You notice a spot or patch in your mouth that does not hurt but persists and will not go away. Your mind may leap to the darkest conclusion, but do not panic. These patches may just be leukoplakia. How do you know? Read on.

What is leukoplakia in dentistry?

Leukoplakia is an oral condition that consists of white or grayish patches that cannot be removed or wiped away. They may be irregular in size or flat textured and hard in random areas. While most cases are benign and not linked to cancer, a variation with raised red lesions called speckled leukoplakia or erythroplakia may be associated with precancerous growth.

These white patches can appear anywhere in the mouth, including:

  • The insides of the lips
  • Floor and roof of the mouth
  • All around the gums and inner cheeks

Another version called hairy leukoplakia usually appears on the sides of the tongue and is often mistaken for thrush, an oral infection that can be wiped away. Hairy leukoplakia is common in people with compromised immune systems.

What causes leukoplakia?

There are four main causes of this condition.

1. Tobacco use

Perhaps the main cause of this condition is chronic irritation, and few things are more chronically irritating than tobacco use.

Whether smoked, dipped, or chewed, regular tobacco users will almost uniformly develop leukoplakia. For those who use smokeless tobacco, leukoplakia most often develops where they hold the tobacco against their cheek or gum.

2. Broken or jagged teeth

Broken, chipped, or otherwise jagged teeth can cause irritation in the mouth that leads to these white patches.

3. Ill-fitting or sharp dentures

Dentures, whether full or partial, can become loose over time.

If a denture wearer ignores the ill fit, this can be irritating to the mouth and lead to leukoplakia. Likewise, dentures that did not fit well to begin with can lead to symptoms.

4. Excessive and long-term alcohol use

Alcohol use is another preventable cause of this condition. This goes beyond a single glass of wine with dinner. Excessive and long-term alcohol use wears down tooth enamel and rinses away beneficial bacteria and saliva that protects the health of teeth, cheeks, and gums.

Other causes

Hairy leukoplakia is caused by infection with the Epstein-Barr virus (EBV). Like chickenpox sufferers who live under the threat of shingles later in life, so too do Epstein-Barr patients worry about developing leukoplakia.

The virus is always in the body and can re-emerge, especially when combined with the above causes. Similarly, those with immune systems weakened by HIV/AIDs or other autoimmune disorders are at risk.

Leukoplakia does increase your risk of oral cancers, with cancerous cells possibly developing adjacent to patches of leukoplakia. The patches themselves may also have pre-cancerous cells. Even after the patches are removed, an increased risk of oral cancer persists.

What are common leukoplakia symptoms?

Common symptoms of leukoplakia include white patches in the mouth but may also include:

  • Ongoing changes in the soft tissues of the mouth
  • Pain in the ears when swallowing
  • Trouble opening the jaw that gets worse as the condition progresses

If you have any of these symptoms, talk to your doctor or dentist immediately.

How do you treat leukoplakia?

This condition is diagnosed with a visual inspection of the patches and thorough discussion of any risk factors that might be present. Your dentist will attempt to wipe away the white patches. If that is not possible, they will make a diagnosis.

Your dentist may order two tests for oral cancer: an oral brush biopsy and an excisional biopsy. An oral brush biopsy removes cells from the surface of the leukoplakia with a spinning brush. This is a non-invasive and painless procedure but can be inaccurate. An excisional biopsy removes tissue from the leukoplakia (or the entire patch) to test. This test is more definitive.

A diagnosis of hairy leukoplakia also includes the above. A weakened immune system is one of the factors that must also be present.

Treatment is simple, on paper: remove the irritant and the symptoms usually clear themselves. As former smokers can attest, this may be easier said than done, but the effort is worth the reward. The same goes for long-term alcohol use. There is help out there for quitting drinking.

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