What is it?
Leukoplakia is the name of an appearance, not a tissue diagnosis on its own. There is a white or greyish white area on the lining of the mouth; it does not come away when wiped with gauze and cannot be explained by any other known condition. Unless both of these apply together, the term leukoplakia is not used. It is seen most often inside the cheek, along the side of the tongue, on the floor of the mouth and on the gum ridge.
What the name means matters here. A diagnosis of leukoplakia says that it is not yet known what this area is, and it is reached by ruling other things out. The white layer of a fungal infection wipes away and leaves a red surface underneath. The white lines of lichen planus form a lace-like pattern and are most often present on both cheeks at once. Whiteness in an area that is constantly bitten or rubbed by a sharp tooth edge recedes once the irritation is removed. Persistent whiteness that fits none of these is dealt with under the heading of leukoplakia.
Leukoplakia is not cancer. It is, however, counted among the lesions that can undergo malignant change; in a proportion of these areas, changes at cell level have been reported over the years. It is not possible to tell which area will take that path simply by looking. For that reason, rather than guessing about a white area that does not rub off, it needs to be assessed.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
Tobacco products
Cigarettes, pipes, waterpipes and above all tobacco products held in the mouth are the most frequently reported factor. On the surfaces the smoke and the tobacco touch directly, the lining of the mouth thickens over the years. Some areas have been reported to recede after tobacco is given up.
- 02
Alcohol combined with tobacco
Alcohol affects the lining of the mouth on its own as well; when it is used together with tobacco, the effect is accepted to be greater. In people in whom the two go together, white areas have been reported to be more widespread and thicker.
- 03
Ongoing mechanical irritation
A sharp tooth edge, a broken filling or an ill-fitting denture creates a protective thickening on the surface it rubs against; this is called frictional keratosis. Once the irritation is removed, it is expected to recede within a few weeks. If it does not, the area is placed under a different heading.
- 04
Areas with no demonstrable cause
Leukoplakia can also be seen in people with no history of tobacco or irritation. In this group the cause most often cannot be established. Not knowing the cause does not mean that monitoring is unnecessary; assessment becomes all the more important.
How does it progress?
- Homogeneous
A flat, uniformly white area
The surface is smooth, thin and of one colour, and the borders are usually well defined. Changes at cell level are reported less often with this appearance; monitoring is still advised.
- Non-homogeneous
A white area with a mixed surface
There are nodules, wart-like raised areas or irregular thickening on the surface, and the colour is not the same throughout. This appearance calls for closer assessment.
- Erythroleukoplakia
White and red areas together
There are red areas within the white patch or at its edge. The addition of a red component is regarded as a finding that calls for tissue examination without delay.
- Widespread
An extensive, multifocal form
This form involves more than one site, spreads over time and can appear again in the same area after it has been removed. It calls for long-term, regular monitoring.
How is it treated?
The dentist's first job is not to make the diagnosis but to describe the area accurately and remove the causes that can be removed. The site, size and appearance of the area are recorded, and whether it wipes away with gauze is tested. A sharp tooth edge, a broken restoration or an ill-fitting denture is corrected, and if you use tobacco, giving up is discussed. After these corrections, the area is usually reviewed within two to four weeks.
In a white area that has not receded in that time, tissue examination is the only method that can confirm what it is. The biopsy and the assessment of the sample are carried out by oral and maxillofacial surgery together with oral medicine. The sample is taken from the most suspicious-looking part of the area; in wide areas with a mixed surface, samples from more than one point may be needed. The result determines whether monitoring or removal follows.
When surgical or laser removal of the area comes up, the decision and the procedure belong to the relevant surgical department. Having it removed does not bring monitoring to an end; because a new area can appear at the same site or elsewhere, check-ups carry on. The dentist's role in this picture is to keep track of the monitoring intervals, remove sources of irritation inside the mouth and notice a new change early.
- If red areas have appeared within the white patch or at its edge
- If the area is thickening, becoming raised or its surface is turning irregular
- If a sore that has not healed for two weeks has formed in the same area
- If the base of the area feels firm to the touch, or numbness has been added in that area
How is it prevented?
- Give up tobacco products; the kinds held in the mouth are included in this.
- Cut down on alcohol; when it is used together with tobacco, the effect on the lining of the mouth increases.
- Have sharp tooth edges and ill-fitting dentures that scratch your cheek or tongue put right.
- Look inside your mouth once a month in good light; do not leave a new white area until your next check-up.
Frequently asked questions
- Is the white patch in my mouth thrush or leukoplakia?
- The first step in telling them apart is simple: the white layer of a fungal infection comes away when wiped with gauze and leaves a red surface underneath that bleeds easily. Leukoplakia does not rub off. Even so, the wipe test on its own does not give a diagnosis; what a persistent white area actually is can only be established by examination and, where needed, by tissue examination.
- Does leukoplakia turn into cancer?
- There is no single definite answer to this question. In the great majority of these areas no such change is seen; in a small proportion, changes at cell level have been reported over the years. For the risk to be discussed for you personally, the site and appearance of the area and the result of the tissue examination are assessed together. The point of monitoring is to be able to make that distinction in time.
- Is a biopsy essential, or can we wait and see for a while?
- When a source of irritation is found, a short period of observation may be used; this is usually a few weeks and depends on your dentist's judgement. But if the area has not receded in that time, extending the wait serves no purpose. It is not possible to say what is happening at cell level by looking at the appearance; only tissue examination can show that.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.