If there is any white or grayish white lesion in the mouth which cannot be scrapped off, and is developed slowly like in a month or two, then it can be Leukoplakia. It is considered to be the precancerous condition and can later o develop into a cancer. These lesions or patches can appear anywhere in mouth like, gums, tongue, roof of mouth, lips or inside cheeks. Patient suffering from Leukoplakia can have one or more white or grayish patches in his mouth. These patches or spots are hard and thick. These patches can be like open sores and can cause the patient to be uncomfortable. These lesions are visibly disturbing for the patient but are not physically painful. Leukoplakia is mainly caused by chronic irritation, tobacco chewing, smoking etc. Tobacco chewing is the major reason of Leukoplakia. If after removal of irritant, the while lesion does not heal within 2 weeks then it needs serious consideration. When we see such lesion in the mouth proper investigations should be carried out. For this mostly Biopsy is done. If the lesion is big then multiple biopsies are done from different regions but if the Leukoplakia lesion is small then single biopsy is done.
Causes of Leukoplakia
Exact cause of Leukoplakia is unknown but a large number of factors have been found that may lead to its occurrence, which are known as “Predisposing factors”.
Tobacco – It used by large number of people in various forms such as cigars, pipe, tobacco chewing. People who use tobacco develop Leukoplakia more often than who do not use.
Irritation - Continuous irritation to mucosa by ill fitting denture, sharp tooth edges and hot or spicy foods.
Diet deficiency - Deficiency of Vitamin A, B, C or Folic acid.
Viral infections - e.g. Herpes simplex virus type1 and Human papilloma virus.
People infected with HIV may sometimes develop white patches on the sides of the tongue which are hairy and are known as white hairy tongue this type of white hairy patches are the first sign that the patient may be suffering from HIV infection.
Incidence and Prevalence of Leukoplakia
Found in approximately 3% of world population.
Age- usually occur after 40 years of life, seldom occurs below 30 years.
Sex- more often in males in a ratio of 2:1
Site- usually on Tongue, inside of cheeks, lower lip, floor of mouth or palate.
Leukoplakia on Palate
Leukoplakia on upper surface of Tongue
Leukoplakia on lower surface of Tongue
Leukoplakia on inside of Cheeks
Symptoms of Leukoplakia
Leukoplakia often does not cause any symptoms. The white patches usually detected by a doctor or dentist. These Leukoplakia patches develop slowly over a period of time. Their shape can be flat or raised. These patches may sometimes take shape of a rough or pebble like texture. Leukoplakia patches may have red areas around them. Usually the patches of Leukoplakia are painless.
Diagnosis of Leukoplakia
If the white patch is present and it is symptomless then on routine examination dentist finds it. But if there is irritation, then first the irritant is removed. If after removing the irritant the lesion does not heal in 2 weeks then dentist send the patient to oral pathologist or the oral surgeon for the biopsy. In biopsy a small part is removed and is examined under microscope to find out whether the lesion has cancerous potential or not. The lesion is then removed surgically.
Expected Duration of Leukoplakia Lesions
Most white patches are caused by irritation. They will go away after the source of the irritation is removed. It takes a couple of weeks for them to go away. If they don't go away within two weeks, and your dentist cannot identify another cause, you should have the leukoplakia removed by surgery. Even though you may have no symptoms, the area should be biopsied.
Prevention of Leukoplakia
Prevention is better than cure. Regular dental checkups are must that will help to catch the lesion before it becomes cancerous. Early diagnosis helps in treatment.
Tobacco chewing is the main case of Leukoplakia. So stopping the use of tobacco is the main preventive measure for Leukoplakia.
Consumption of alcohol also puts the patient in the risk category for Leukoplakia especially if along with alcohol tobacco is also used. So to prevent Leukoplakia, alcohol consumption and tobacco chewing should be stopped.
Avoiding sun rays by using sun screen on the lips is another preventive measure for the white lesions especially of the lips. While going out lips should be covered either by lip balm or the sunscreen.
Other conditions that resembles Leukoplakia
1. Lichen planus
3. White sponge nevus
5. Frictional keratosis
6. Chemical burns
Chance of Leukoplakia developing into cancerous condition is about 3 to 6%. Depends upon factors like age, sex, type of habits, site of lesion. Malignant transformation will lead to Squamous cell carcinoma.
The goal of treatment is to get rid of the lesion. Removing the source of irritation is important and may cause the lesion to disappear. Treat dental causes such as rough teeth, irregular Denture surface, or fillings as soon as possible. Stop smoking or using other tobacco products. Do not drink alcohol.
If the patch is there for more than 2 weeks then get the biopsy done. If the white lesion is large then the biopsy pieces are taken from different sites but if it is small then one piece is taken. If the cancerous or the precancerous cells are found then the whole lesion is removed. Normally this type of surgery is done under local anesthesia.
When to see the Doctor for Leukoplakia
If you see any lesion in the mouth which does not heal or start decreasing within 2 weeks then you should visit your dentist and get the o professional opinion. It is better not to delay because if it is cancerous early diagnosis helps in the treatment.
Lesions often clear up in a few weeks or months after the source of irritation is removed. Oral hairy Leukoplakia is often a sign of HIV infection and an increased likelihood of developing AIDS, but it is not harmful by itself.