may confirm a diagnosis of cancer.
Treatment for leukoplakia generally involves removing all irritating factors causing the condition. Eliminating tobacco use and avoiding or limiting alcohol consumption is important. It may also involve correcting any ill-fitting dental appliances or smoothing rough tooth surfaces in the mouth. Leukoplakia typically goes away within a year after the cause is removed. Prevention involves continuing these activities. Regular dental examinations and a diet high in fruits and vegetables (especially those that contain beta carotene) may also help.
Leukoplakia is a clinical term describing white lesions that can develop in the mouth. They may appear on the inner cheeks, lips, gums, tongue, roof or floor of the mouth.
These lesions occur due to cellular changes in the mucous membranes that line the mouth. This often occurs due to chronic irritation. A variety of factors may cause this irritation. The most common is tobacco and alcohol use or repeated physical irritation in the area.
Leukoplakia does not usually cause permanent damage to a patient’s mouth. Sometimes, leukoplakia is due to a viral, bacterial or fungal infection. In a small number of cases, leukoplakia may lead to oral cancer. Approximately 3 percent of patients with leukoplakia later develop oral cancer, according to the National Institutes of Health.
Several other types of lesions in the mouth may be similar to leukoplakia. Hairy leukoplakia also produces white lesions within the mouth, although they typically appear fuzzy or ridged, and occur most often on the tongue. This type of leukoplakia is seen almost exclusively in patients with human immunodeficiency virus (HIV) infection. Like leukoplakia, hairy leukoplakia is not usually painful but hairy leukoplakia does not increase the risk of oral cancer. Erythroplakia appears as a red patch of tissue within the mouth. It is not a type of leukoplakia, but may appear near or within leukoplakia lesions and may indicate oral cancer.
Risk factors and causes of leukoplakia
Leukoplakia can be caused by a wide range of factors. The most common cause of leukoplakia is chronic irritation. A large number of irritants may be responsible, including:
- Tobacco products. This includes all types of tobacco products, including those that are smoked or chewed. Tobacco is responsible for the majority of cases of leukoplakia. Other plant-based chewing products such as betel, commonly used in Southeast Asia, can also cause leukoplakia.
- Long-term alcohol use. Long-term consumption of alcohol, especially among heavy drinkers, is a common cause of oral irritation that can lead to leukoplakia.
- Ill-fitting dentures or dental appliances. Dental appliances that do not fit properly can irritate the lining of the mouth and result in leukoplakia.
- Chewing the inner cheeks. Repeatedly biting or chewing the inside cheeks can injure the lining of the mouth and lead to leukoplakia.
- Rough edges inside the mouth. Sharp areas of teeth (or their restorations) can poke or irritate the mucous membrane lining of the mouth.
- Sanguinarine. This antimicrobial ingredient found in some toothpastes and mouth rinses has been associated with leukoplakia.
Occasionally leukoplakia will appear on external female and male genitals. The cause for this is not fully understood but may involve infection with the human papilloma virus (HPV).
Infections have been found in some leukoplakia lesions. It is not clear whether these infections cause leukoplakia, or whether they occurred after the lesion developed. Infections associated with leukoplakia include:
- Fungal infections (e.g., Candida albicans fungi, which cause thrush)
- Viral infections (e.g., HPV, which may cause genital warts)
- Bacterial infections (in particular the sexually transmitted disease syphilis)
Hairy leukoplakia develops as the result of reactivation of the Epstein-Barr virus that can cause mononucleosis. This virus is usually contracted during childhood, often without the child displaying any symptoms. It may become reactivated in adulthood due to an immune system deficiency, usually human immunodeficiency virus (HIV) infection.
Some people may be more susceptible to leukoplakia than others. For example, leukoplakia occurs more often among men than women. However, this may be due to the tendency for men to use tobacco and consume alcohol more often than women. However, women who develop leukoplakia may be more likely to develop oral cancer. Leukoplakia is also more likely to occur in people over the age of 40.
Given the multiple irritants that cause leukoplakia, tobacco and alcohol use are the primary factors that place a person at risk of developing the condition. In addition, people with ill-fitting dental appliances or sharp teeth (or restorations) may also be at risk of developing leukoplakia.
Signs and symptoms of leukoplakia
Leukoplakia refers to lesions that appear in a person’s mouth as white patches of skin. These can appear on the inner cheeks, lips, gums, tongue, and roof or floor of the mouth. The discolored areas are not usually painful, but may be sensitive to touch or spicy foods. The patches begin as flat, gray sores before turning white and developing a rough, hardened texture. Some lesions are speckled white and red. They may be any size and typically develop slowly, taking weeks or months to form. In some cases, leukoplakia lesions may develop on external female genitals.
Hairy leukoplakia is similar in appearance except that the white lesions appear fuzzy and can resemble ridges. Hairy leukoplakia most often appears on the tongue.
Patients should consult their dentist if they have a mouth sore or area of discoloration that lasts a week or longer. Red lesions (erythroplakia) may indicate the potential development of oral cancer.
Diagnosis methods for leukoplakia
The presence of leukoplakia requires diagnostic work to determine its cause as well as a microscopic (histologic) diagnosis. A dentist may diagnose the condition starting with a patient’s dental history and medical history. This may include questions about the patient’s dental hygiene, current medications and health conditions, including any recent infections. If leukoplakia is suspected, the dentist may also ask whether the patient has a family history of leukoplakia or oral cancer.
An examination of the entire mouth is usually performed, which includes inspection of the inner cheeks, lips, gums, floor and roof of the mouth. The sides of the face and jaw are also usually examined. Patients may be asked to stick out their tongue, which can be held with gauze while the dentist examines its sides, top and bottom. The dentist may feel (palpate) the neck to check the patient’s lymph nodes. A dentist is usually able to identify leukoplakia by its appearance and location in the mouth. A dentist may also press a finger against the floor of the mouth to check for any lumps or sensitivity. Patients with dentures or other removable dental appliances may be asked to remove them prior to the examination.
An oral brush biopsy may be performed as a screening test to identify signs of oral cancer that may be present in or near a leukoplakia lesion. This type of biopsy is a quick and painless procedure in which a small brush is used to remove some tissue from the area, which is then sent to a laboratory for analysis. No anesthesia is required for this test, which can identify any abnormal cells in the sample taken.
Depending on the results of the oral brush biopsy, a dentist may perform a biopsy with a scalpel to confirm the diagnosis. This involves removing a small tissue sample from the area and examining it under a microscope.
Treatment and prevention of leukoplakia
In most cases, treating leukoplakia involves removing the cause of irritation. Leukoplakia usually goes away after eliminating the irritating factors. Leukoplakia may remain for weeks or months after ill-fitting dental appliances are removed, or up to a year after tobacco or alcohol use is stopped or diminished.
If signs of oral cancer are identified, the entire leukoplakia lesion may be removed from a patient’s mouth. This may be done with a scalpel, laser or cryoprobe (device that freezes cells in the area). Preventing leukoplakia involves avoiding its causes.
Treating and preventing leukoplakia may also include:
- Eliminate use of tobacco products. This includes tobacco that is smoked (e.g., cigarettes, pipe) and chewed or held inside the mouth (e.g., chew, snuff). Most leukoplakia lesions heal within a year of eliminating tobacco use.
- Avoid or limit alcohol consumption. Alcohol irritates the mucous membrane lining of the mouth. Restricting alcohol consumption can help heal as well as prevent leukoplakia lesions inside the mouth.
- Schedule regular dental examinations. These may identify any causes of concern in a patient’s mouth while they are easy to treat or before they become larger problems (e.g., oral cancer). Dental appliances may be periodically checked and adjusted for a proper fit.
- Have sharp edges smoothed. A dentist can smooth rough edges on sharp teeth or restorations that can irritate the lining of the mouth.
- Eat plenty of fruits and vegetables. A healthy, well-balanced diet should include plenty of fruits and vegetables to maintain a patient’s overall health and immune system function. In addition, certain types of fruits and vegetables contain beta carotene, an antioxidant that is transformed into vitamin A in the body and may help reduce leukoplakia lesions. These include yellow and orange fruits and vegetables (e.g., apricots, cantaloupe, carrots) and green, leafy vegetables (e.g., spinach).
In cases of hairy leukoplakia, medications may be used to treat the infection causing the condition. For example, antiviral drugs may be used if the Epstein-Barr virus is the cause. Antifungal medication may be used for secondary fungal infections. However, most cases of hairy leukoplakia return after medications are stopped. Not all cases of hairy leukoplakia require treatment. A dentist or physician may recommend simply monitoring the condition to see if it worsens.
Questions for your doctor regarding leukoplakia
Preparing questions in advance can help patients to have more meaningful discussions regarding their conditions. Patients may wish to ask their doctor the following leukoplakia-related questions:
- I seem to have a white-colored area in my mouth. Could this be leukoplakia?
- What is the cause of my leukoplakia?
- How do you recommend we treat my leukoplakia?
- If I need to take medications, what are their side effects?
- Will my leukoplakia return after I stop taking the medication?
- Are there particular fruits or vegetables that may help heal my leukoplakia?
- What else can I do to help heal my leukoplakia?
- How often should I have a dental examination that includes a complete mouth inspection?
- What can I do to prevent leukoplakia or oral cancer?
- What change in my symptoms should I report to you?