Leukoplakia is a condition that causes white patches or plaques to develop on the tongue and mucosa in the mouth.

Mouth irritants and irritating activities, such as smoking, often cause leukoplakia. Doctors can usually differentiate leukoplakia from other similar benign plaques and patches in the mouth by doing an exam.

Doctors consider leukoplakia a precancerous lesion and may recommend a biopsy to rule out cancer.

The World Health Organization (WHO) define leukoplakia as "A predominantly white patch or plaque that cannot be characterized clinically or pathologically as any other disorder."

Different organizations use various names for the tests and terms that can identify leukoplakia.

In this article, we explain the symptoms, when to see a doctor, and the risk factors of the condition. We also cover how healthcare professionals diagnose and treat leukoplakia.

Leukoplakia causes white plaques and patches on the mucous membranes of the mouth. Sometimes, a lesion may contain speckles of reddish discoloration.

The patches and plaques seen with leukoplakia are often painless. However, people who have an underlying condition, including cancer, may experience some pain.

Leukoplakia typically develops in the following places:

  • inner lining of the cheeks
  • gums
  • bottom of the mouth under the tongue
  • tongue

In some cases, leukoplakia patches also affect other regions of the body, most often the genitals.

When to see a doctor

Many instances of white patches in the mouth are nothing to worry about. However, anyone who develops oral white plaques should see a doctor for a full evaluation. These plaques can sometimes be a symptom of a more severe health complication that requires medical treatment, such as cancer.

Although leukoplakia is not cancer, specialists often consider leukoplakia precancerous. Sometimes, oral tumors develop within persistent, painful, or severe leukoplakia patches or plaques.

According to WHO, around 657,000 people globally receive a diagnosis of oral cancer each year.

People should see a doctor to check for oral cancer if they notice the following symptoms:

  • white patches speckled with raised, red regions
  • white lumps with dark or red patches
  • patches with an irregular texture
  • pain or difficulties when eating, swallowing, or moving the jaw
  • sores that last for longer than 2 weeks without healing
  • changes to surrounding tissues in the mouth
  • ear pain

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One of the main causes of leukoplakia is smoking tobacco.

Research continues into the causes of leukoplakia development.

For most people with leukoplakia, chronic irritation, such as that caused by tobacco, seems to play a significant role. On-going damage to oral tissues appears to cause enlargement and thickening of the skin. The thickening may represent hyperkeratosis (or increased thickening of the outer layer of the skin) as well as atypical skin cells present in the skin.

There are several other causes of harmless white patches in the mouth. These include linea alba of the oral mucosa, which develops due to the friction or pressure of the teeth against the skin in the mouth.

Another cause of benign white plaques in the mouth is white sponge nevus. This is usually present from a young age.

There is no single or definitive cause for leukoplakia. Tobacco use of any kind is the most common influencing factor in the development of the condition. People who smoke are six times more likely to develop leukoplakia.

In general, any damage or chronic irritation to the tissues of the mouth may increase a person's risk of developing leukoplakia.

Other factors that might play a role in the development and progression of leukoplakia include:

  • human papillomavirus (HPV), which might increase the risk of leukoplakia becoming oral cancer
  • poor oral hygiene
  • repeated cheek or tongue biting
  • excessive alcohol use
  • chewing certain nuts and leaves, such as betel leaf and areca nut

Hairy leukoplakia, which is another type of leukoplakia, is common among people with weakened immune systems. People with HIV and the Epstein-Barr virus (EBV) may develop hairy leukoplakia.

The condition causes leukoplakia patches that have a fuzzy appearance. Hairy leukoplakia lesions are painless and do not increase the risk of oral cancer.

A doctor will usually diagnose leukoplakia by ruling out all other potential causes. This often includes a physical exam and a review of a person's medical history.

If the doctor suspects leukoplakia, they are likely to request a biopsy to rule out cancer.

A doctor may request the following types of biopsy:

  • Oral brush biopsy: A doctor uses a small, spinning brush to collect cells from mouth patches. They will then send the cells for examination.
  • Excisional biopsy: A surgeon removes patches of leukoplakia for examination. An ear, nose, and throat (ENT) specialist often becomes involved in the treatment at this point.

If cancer is not evident in the results, doctors typically recommend that a person stops using tobacco products. Doctors also advise good oral hygiene.

If the patches do not clear up without treatment, a person may need an operation to remove leukoplakia.

Doctors recommend frequent follow up appointments for on-going leukoplakia. If leukoplakia has resolved, a person may require yearly checkups.

When the patches develop due to conditions such as HIV, a doctor might prescribe antiviral medications.

If a doctor discovers precancerous or cancerous cells, they will carry out additional testing measures to determine the extent of the condition. Treatment will depend on which type of cells are present.

Experts estimate that about 5% of oral leukoplakia may lead to oral cancer.

Learn more about biopsies here.

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A person can help prevent leukoplakia by attending routine dental exams.

Practicing good oral hygiene and stopping activities that damage or stress the mouth lining are the easiest ways to manage and prevent leukoplakia.

Recommended ways to prevent leukoplakia and its complications include:

  • avoiding tobacco products of any kind
  • avoiding inhaled or smoked products, including cannabis, cloves, and resin
  • reducing or stopping alcohol consumption
  • routine self-exams and checkups with a doctor
  • attending routine dental exams and maintaining dental hygiene
  • avoiding abrasive dental hygiene products, such as whiteners and rinses
  • filing the teeth correctly to make sure that cavities are not rough or uneven
  • ensuring that dental devices, such as dentures and braces, fit well without rough or exposed edges
  • keeping mouth wounds clean
  • waiting for hot drinks or foods to cool before drinking
  • avoiding candies or chewing products that have rough edges or cause mouth irritation
  • following a healthful, balanced diet to avoid nutrient imbalances or deficiencies
  • practicing safe sex to reduce the risk of HPV transmission, including the use of a condom or dental dam during oral intercourse

Trying to quit smoking? Read more on the best ways to stop.

More often than not, white patches in the mouth should provide very few reasons to worry.

However, if the patches do not resolve or become painful and persistent, they may be due to leukoplakia. Only a doctor can diagnose this condition. Leukoplakia can increase the risk of oral cancer.

Doctors do not know what causes leukoplakia, although smoking and HPV infection are major risk factors. People with reduced immunity might also develop leukoplakia.

Avoiding or quitting smoking and maintaining good oral hygiene are effective methods for reducing the risk of the condition.

Q:

Does leukoplakia of the genitals also turn into a form of cancer?

A:

Doctors generally diagnose leukoplakia in the oral mucosa. They usually regard it as a precancerous lesion.

If a doctor makes a diagnosis in the genital region, the same may be true. However, findings in the genital area are more likely to represent another precancerous disorder, such as vulvar intraepithelial neoplasia.

A discussion with your doctor will help clarify the cause of white patches or plaques in your genital region and the risk of cancer associated with them.

Owen Kramer, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.