Oral Leukoplakia

Oral leukoplakia cancer

Last Updated December 20th, 2021

Overview of oral leukoplakia

Oral diseases are very common in all age groups and genders. They arise from infections in the mucosal lining in most cases. Infections of the tongue may be of severe types and may even give rise to chronic tongue diseases. In due course of time, it may even lead to oral cancer. The World Health Organization statistics show that nearly 300,000 new cases of oral cancer are reported each year all over the world.

 

What is oral leukoplakia?

Oral leukoplakia modelLeukoplakia, also called “leukokeratosis” or “leukoplasia” is a medical condition in which plaque, keratin, and irregular patch formation occur on the mucous membrane of the oral cavity.

It is characterized by the formation of irregular white patches on the mucosal linings, accompanied by pain, inflammation, and tenderness.

Fluid-filled blisters may form when the condition becomes very critical.

 

What causes oral leukoplakia?

Oral leukoplakia may result from a number of environmental, pathogenic and dietary factors. The commonly studied causes are given below-

Tobacco

More than 80% of the leukoplakia patients have a history of smoking. Research studies have revealed a positive correlation between the degree of smoking and the size of the lesions seen in leukoplakia.

These people usually suffer from diffuse leukoplakia of the tongue, buccal mucosa, lips and in some cases, the floor of the mouth. Most affected are the people who practice reverse smoking.

Chewing tobacco is even more dangerous and may lead to white patches in buccal sulcus, commonly known as “tobacco pouch keratosis”. The symptoms may disappear on cessation of tobacco consumption.

Alcohol

People used to alcohol abuse alongside tobacco consumption develop severe mucosal infections. Overuse of mouthwashes containing more than 25% alcohol content leads to the formation of greyish plaques on buccal mucosa.

Sanguinaria

This is a variety of herbal extract found in toothpastes. It causes “sanguinaria associated keratosis”. It is often accompanied by dysplasia. This may or may not give rise to malignancy.

Ultraviolet radiation

It gives rise to lesions in the lower lip and is often associated with cheilosis.

Pathogens

Certain varieties of microbial pathogens like Candida and Human Papillomavirus (HPV) can attack and damage the squamous epithelium in the mouth.

Epithelial atrophy

Mucosal and epithelial atrophy may arise from certain conditions like vitamin deficiency, iron deficiency or oral fibrosis.

Tumor suppressor genes

Mutations in the tumor suppressor gene p53 can lead to an uncontrolled cell growth and eventually result in leukoplakia along with dysplasia. People who are used to excessive drinking and smoking can develop these symptoms.

Trauma

Trauma induced by friction or irritation may lead to keratosis. Nicotine stomatitis, which results from the heat generated in tobacco smoking is an example of this category. Mechanical trauma may also be caused by the pointed edges of dentures or a broken tooth. The plaques, in this case, resemble callus on the skin.

 

What are the main symptoms of oral leukoplakia?

Oral leukoplakia cancerOral leukoplakia generally manifests as-

  • The appearance of whitish, yellowish white or greyish patches on the mucosal linings
  • Transformation of patches into lesions
  • Alteration in the surface texture and color of the affected surface
  • Formation of thickened plaques on the mucosal surface
  • The appearance of fluid-filled blisters that may release a purulent discharge on being rubbed or scratched
  • Scalding, tingling and numbness in the entire mouth
  • Extreme dryness and roughness of tongue
  • A bitter or metallic taste in the mouth
  • Reduced ability to taste (hypogeusia)
  • Pain in the tongue (glossodynia)
  • Burning sensation in the tongue (glossoptosis)
  • Damaged oral mucosa
  • Problems in swallowing (dysphagia)
  • Altered taste sensations (dysgeusia)

 

What are the different types of oral leukoplakia?

Based on the site affected, oral leukoplakia is of two types-

  • Leukoplakia buccalis: Plaque formation and infection occur in the buccal mucosa.
  • Leukoplakia lingualis: The lingual mucosa is severely affected in this case.

Based on the etiology and the intensity of the disease, the following types have been identified-

  • Homogeneous leukoplakia: Here the plaque is generally uniform, thick and extends over a wider area. It presents with a corrugated and wrinkled surface texture. On being touched it appears leathery and dry with some superficial irregularities.
  • Non-homogeneous leukoplakia: Here, the plaques are nodular with irregularities at certain places. Thick and white papillary lesions are formed which are collectively known as- verrucous leukoplakia. The lesions, in this case, are localized or spread out.
  • Proliferative verrucous leukoplakia: It is a type of non-homogeneous leukoplakia that affects the gum and the buccal mucosa. Veruccoid keratotic plaques are formed in this case, that spread to adjoining areas. This may lead to dysplasia, that may eventually progress to verrucous carcinoma.
  • Erythroleukoplakia: It is characterized by the formation of reddish and whitish lesions. It affects the buccal mucosa. It has extremely high risks of developing into carcinoma.
  • Sublingual keratosis: This refers to the leukoplakia of the floor of the mouth or below the tongue. It often gives rise to an “ebbing tide” structure due to the parallel and ridged appearance.
  • Candidal leukoplakia: It is also called chronic hyperplastic candidiasis and is caused by the Candida species.
  • Oral hairy leukoplakia: Rough and hairy lesions form on the sides of the tongue due to infections caused by the Epstein-Barr virus.
  • Syphilitic leukoplakia: It is commonly seen in syphilis patients. The causative agent, in this case, is Treponema pallidum.

 

Diagnosis

The doctors generally recommend the following diagnostic tests-

  • Cystoscopy (endoscopy of the urinary bladder): Teveals the white lesions on the urothelium
  • Tissue biopsy: To rule out malignancy
  • Brush biopsy / exfoliative cytology: To remove and test sample cells from the affected area
  • Histological examinations: To determine the degree of hyperplasia and inflammatory cell infiltration

In the early stages, certain topical and systemic medications can help cure the symptoms. The most important ones are- carotenoids, retinoids, antimycotics and anti-inflammatory drugs. Photodynamic therapy is carried out in more advanced stages.

 

Treatment & Prevention

In many cases of oral leukoplakia, there is no major treatment requirement as it resolves on its own. The only thing advised in such cases is strict avoidance of triggers such as tobacco. If the underlying issue is misalignment of teeth or ill-fitting dentures/crowns, then oral leukoplakia will be treated by correcting these errors. If the biopsy report of the oral leukoplakia reveals a malignant feature, additional diagnostic measure would be required to ensure it’s cancerous (or precancerous).  If it’s benign, the dentist will use a scalpel to remove the white patches. In all of these cases, practicing good oral hygiene is a must for all patients. In the rare case the oral leukoplakia is caused by a viral agent such as HIV, antiviral therapy is prescribed.

Oral leukoplakia can be largely prevented by following these measures:

  • Refrain from tobacco consumption. Any kind of inhaled smoked product such as cloves, resin, or cannabis should be avoided.
  • Go for regular dental check-ups, regardless of whether you have a dental issue or not.
  • Avoid alcohol consumption.
  • Stay away from materials which are abrasive for teeth.
  • Make sure that your dental cavities are filled properly.
  • Similarly, make a note that any dental device (crowns, dentures etc.) that is fit in your oral cavity is well fitting and its rough edges are not irritating the oral mucosa.
  • Avoid foods that may irritate your oral cavity – hard candies, soda drinks, acidic foods etc.
  • Practice safe sex. The Human Papillomavirus is known to cause leukoplakia. Using proper protection can ensure that the virus doesn’t spread.

Facts

  • Oral leukoplakia is the medical term for “white patches” formed in the oral cavity. In fact, it is the most commonly prevalent potentially malignant lesion of the oral region.
  • Oral cavity is not the only region where leukoplakia can develop. It can also occur in the gastrointestinal tract, the genitals, and the urinary tract.

Facts

  • Every year there are more than 300,000 cases of oral cavity cancers reported worldwide. In many of these, oral leukoplakia is one of the primary symptoms.
  • Though it can occur at any age, it is most commonly observed in people under the age of 40.

Facts

  • It is 6 times more common among smokers than non-smokers.
  • Oral cancer is the 11th most common cancer globally. Tobacco use is noted among 41% of male and 11% of female population diagnosed with oral cancer.

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Dos and Don'ts

Dos
  • If you have malocclusion (misaligned dental arches) or ill-fitting dentures, get them treated as soon as possible.
  • If you have a substance abuse issue (smoking or drinking or both), seek immediate help for quitting it.
  • Make sure that your diet is not deficient in vitamin A and B.
Don'ts
  • Indulge in ANY form of tobacco consumption. This includes smoking, chewing tobacco, use of cigars and pipes, and even smokeless cigar.
  • Delay in getting a biopsy in case there are changes observed in the appearance of white patches.
  • Consume excessively hot or cold foods.

 

 

 

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How to scrub away stress and fatigue with an Epsom salt bath? Epsom salt is a popular home remedy for many skin ailments. Though there is a lack of scientific…
Surgery or home-remedy; what is the right way to treat a burn The treatment of a burn injury depends on its severity. You can save a life by offering the…
6 arguments in favour of glucosamine and where can you find it Studies have shown that glucosamine works by preventing the breakdown of cartilage of the joints. This is usually…
Bronchoscopy procedure
Bronchoscopy Bronchoscopy is a procedure where in a scope is inserted into the lung pathway to observe any growth…
LFT-test
Liver Function Test – LFT LFT or Liver Function Test is a blood test used to determine the levels of hepatic enzymes which…
PROLACTIN-(PRL)
Prolactin Test (PRL) Prolactin or PRL is a lactogenic hormone produced to induce milk production in lactating mothers. PRL test measures…
EMA antibodies
Endomysial Antibodies (EMA) Test EMA test is an investigative blood examination to locate the presence of certain antibodies, called Endomysial antibodies or…
dhea adrenal
Androstenedione Test Androstenedione is produced by the adrenal gland, the test of the levels of Androstenedione helps in the evaluation…
calories healthy
Calories: How to keep a check on these for faster weight loss Did you know you can burn calories while sleeping? Calorie-burning is what causes weight loss. How much should…
black seed oil benefits
Black Seed Oil: What secret benefits could it bestow on your health? Black seeds or nigella seeds are tiny packets of health brimming with amazing benefits. Find out why should…
Psyllium Husk: More than just an effective natural laxative Psyllium husk, or isabgol, is a popular natural laxative . But did you in addition to regulating bowels,…
How can berberine supplements help you live longer and healthier? Berberine is a turmeric look-alike herbal extract that is credited with numerous health benefits ranging from diabetes cure…
Find all the instant ways to get rid of blackheads Blackheads - Not only are they aesthetically unappealing but if left untreated these can cause bacterial overgrowth on…
waterchestnut
Water Chestnuts: The tastiest ways to include this healthy tuber in your diet Water chestnut is not a nut after all. It is a tuber (much like the potatoes) growing close…
Hydroquinone: Is it the best topical treatment for hyperpigmentation? Darkening of the skin due to high melanin levels is called hyperpigmentation.  Hydroquinone interferes with melanin production thus treating…
The Cabbage Soup Diet: The healthiest way to instant weight loss Cabbage soup diet rapid weight loss diet for those who want to shed those extra pounds in less…
PROSTATE-SPECIFIC-ANTIGEN
Prostate-Specific Antigen (PSA) Test Prostate specific antigen test is a blood test used to determine the presence of prostate cancer or any…
bilirubin-test-result
Bilirubin Test Bilirubin is a substance produced in the body as a result of red blood cell breakdown. A bilirubin…
biopsy procedure
Biopsy Biopsy is a procedure of studying a live tissue sample collected from a specific organ for diagnosing a…
HSV-IgM test
Herpes Simplex Virus (HSV)-IgM Test The HSV-IgM class antibody is produced by the body a few days after an initial HSV infection and…
beta 2 glycoprotein 1 IgG
Beta 2 Glycoprotein 1 IgG Beta 2 glycoprotein 1 antibody test involves detecting and measuring the presence of the IgG class of beta…
lp-pla2
LP-PLA2 Test The LP-PLA2 test is a test which is carried out to assess the levels of Lipoprotein-Associated Phospholipase A2…
AUTOIMMUNE HEPATITIS liver
Hepatitis Profile A hepatitis profile or a hepatitis panel is a blood test that checks for markers of hepatitis infection…
stress depressed anxiety
Are you depressed or just stressed? Know when to see a doctor Why are some people more anxious than others? Is being depressed the same as feeling sad? Have you…
Serotonin happiness
Serotonin: What you didn’t know about this “feel-good” chemical Serotonin : Did you know that this "feel-good" hormone could well impact your sleep cycle, sex drive, appetite,…
Bulletproof coffee recipe
Bulletproof Coffee – Breakfast of champions or yet another health fad? Can this special ketogenic coffee really make your body race as fast as a bullet?
sleep deprivation
Don’t let your sleep deficit grow into memory loss or heart attack Why is sleep important for us? How could sleep deprivation harm you? We bet you didn't know about…
Pumpkin Seeds: Why pumpkins are more than just for pies! Pumpkins have been long associated with Halloween carvings and delicious pies. But did you know that pumpkin seeds…