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Leukoplakia
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Leukoplakia

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Dental Care

Leukoplakia is a condition in which thickened, white patches form on your gums, on the inside of your cheeks and sometimes on your tongue - usually as a result of chronic irritation. Tobacco, either smoked or chewed, is the main culprit, but irritation can also come from ill-fitting dentures and long-term alcohol use.

Although anyone can develop leukoplakia, it's most common in older men. People with compromised immune systems sometimes develop an unusual form of the disorder called hairy leukoplakia.

In general, leukoplakia isn't painful, but the patches may be sensitive when you touch them or eat spicy foods. And though the disorder usually isn't dangerous, it can be serious. About 5 percent of leukoplakic patches show early signs of cancer, and a large percentage of cancers of the mouth (oral cancers) occur next to areas of leukoplakia. For that reason, it's best to see your dentist if you have unusual changes in your mouth lasting longer than a week.

Signs and symptoms

Leukoplakia first appears as flat, gray sores — usually on your gums or on the insides of your cheeks and sometimes on your tongue. Over weeks or months, leukoplakic sores develop into patches with the following characteristics:

  • White color

  • Thick, rough texture

  • Hardened surface

Leukoplakia appears as thick, white patches on your gums or on the insides of your cheeks....

Sometimes you may also have raised red lesions (erythroplakia), which are more likely to show pre-cancerous changes.

A type of leukoplakia called hairy leukoplakia primarily affects people whose immune systems have been weakened by medications or disease, especially HIV or AIDS. Hairy leukoplakia causes fuzzy, white patches that resemble folds or ridges on the sides of the tongue. It's often mistaken for oral thrush — an infection marked by creamy white patches on your pharynx and the insides of your cheeks.

Causes

Most often, leukoplakia results from chronic irritation of your mouth's delicate tissues. The irritation may come from a number of sources, including poorly-fitting dentures, rough spots on your teeth or fillings, and long-term alcohol use.

But tobacco use is responsible for most cases of leukoplakia. The vast majority of people who develop leukoplakia are smokers, and most leukoplakic patches either improve or disappear within a year after stopping smoking. Chewing tobacco and snuff also play a key role — as many as 95 percent of regular users of "smokeless tobacco" products eventually develop leukoplakia.

In addition, researchers have identified both Candida albicans the fungus that causes oral thrush — and human papillomavirus, which causes genital warts, in leukoplakic patches. But it's not known whether these microorganisms occur as a secondary infection or actually cause leukoplakia.

Hairy leukoplakia
Hairy leukoplakia results from infection with the Epstein-Barr virus (EVB). Most people are initially exposed to EVB in childhood — often without having any symptoms, although EVB can be associated with a number of diseases, including mononucleosis and several types of cancer.

Once you've been infected with EBV, the virus remains in your body for life. Normally the virus is dormant. But if your immune system is weakened, either from disease or certain medications, the virus can become reactivated, leading to conditions such as hairy leukoplakia.

People with HIV infection or AIDS are especially likely to develop hairy leukoplakia. Although the use of antiretroviral drugs has reduced the number of cases, hairy leukoplakia still may affect as many as 25 percent of HIV-positive people, and may be one of the first signs of HIV infection.

Risk factors

Tobacco use puts you at high risk of developing both leukoplakia and oral cancer. Drinking alcohol in conjunction with smoking further increases your risk. In fact, leukoplakia occurs more often in men than in women primarily because men are more likely to both drink alcohol and smoke.

In recent years, however, as more women have started smoking, the rate of leukoplakia in women has increased. Women who develop leukoplakia are more likely to experience cancerous changes in their mouth tissues than men are.

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