Leukoplakia

Overview

Leukoplakia is a condition marked by the development of thick, white patches on the gums, inside cheeks, bottom of the mouth, and sometimes on the tongue. These patches are distinctive because they cannot be scraped off. The exact cause of leukoplakia remains unknown, but it is often linked to continuous irritation from tobacco use in various forms, such as smoking, dipping, or chewing. Long-term alcohol consumption is also considered a contributing factor.

Most cases of leukoplakia do not lead to cancer, however, some patches may exhibit early signs of malignancy. Areas of leukoplakia can be particularly concerning when they appear alongside cancers in the mouth, with patches that have both white and red areas, known as speckled leukoplakia, being potentially cancerous. Therefore, any persistent changes in the mouth should prompt a consultation with a dentist or doctor. Hairy leukoplakia, a specific variant, typically affects individuals with compromised immune systems, notably those with HIV/AIDS.

Leukoplakia, a condition involving white patches in the mouth, is categorized into two main types: homogeneous and non-homogeneous leukoplakia, each with distinct characteristics and risks. Additionally, there are subtypes of leukoplakia that present unique features and implications for oral health.

• Homogeneous leukoplakia: Characterized by flat white patches that may appear smooth, wrinkled, or ridged, homogeneous leukoplakia is typically benign and less likely to progress to oral cancer. This form is more common and usually presents a lower risk to individuals.
• Non-homogeneous leukoplakia: This variation is marked by irregular white or red patches that may be flat or raised. Non-homogeneous leukoplakia poses a higher risk, being seven times more likely to develop into cancer compared to its homogeneous counterpart.
• Subtypes of Leukoplakia:
  • Proliferative verrucous leukoplakia (PVL): Characterized by rapid growth, PVL manifests as small white patches that may occur on the tongue, gums, inner cheeks, and other soft tissues in the mouth. Over 60% of individuals with PVL may progress to oral cancer, making it a particularly concerning condition.
  • Oral hairy leukoplakia: True to its name, this subtype features white patches with a hairy appearance, often found on the tongue but can appear elsewhere in the mouth. Mostly associated with individuals having HIV/AIDS or Epstein-Barr virus, oral hairy leukoplakia is not considered cancerous.

Understanding these types and subtypes of leukoplakia is crucial for early detection, appropriate treatment, and minimizing the risk of progression to more severe conditions.

Symptoms

Leukoplakia is a condition characterized by white or gray patches in the mouth, commonly found on the gums, insides of the cheeks, the bottom of the mouth under the tongue, and occasionally, on the tongue itself. These patches, often unnoticed due to their painless nature, can vary in appearance:

• Color: Typically, white or gray, and cannot be wiped away.
• Texture and surface: May present as rough, ridged, wrinkled, smooth, or a combination of these textures.
• Shape and edges: Usually irregular in shape and edge definition.
• Consistency: Patches can be thick, hard, or both.

Special types of leukoplakia:

• Speckled leukoplakia: Involves white patches accompanied by raised, red areas known as erythroplakia, increasing the risk of cancerous changes.
• Hairy leukoplakia: Features fuzzy, white patches resembling folds or ridges, primarily on the sides of the tongue. It’s often confused with oral thrush but differs as it cannot be wiped away and is more common in individuals with compromised immune systems.

Leukoplakia might not always cause discomfort, but it can be a sign of a more severe condition. It’s crucial to seek medical advice if you experience:

• Persistent white patches or sores in the mouth that don’t heal within two weeks.
• Lumps within the mouth.
• Any white, red, or dark patches inside the mouth.
• Persistent changes in the mouth’s interior.
• Ear pain, difficulty swallowing, or issues opening the jaw.

Prompt consultation with a healthcare professional is advisable to assess the condition accurately and to rule out or treat any underlying issues.

Causes

Leukoplakia can develop when the tissue lining the inside of the mouth is irritated. Although the cause why this occur is still unknown, it can be attributed to various factors, such as:

• Long-term discomfort from tobacco use, both smokeless and smoked, where leukoplakia develop in the area between the cheeks and gums
• Use of areca nuts, commonly known as betel nuts, which is placed between the cheek and gums
• Long-term, excessive alcohol consumption
• Poorly fitting or broken dentures
• Friction from jagged, broken, or sharp teeth rubbing against tongue surfaces

With hairy leukoplakia, the cause is the Epstein-Barr virus (EBV), which stays in the body for life after infection. This can occur in people with weakened immune systems, due to conditions like HIV/AIDS, where the virus which is normally inactive becomes active. Genetic mutations may also contribute to the condition, causing cells in the mouth tissue to multiply at an accelerated rate, leading to the formation of patches. Genes play a crucial role in regulating cell behavior, determining factors like growth rate and cell turnover.

Risk factors

Several factors and activities can contribute to one’s risk of having leukoplakia, such as:

• Having specific health conditions that impact the immune system, such as the Epstein-Barr virus or HIV
• Prolonged and excessive alcohol consumption
• Smoking or the use of chewing and smokeless tobacco