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Leukoplakia: Causes, Symptoms and Treatment

Leukoplakia (also leukoplasia) is a medical term describing white lesions that develop in the oral cavity when cells within the mucous membrane change. These lesions may appear on the inner cheeks, gums, lips, tongue, floor or roof of the mouth. Leukoplakia often occurs due to chronic irritation of the mucous membranes that line the mouth. In some cases, a bacterial, fungal or viral infection can cause leukoplakia. Leukoplakia is not usually painful and does not cause permanent damage to the mouth tissues. However, about 3% of patients with leukoplakia later develop oral cancer.

Some other types of lesions occurring in the mouth may look similar to leukoplakia. Hairy leukoplakia, for example, is also characterized by white lesions, although they typically appear fuzzy or ridged and usually only affect the tongue. Hairy leukoplakia is seen almost exclusively in patients with HIV infection. However, this type of leukoplakia does not appear to increase the risk of developing oral cancer. Erythroplakia, on the other hand, appears as a red patch of tissue within the oral cavity. Erythroplakia is not a type of leukoplakia, but may appear near or within leukoplakia lesions and signal oral cancer.

Causes of Leukoplakia

The most common cause of leukoplakia is chronic irritation triggering cellular changes in the mucous membranes lining the mouth. Many irritants may be responsible, including:

  • Tobacco products. This includes all types of tobacco products that are either smoked or chewed. Tobacco is the biggest single cause of leukoplakia.
  • Long-term alcohol use. Long-term consumption of alcohol is another common cause of oral irritation that can result in leukoplakia.
  • Dental restorations. Tooth restorations that do not fit properly or have sharp areas can irritate the lining of the mouth and cause leukoplakia.
  • Biting the inner cheeks. Repeatedly biting the inside cheeks can injure the mucous membrane lining of the mouth and trigger leukoplakia.
  • Sanguinarine. This antimicrobial and antiplaque agent found in some toothpastes and mouth rinses has been associated with leukoplakia.

In rare cases, leukoplakia may also appear on external genitals. The cause for this is not fully understood but is suspected to involve infection with the human papilloma virus.

Infections have been found in some leukoplakia lesions but it is not clear whether they triggered leukoplakia, or whether they occurred only after the lesion developed. These infections include:

  • Bacterial infections, such as the sexually transmitted disease syphilis
  • Fungal infections, such as Candida albicans fungi, which cause thrush
  • Viral infections, such as the human papilloma virus, which causes genital warts

In addition, reactivation of the Epstein-Barr virus, best known for causing infectious mononucleosis, can lead to developing hairy leukoplakia. This virus, which is usually contracted during childhood, and often causing no symptoms, may become reactivated in adulthood due to an immune system deficiency (most often due to HIV infection). Other factors that may contribute to developing leukoplasia include excessive sun exposure, severe vitamin deficiency and endocrine disturbances.

Symptoms of Leukoplakia

The most typical sign of leukoplakia are lesions that appear in the oral cavity as white patches of skin. The discolored areas are usually not painful, but may be sensitive to spicy or acidic foods or when touched. The lesions occur on the inner cheeks, gums, lips, tongue and floor or roof of the mouth. The patches normally begin as flat, grey sores before turning white and developing a rough, hardened texture. Some lesions may also be speckled white and red. The lesions may be any size and usually take weeks or months to form. Sometimes, leukoplakia lesions develop on external female genitals.

Hairy leukoplakia, which most often occurs on the tongue, is similar in appearance except that the white lesions appear fuzzy and can resemble ridges. But, keep in mind that red lesions inside the mouth may indicate the potential development of oral cancer.

Diagnosing Leukoplakia

If leukoplakia is suspected, the dentist will examine the entire mouth, tongue and the sides of the face and jaw. He/she may press a finger against the floor of the mouth to check for any lumps or sensitivity and feel the neck to check the lymph nodes. A dentist is usually able to diagnose leukoplakia by its appearance and location in the mouth.

An oral brush biopsy, a quick and painless procedure, may be performed to identify signs of oral cancer that may be present in or near a leukoplakia lesion. Depending on the outcome of the oral brush biopsy, a scalpel biopsy may be performed to confirm a diagnosis of cancer.

Treatment of Leukoplakia

When treating leukoplakia it is necessary to remove the cause of irritation (tobacco, alcohol, ill-fitting or sharp-edged tooth restorations, etc.). However, leukoplakia may remain for months or up to a year after eliminating the irritating factors, especially when caused by tobacco or alcohol use. If signs of oral cancer are detected, the entire leukoplakia lesion may need to be removed. It goes without saying that the most effective way of preventing leukoplakia involves avoiding its causes.

Furthermore, patients with leukoplasia lesions should eat a healthy, well-balanced diet that includes plenty of fruits and vegetables to help them maintain strong immune system function. Consuming fruits and vegetables that are rich in beta-carotene (mostly those that are yellow and orange in color as well as green, leafy vegetables) may help the patient reduce leukoplakia lesions.

When it comes to treating hairy leukoplakia, antiviral medications may be used to fight the infection (Epstein-Barr virus) causing the disease. Also, antifungal drugs may be prescribed to treat secondary fungal infections. However, most cases of hairy leukoplakia return after medications are stopped. But, hairy leukoplakia does not always require treatment. In many cases, a doctor may simply recommend monitoring the condition to see if it worsens.

Where to Get More Information: American Academy of Oral and Maxillofacial Pathology