Leukoplakia can have various appearances. Changes usually occur on your gums, the insides of your cheeks, the bottom of your mouth and, sometimes, your tongue.
Leukoplakia may appear:
- White or grayish in patches that can't be wiped away
- Irregular or flat-textured
- Thickened or hardened in areas
- Along with raised, red lesions (erythroplakia), which are more likely to show precancerous changes
A type of leukoplakia called hairy leukoplakia primarily affects people whose immune systems have been weakened by medications or disease, especially HIV/AIDS. Hairy leukoplakia causes fuzzy, white patches that resemble folds or ridges on the sides of your tongue. It's often mistaken for oral thrush — an infection marked by creamy white patches, which can be wiped away, on the area that extends from the back of your throat to the top of your esophagus (pharynx) and the insides of the cheeks. Oral thrush also is common in people with HIV/AIDS.
When to see a doctor
Sometimes mouth sores can be annoying or painful without being harmful. But in other cases, mouth problems can indicate a more serious condition.
See your dentist if you have any of the following:
- White plaques or sores in your mouth that don't heal on their own within two weeks
- Lumps or white, red or dark patches in your mouth
- Persistent changes in the tissues of your mouth
The cause of leukoplakia depends on whether you have the standard or hairy variety.
Although the cause of leukoplakia is unknown, tobacco use, including smoking and chewing, appears to be responsible for most cases. Often, regular users of smokeless tobacco products eventually develop leukoplakia where they hold the tobacco against their cheeks. Long-term alcohol use and other chronic irritants also may contribute to leukoplakia.
Hairy leukoplakia, sometimes called oral hairy leukoplakia, results from infection with the Epstein-Barr virus (EBV). 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/AIDS are especially likely to develop hairy leukoplakia. Although the use of antiretroviral drugs has reduced the number of cases, hairy leukoplakia still affects a number of HIV-positive people and it may be one of the first signs of HIV infection. The appearance of oral hairy leukoplakia may also be an indication that antiretroviral therapy is failing.
Tobacco use puts you at high risk of leukoplakia and oral cancer. Drinking alcohol combined with smoking further increases your risk.
Leukoplakia usually doesn't cause permanent damage to tissues in your mouth. However, oral cancer is a potentially serious complication of leukoplakia. Oral cancers often form near leukoplakia patches, and the patches themselves may show cancerous changes. Even after leukoplakia patches are removed, the risk of oral cancer remains.
Hairy leukoplakia, on the other hand, isn't painful and isn't likely to lead to cancer. But it may indicate HIV infection or AIDS.
You may be able to prevent leukoplakia if you:
- Avoid all tobacco products. Talk to your doctor about methods to help you quit. If friends or family members continue to smoke or chew tobacco, encourage them to have frequent dental checkups. Oral cancers are usually painless until fairly advanced.
- Avoid or limit alcohol use. Alcohol is a factor in both leukoplakia and oral cancer. Combining alcohol and smoking may make it easier for the harmful chemicals in tobacco to penetrate the tissues in your mouth.