Leukoplakia is a condition in which one or more white patches or plaque-like spots (lesions) forms on the tongue, gums, and oral mucosa. The substances and habits (e.g. smoking) that stimulate oral mucosa can cause leukoplakia. Most white patches that appear inside the oral cavity are not painful and go away on their own, whereas the white patches or plaque-like spots caused by leukoplakia can be a prognosis of oral cancer. The World Health Organization (WHO) defines leukoplakia as white patches or plaques that cannot be characterized, clinically, or pathologically as any other disease. Leukoplakia is a clinical term that refers to a large number of white mouth lesions. This condition is usually diagnosed through biopsy and other tests.
Symptoms of leukoplakia
As mentioned earlier, leukoplakia forms thick plaque-like white patches on the oral mucosa. These painless patches are sometimes colorless or gray with either a clear margin or a cracked surface.
The most common areas of the oral cavity affected by leukoplakia are:
- The internal surfaces cheeks
- Gums
- Floor of the mouth under the tongue
- Tongue
- Leukoplakia can sometimes be found in areas other than the mouth, the most common of which is the genital area.
Causes of leukoplakia
Chronic irritants play a major role in the development of leukoplakia. Repeated damage to oral tissues and dental infections cause a thick layer of keratin on the affected area. Keratin is a protein that is essential for maintaining the health of the outer layer of the skin and protects the cells of the inner layers against stress and damage. This protein also plays a key role in wound healing.
Similar to many other diseases, there is no obvious cause for leukoplakia. Small white patches that commonly appear inside the mouth by irritants are different from leukoplakia.
Smoking is one of the major causes of leukoplakia. In general, anything that causes damage or injury to oral mucosa can be a risk factor for leukoplakia. The most important risk factors for this condition are as follows:
- Excessive or prolonged smoking
- Human papillomavirus (HPV), which causes genital herpes
- Conditions that weaken the immune system, such as HIV, chemotherapy, or major surgery
- Mouth ulcers
- Severe and frequent burns of the oral mucosa caused by hot liquids and foods
- Excessive and long-term use of dental abrasives and whitening products
- Loose teeth, orthodontic brackets with sharp edges, and retainers
- Sharp and jagged dental surfaces
- Excessive and prolonged use of inhaled steroids without rinsing the mouth after taking them
- Poor oral hygiene
- Frequent biting or chewing of cheek and tongue mucosa
- Alcohol abuse
- Chewing certain plant leaves or seeds such as betel leaf and areca nut.
Leukoplakia is often confused with fungal infections because they look almost the same. There is a type of leukoplakia called Hairy Leukoplakia, which is characterized by usually painless lesions with a corrugated or hairy appearance. It is caused by the Epstein-Barr virus (EBV) and occurs usually in persons who are immunocompromised, especially those with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS).
Diagnosis and treatment of leukoplakia
The dentist can usually suspect leukoplakia by reviewing the patient’s medical history and performing clinical examinations. If the dentist suspects leukoplakia, a biopsy should be then performed to make a definitive diagnosis and evaluate the risk of cancer. Biopsy for leukoplakia is done in two ways:
- Oral brush biopsy. This involves removing cells from the surface of the lesion with a small, spinning brush.
- Excisional biopsy: An excisional biopsy is a medical test in which the whole lesion or mass is removed and tested.
If no cancerous cells are seen in the sample, the patient is advised to try to eliminate the irritant and maintain good oral hygiene. If the lesions still remain, the patient should visit a trained and specialized dentist to remove the lesions in a surgical procedure.
Since leukoplakia is a recurrent condition, the patient should always be under the supervision of the dentist (at least once a year) even after full recovery. In addition to the above-mentioned measures, the dentist should also prescribe specific antiviral drugs in cases where leukoplakia is accompanied by HIV or AIDS. If precancerous or cancerous cells are seen in the tissue sample, there is a need for more specialized tests to accurately determine the severity of the condition. Although it is difficult to precisely estimate, about 5% of leukoplakia cases are or will be cancerous.
Prevention of leukoplakia
The most important measures to prevent leukoplakia are to main good oral hygiene and avoid stressors and the agents irritating oral mucosa. Other preventive measures are as follows:
- Stop smoking
- Do not use inhaled or tobacco products containing cannabis, cloves, and resin
- Stop or cut down on alcohol consumption
- Regularly visit a dentist for dental checkups
- Do not use oral hygiene products that contain strong abrasives or bleaches
- Do not use loose dentures, sharp-edged brackets, and other similar appliances that cause chronic irritation of the oral mucosa
- Keep mouth ulcers clean
- Avoid having hot liquids and foods; let hot foods or drinks slightly cool
- Do not use candies or similar sweets that contain stimulants
- Follow a balanced diet consisting of a variety of food groups, minerals, and vitamins
- Do not use food allergens
- Avoid unconventional, dangerous, or unprotected sexual behaviors
Oral pimples
There are many causes of oral pimples. In some cases, a mouth ulcer caused by the patient’s carelessness is confused with an oral pimple. Tooth infection, the friction between a fractured tooth and the inner wall of the mouth, and any damage to the orthodontic appliance inside the mouth can lead to mouth ulcers or pimples. Oral pimples may also occur due to the deficiency of vitamins B and C or iron.
If the consumption of stimulating or hot foods causes an oral pimple, you do not need to be worried about it because it will gradually improve. Otherwise, you must visit an oral medicine doctor. If there is a problem with your orthodontic appliance, you need to visit your orthodontist. If you have a fractured tooth irritating the mouth wall, visit a dentist to repair the fractured tooth. Finally, if oral pimples are caused by your diet and eating habit, it is better to consult a specialist to give you some helpful advice.
Oral ulcer
There are two types of oral ulcer: minor and major. Some cases of oral ulcer are caused by the herpes simplex virus and appear in the form of herpes. These painful mucosal lesions usually take about 10-14 days to improve. The prevalence of oral ulcer varies in different parts of the world, and there are various data available on this condition in different geographical areas, ranging from 6% to 66%. It is noteworthy that oral ulcer is a non-contagious condition mainly caused by genetic factors. In addition to genetic factors, other causes of aphthous stomatitis are hormonal or immunological problems, smoking, food allergies, food poverty, and deficiency of some vitamins.
It is recommended to visit an oral medicine doctor to treat oral ulcer. After diagnosing the condition, the oral medicine doctor will prescribe you appropriate mouthwashes and medical solutions.
This condition can be also recurrent. The recurrent form of this condition is called recurrent oral ulcer (RAS). Therefore, maintaining good oral hygiene, brushing and flossing the teeth regularly, and using an appropriate mouthwash can help you to greatly prevent the recurrence of oral ulcer. People who suffer from long-term oral ulcer are advised to take specialized tests to determine the exact cause of the condition.
When should see a dentist for leukoplakia?
Most white oral lesions can be removed without any special treatment and only by observing oral hygiene and eliminating the irritating agent. However, the white oral lesions caused by leukoplakia, which are usually associated with other diseases and need treatment, remain in the mouth for a long time. Although leukoplakia alone does not cause cancer, it can increase the risk of oral cancer. Oral tumors usually arise from severe and long-lasting leukoplakia, which change over time and cause oral cancers, including squamous cell carcinoma. WHO reports that more than 529,000 people worldwide are annually diagnosed with oral cancer, most of whom are aged over 40 years and have a history of long-term smoking.
You need to visit a dentist whenever observe any of the following items:
- white patches with prominent red spots
- white bumps with dark or red patches
- patches irregular and heterogeneous consistency
- difficulty with eating, swallowing, or jaw movements
- oral wounds that remain unimproved after two weeks
- changes in oral tissues
- earache when swallowing