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White Patches (Leukoplakia)

Leukoplakia is a condition whereby thickened, white patches form on the gums, the insides of the cheeks, the bottom of the mouth and sometimes, the tongue. These white patches cannot be scrapped off. Doctors are not yet sure what causes leukoplakia but consider chronic irritation from tobacco – whether dipped, smoked or chewed – to be the main culprit.

Most leukoplakia patches are benign (noncancerous), though some can possibly be early signs of cancer. Cancers which tend to occur at the bottom of the mouth can occur next to areas of leukoplakia. White areas which are mixed in with red areas (speckled leukoplakia) can be an indication of potential cancer. That is why it is best to see a dentist or a physician if you have unusual, persistent changes in your mouth.

A type of leukoplakia known as hairy leukoplakia or oral hairy leukoplakia, primarily affects individuals whose immune systems have been weakened by disease such as HIV/AIDS.

Symptoms of Leukoplakia

Leukoplakia usually occurs on the gums, the insides of the cheeks, the bottom of the mouth (beneath the tongue) and on the tongue. It is particularly not painful, and it can go unnoticed for a while.

Leukoplakia can appear:

  • Grayish or white in patches that can’t be wiped away
  • Flat or irregular textured patches in the mouth
  • Hardened or thickened in areas inside the oral cavity
  • Along with raised, erythroplasia (red lesions, speckled leukoplakia), which are more likely to show precancerous changes

Hairy leukoplakia

Hairy leukoplakia causes fuzzy, white patches that resemble ridges or folds, on the sides of the tongue. It can be mistaken for oral thrush which is an infection that is marked by creamy white patches which can be wiped away and is common in individuals with a weakened immune system.

Although leukoplakia does not cause discomfort, it can sometimes be an indication of a more serious condition.

You should see your dentist or physician if you have any of the following:

  • White plaques or sores in the mouth that don’t heal on their own within two weeks
  • Lumps or red, white or dark patches in the mouth
  • Persistent changes in the tissues of the mouth
  • Ear pain when swallowing
  • Progressive reduction in the ability to open your jaw

Causes of Leukoplakia

Although the causes of leukoplakia are unknown, chronic irritation, such as from tobacco use, including chewing and smoking, appears to be responsible for most cases. Often, regular users of smokeless tobacco products develop leukoplakia when they hold the tobacco against their cheeks.

Other causes can include chronic irritation from:

  • Ill-fitting or broken dentures
  • Broken, jagged or sharp teeth rubbing on tongue surfaces
  • Long-term alcohol use

Hairy leukoplakia

Hairy leukoplakia often results from infection with the Epstein-Barr virus (EBV). Once you’re infected with EBV, the virus remains in your body for life. The virus is normally dormant, but if your immune system is weakened, especially from HIV/AIDS, the virus can be reactivated, leading to conditions such as hairy leukoplakia.

Diagnosis of Leukoplakia

Leukoplakia can be diagnosed by:

  • Attempting to wipe off the white patches
  • Examination of the patches in your mouth
  • Discussing your medical history and possible risk factors
  • Ruling out other possible causes

Testing for cancer

If you have leukoplakia, you will likely be tested for early signs of cancer by:

  • Oral brush biopsy: This involves the removal of cells from the surface of the lesion with a small, spinning brush. The procedure is non-invasive and does not always result in a definitive diagnosis.
  • Excision biopsy: This involves the surgical removal of the tissue from the leukoplakia patch or removing the entire patch if it is small. An excision biopsy is usually more comprehensive and results in a definitive diagnosis.

If the biopsy is positive for cancer and your physician performed an excisional biopsy that involved removing the entire patch, further treatment may not be needed. If the patch is large, you can be referred to an oral surgeon or ear, nose and throat (ENT) specialist for treatment.

On the other hand, if you have hairy leukoplakia, you will be evaluated for conditions that may contribute to a weakened immune system.

Treatment of Leukoplakia

Leukoplakia treatment is mostly successful if a lesion is found and treated early on when it’s still small. Regular check-ups are important, as is the routine inspection of the mouth for areas that do not look normal.

For most individuals, removing the source of irritation, such as stopping alcohol or tobacco use might clear the condition. When this is not effective or if the lesions tend to show early signs of cancer, the treatment plan may involve:

  • Removal of leukoplakia patches: Patches may be removed using a laser, scalpel or an extremely cold probe that freezes and destroys cancer cells (cryoprobe).
  • Follow-up visits to check the area: Once you have had leukoplakia, recurrences are often common.

Treating hairy leukoplakia

Treatment for hairy leukoplakia isn’t usually needed. The condition often does not have symptoms and isn’t likely to lead to mouth cancer.

If your physician recommends treatment, it may include:

  • Medication: You may be given a pill that affects your whole system (systematic medication), such as antiviral medications. These types of medication can suppress the Epstein-Barr virus, which is the cause of hairy leukoplakia. You may also be prescribed topical treatment.
  • Follow-up visits: Once you stop treatment, the white patches of hairy leukoplakia can return. Regular follow-up visits to monitor changes in your mouth may be recommended by your physician as well as ongoing therapy to prevent leukoplakia patches from returning.

Next Step

At King’s College Hospital Dubai, we focus on offering an exemplary service from initial consultation through to the final diagnosis and treatment and beyond. Our team of expert doctors and nurses are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.

If you’d like to book an appointment, simply fill in the appointment form below.

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