Leukoplakia
Not all cases of leukoplakia turn into cancer; however, it may be a premalignant condition that can turn cancerous among smokers.

Leukoplakia or oral leukoplakia is a disorder that causes thicker, white patches to grow on the tongue, gums, and inside of the cheek, which cannot be scraped off easily. Although the appearance of the sores varies, they are generally white or gray, thick, and somewhat elevated with a firm surface.

Leukoplakia is usually painless; however, some individuals report sensitivity in the affected region. The patches frequently appear gradually over weeks or months. They might be smooth or somewhat rough, flat or elevated.

It is believed that persistent irritation may be the source of the disease; however, this is not always the case. Removing the source of irritation may alleviate the problem, but surgical removal of the sores may be required in certain situations.

Tobacco usage is thought to be the primary cause of its growth in the mouth. It is six times more common in smokers than nonsmokers. It may also be associated with alcohol use and eating betel quid.

Usually, leukoplakia is harmless and is just cosmetic. However, leukoplakia can occasionally be a precursor to oral cancer and an early indication of malignancy. To be safe, any oral lesions should be addressed carefully as soon as they appear until they can be proven benign.

Leukoplakia Symptoms and Signs

Signs and symptoms of leukoplakia include thick, white patches on the inside surfaces of the mouth. The affected areas may have developed slowly over weeks to months. The plaques may appear thick, slightly raised, and may eventually take on a hardened and rough texture. Leukoplakia usually is painless but may be sensitive to touch, heat, spicy foods, or other irritation.

What are the symptoms and causes of leukoplakia?

Symptoms of leukoplakia may be similar to those of other illnesses. 

  • The major sign of leukoplakia is elevated or hardened white spots in the mouth, particularly within the cheeks or on the tongue. 
  • These patches or lesions are generally harmless, and people are often unaware of their presence until they are apparent. 
  • There may also be red scaly patches or a combination of hard red and white raised pimples in the mouth.
  • These white or red and white patches are distinguished by their rough look and the fact that they do not dissolve when the mouth is cleaned or scraped with an appropriate dental instrument.

The following are some of the most common causes of leukoplakia:

What are the types of leukoplakia?

Leukoplakia is classified into various types that include:

  • Homogenous leukoplakia
    • All white lesions with no hint of red. 
    • Has a very low risk of oral or mouth cancer, and the cells in a homogenous lesion are rarely precancerous.
  • Nonhomogenous leukoplakia
    • An uneven blend of white and red lesions.
    • If the red areas are not treated, they are more likely to become precancerous or cancerous. 
  • Proliferative verrucous leukoplakia
    • An uncommon type of leukoplakia, which mainly affects elderly women. 
    • Lesions are located all over the mouth rather than in specific locations such as the cheek and tongue. 
    • This can lead to tongue cancer, as well as oral cancer.
  • Hairy leukoplakia
    • The lesions in hairy leukoplakia are folded or ridged, with thin hairlike filaments sprouting from the lesion.
    • Results when the immune system is compromised following Epstein–Barr virus and HIV attacks.

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Is leukoplakia cancerous?

Not all cases of leukoplakia turn into cancer; however, oral leukoplakia may be a premalignant condition that can turn cancerous and is most typically found among smokers. 

People with oral leukoplakia are more likely to acquire oral cancer than those with normal oral mucosa. Leukoplakia is one of the most prevalent oral potentially malignant diseases, with a global incidence of 1.5 to 2.6 percent. 

This premalignant condition can progress to oral cancer, especially squamous cell carcinoma, with transformation rates ranging from 0.1 to 17.5 percent. Because of the diversity in the transition to malignancy, early detection, treatment, and monitoring are crucial.

When oral leukoplakia is identified, the primary objective is to prevent it from progressing to invasive cancer using therapeutic approaches, such as classic knife excision, cryotherapy, and carbon dioxide laser therapy.

How is leukoplakia diagnosed?

Your healthcare provider conducts an oral examination and may attempt to remove the white areas. If the white patches can be wiped off easily, then it is probably not leukoplakia. A detailed medical history to identify potential risk factors, such as smoking or chewing tobacco, will be noted. 

Sometimes, it may not be easy to know if the spots are leukoplakia or another condition, such as oral thrush, just by looking at them. To establish what is causing the patches, a doctor will need to conduct some tests. 

You may be screened for cancer, and the doctor might look for early warning symptoms and suggest a biopsy. 

A biopsy removes tissue from the body to test for diseases like cancer. Cancer screening for people with leukoplakia may involve the following tests:

  • Oral brush biopsy
    • A small spinning brush is used to remove some cells from the outer surface of the lesion. 
    • The collected cells sample are further screened for malignancy
  • Excisional biopsy
    • Surgical excision of some tissue from the leukoplakia lesion is performed and tested for malignancy.
    • Excisional biopsy is a more reliable test to detect cancer than oral brush biopsy.

If the excisional biopsy report comes positive for cancer, your doctor may refer you to a specialist for further treatment. In some instances, the leukoplakia patch may be so small that it may be eradicated with excisional biopsy. That implies no further active treatment may be necessary other than continuous observation.

How do you get rid of leukoplakia?

Leukoplakia is best managed when diagnosed and treated in the early stages. Mild leukoplakia does not require active treatment, and it subsides independently. However, if leukoplakia necessitates treatment, the first step should be eliminating the cause or source of irritation. 

If leukoplakia is caused by a rough tooth or an uneven surface on a denture or filling, the tooth will be smoothed, and dental equipment will be corrected. If smoking is the cause of your leukoplakia, you will be urged to reduce or quit smoking or use other tobacco products.

Leukoplakia usually is benign, and lesions resolve after a few weeks or months of removing the source of irritation. If removing the cause of irritation does not reduce the leukoplakia, the lesion may need to be surgically removed. Either your conventional dentist or an oral surgeon can remove the lesion.

Prevention is the best treatment for leukoplakia. The following suggestions can assist you in keeping these discolored lesions at bay:

  • Stop smoking and using tobacco products.
  • Consume alcohol in moderation.
  • Regular visits to the dentist are recommended two times a year.

IMAGES

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Medically Reviewed on 12/9/2022
References
Image Source: iStock image

Leukoplakia: https://www.sparrow.org/departments-conditions/conditions/leukoplakia

Leukoplakia: Diagnosis and Treatment of This Soft Tissue Condition: https://www.jawdocs.net/leukoplakia-diagnosis-and-treatment-of-this-soft-tissue-condition