With leukoplakia (loo-koh-PLAY-key-uh), thickened, white patches form on your gums, the insides of your cheeks, the bottom of your mouth and, sometimes, your tongue. These patches can't be scraped off.
Doctors don't know what causes leukoplakia but consider tobacco — whether smoked, dipped or chewed — to be the main culprit in its development.
Leukoplakia usually isn't dangerous, but it can sometimes be serious. Although most leukoplakia patches are noncancerous (benign), some show early signs of cancer. Many cancers on the floor of the mouth — beneath the tongue — occur next to areas of leukoplakia. For that reason, it's best to see your dentist if you have unusual, persistent changes in your mouth.
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.
Most often, your dentist diagnoses leukoplakia by examining the patches in your mouth and ruling out other possible causes. To test for early signs of cancer, your dentist may:
Remove a tissue sample (biopsy) for analysis. This involves removing cells from the surface of the lesion with a small, spinning brush (oral brush biopsy) or surgically removing the entire leukoplakia patch (excisional biopsy) if the patch is small.
Send the tissue for lab analysis. A highly specialized imaging system allows a pathologist to detect abnormal cells.
If the biopsy is positive and your dentist performed an excisional biopsy that removed the entire leukoplakia patch, you may not need further treatment. If the patch is large, your dentist may refer you to an oral surgeon or ENT specialist for treatment.
For most people, stopping tobacco or alcohol use clears the condition. When this isn't effective or if the lesions show early signs of cancer, your dentist may refer you for treatment, which involves:
Removal of leukoplakia patches. Patches may be removed using a scalpel, a laser or an extremely cold probe that freezes and destroys cancer cells (cryoprobe).
Follow-up visits. Recurrences are common.
Leukoplakia treatment is most successful when a lesion is found and treated early, when it's small. Regular checkups are important, as is routinely inspecting your mouth for areas that don't look normal.
Treating hairy leukoplakia
Usually, you don't need treatment for hairy leukoplakia. The condition often causes no symptoms and isn't likely to lead to mouth cancer.
If your doctor or dentist recommends treatment, you may take a pill that affects your whole system (systemic medication), such as the antiviral medicine acyclovir (Zovirax) or antiretroviral medicine zidovudine (Retrovir). Or you may use a medication solution that you apply directly to the lesions in your mouth (topical medication), such as podophyllum.
Once you stop treatment, the white patches of hairy leukoplakia may return. Your doctor or dentist may recommend follow-up visits every three months to monitor changes to your mouth or ongoing therapy to prevent leukoplakia patches from returning.