Patches in the Mouth? Here are Ways You Can Deal with Leukoplakia

Paying attention while brushing your teeth can help you notice any unexpected changes in the mouth early on. One such condition is called leukoplakia or leukoplakia disease, which manifests as white patches, white dots, or red patches in the oral cavity.

Though harmless initially, these patches can be precancerous. Detecting and treating this condition at an early stage can help prevent more serious complications. 

What is leukoplakia?

Science defines leukoplakia, leukoplakia disease, or oral leukoplakia as a non-scrapable white patch or plaque in the oral cavity. It is specific to mucosal tissues — soft, moist tissues that line the insides of body parts like the intestines and genitals.

Is there more than one type of leukoplakia?

The two main types of leukoplakia are homogenous leukoplakia and non-homogenous leukoplakia. As the names suggest, the homogenous varieties have a uniform whitish-greyish colour, remain asymptomatic, and rarely turn cancerous.

The non-homogeneous variety may have intermittent red patches. It can be irregularly flat, nodular, or have external growths that have a higher chance of turning malignant.

Oral hairy leukoplakia types are another variety triggered by the Epstein-Barr virus (EBV). They usually occur when you have poor immunity, for example, if you are an HIV-positive patient.

What can cause leukoplakia?

Leukoplakia is a response of mucous tissues to persistent, chronic external abuse or trauma. Some of the common causes of leukoplakia are:

• The biggest risk factor for leukoplakia is tobacco use. Tobacco in both forms — smoked or chewed — is harmful. Chewing betel nuts, a routine practice in several regions of Asia and Africa, adds to the burden of leukoplakia. Holding smoke in the mouth from cigarettes or similar devices like e-cigarettes or vapes also causes oral lesions, including leukoplakia. 

• Chronic abrasions from cheek biting, tongue biting, ragged, sharp tooth edges, rough tooth fillings/dental crowns, and ill-fitted dentures can also form white to greyish thick patches. 

• Oral galvanism or galvanic currents induced by tooth prosthetics made of different metals increases the risk of developing leukoplakic lesions.

• Chronic fungal infections, particularly certain types of candidiasis, are linked to non-homogeneous leukoplakia, possibly due to chemicals produced by the fungi. 

• Alcohol consumption, vitamin deficiencies, hormonal changes, etc. are other risk factors.

• Exposure to ultraviolet radiation may also cause leukoplakia.

When mucous tissue cells encounter abrasives or potential carcinogens, they likely try to adapt. When the tissues attempt to adapt, they thicken to become stronger. Thickening involves cell growth and changes in cell structure. In the mouth, this adaptation first appears as rapid cell growth (hyperplasia) that we see as leukoplakia, mild degeneration of the original cell structure (atrophy), and eventually irreversible damage — which will result in cancer.

Leukoplakia vs other oral white patches: How to tell the difference

White patches in the mouth are a common finding and can arise from a variety of causes, ranging from harmless habits to conditions requiring medical attention. For both patients and healthcare providers, distinguishing between these patches is crucial, as some may be benign while others, like leukoplakia, could carry a risk for future complications such as oral cancer. Recognising the key features that separate leukoplakia from other types of oral white patches helps ensure timely and appropriate care.

Leukoplakia:

• Presents as thick, white, or greyish patches inside the mouth (tongue, gums, cheeks).
• Patches cannot be wiped or scraped away.
• Usually painless, may feel slightly raised or hardened.
• Often linked to chronic irritants, especially tobacco or alcohol use.
• Considered potentially pre-cancerous and needs medical evaluation if persistent.

Other oral white patches (e.g., oral candidiasis, lichen planus):

• Oral candidiasis (thrush) appears as creamy white spots that can often be wiped away with gentle scraping.
• May cause discomfort, burning, or altered taste
• Lichen planus and cheek biting produce white patches with different textures and patterns.
• Tend to have different underlying causes and clinical behaviour

Mind your mouth: Symptoms of leukoplakia

Leukoplakia’s characteristic symptoms include:

• Whitish to greyish patches, thick plaques, nodules, or growths in the mouth that do not go away for more than 2 weeks.

• The area may have reddish regions.

• They occur anywhere on the cheeks, gums, sides of the tongue, floor of the mouth, corner of the mouth, etc. 

• One may experience discomfort in the tongue

• Swallowing may be disrupted

• The condition may be associated with an earache.

If you notice the above symptoms, it's best to visit the dentist at the earliest.

How can I stop this from happening?

It is possible to prevent leukoplakia by adopting certain lifestyle choices. Some of these are: 

• Cut back on tobacco use — do not chew or pouch tobacco inside the cheeks, or hold smoke in the mouth. 

• Alcohol abuse has also been related to leukoplakia. Cutting down on alcohol consumption is essential. 

• Eat antioxidant-rich, healthy foods that boost cellular health. Also, remember to hydrate yourself.

• Be very vigilant of anything sharp or jagged in the mouth. The mouth tissues are soft, and they will react to this soon. Before matters get complicated, get the sharp edges smoothened or dental crowns/dentures changed by your dentist.

Leukoplakia treatment starts with a confirmed diagnosis and pathological tests to see the extent of cell changes. Before opting for any treatment, it is imperative that you consult your doctor.

Don’t be all mouth

The fastest way to enable the detection of such oral lesions is to know what leukoplakia is and be vigilant about it during routine teeth brushing and flossing. Though precancerous in its later stages, leukoplakia can be resolved by removing its causative factors early. A healthy lifestyle, nutritious food, avoiding tobacco, and periodic dental checkups are the best ways to say no to leukoplakia.