Leukoplakia : Causes, Types, Treatment and Symptoms

Leukoplakia is a potentially precancerous condition characterized by firmly attached, white or grayish spots that cannot be removed and are separate from conditions such as thrush. Given its strong link to risk factors such as tobacco smoking and the probability of pre-cancerous transformation (particularly if red spots develop), any non-healing patches in the mouth should be checked by a dentist or physician as soon as possible.

Most Common Leukoplakia Symptoms:

• Usually asymptomatic
• Mild discomfort and sensitivity
• Rarely, pain occurs in the area when infected for the second time.
• Non-healing sores and lumps
• Problems with swallowing
• Restricted jaw opening
• Fuzzy, folded, or rigged white lesions are usually found on the side of the tongue in the case of hairy leukoplakia.
• White or grey patches on the gums, inside the cheeks, or under the tongue.
• Flat or slightly raised patches with irregular shapes.
• Patches that cannot be rubbed, peeled, or scraped off.

Common, Uncommon or Underlying Causes of Leukoplakia

Chronic irritation and exposure to risk factors, particularly tobacco use (smoked or chewed) and betel nut, are the most common causes of leukoplakia, with heavy alcohol intake and poor oral hygiene also playing a significant role.

• Tobacco: Smoking and chewing tobacco are the leading risk factors.
• Beetel nut and areca nut chewing
• Weakened immune system
• Human papillomavirus (HPV) infection
• Chronic and excessive alcohol consumption
• Chronic inflammatory conditions in the mouth
• Chronic mechanical irritation: Poorly fitting dentures, braces, rough teeth, and frequent tongue/cheek biting.
• Nutritional deficiencies: Low levels of vitamin A, B, or iron deficiency
• Chronic fungal infection: Also known as oral candidiasis, linked to non-homogeneous leukoplakia.
• Epstein-Barr Virus (EBV): Causes hairy leukoplakia seen in people with a weakened immune system.
• Ultraviolet light exposure: Sun’s UV radiation can cause leukoplakia of the lower lip.

When to Seek a Specialist for Your Leukoplakia?

You should seek quick examination for leukoplakia from a specialist, such as an oral pathologist, oral surgeon, or ENT, who will inspect the lesions, maybe perform a biopsy to rule out malignant alterations, and choose the best course of action, follow-up care, or surgery.

Visit your specialist if these Leukoplakia symptoms are present:

• White patches in the mouth persist for more than 2 weeks
• When you experience pain, swelling, and discomfort, difficulty eating or swallowing, and difficulty moving your jaw.
• Personal or family history of oral cancer
• When the patch converts into a thickened and red-spotted region
• If there is no improvement after removing the possible cause of irritation after several weeks.
• When the cause cannot be clearly identified

Don’t wait for signs to grow severe. Consult our ENT Specialists today

Diagnostic Approach for Leukoplakia

The diagnostic gold standard for leukoplakia is a combination of meticulous clinical examination and confirming tissue biopsy, which is required for exact diagnosis, risk assessment, and immediate therapy or monitoring of any found dysplasia or cancer.

• Visual inspection and manual palpation to distinguish from other white patches.
• Differentiate between homogeneous and non-homogeneous to systematically categorize individuals based on their severity.
• Rule out other oral white lesions using clinical features and patient history.
• Adjunct tests: Toluidine blue staining or oral brush biopsy.
• Biopsy: Performed to remove a part or all of the lesion.
• Multiple biopsies or field mapping for extensive leukoplakia or extensive lesions.
• Prognosis and management when the tissue is examined for dysplasia and cellular atypia.

Types of Leukoplakia

Leukoplakia is clinically characterized based on its appearance and texture to aid in prognosis and care, since non-homogeneous forms have a higher chance of malignant development.

Some common types of Leukoplakia include:

1. Main Clinical Types:

• Homogeneous Leukoplakia: Appears flat with white patches with a uniform texture and spread, and carries a low risk of malignancy.
• Non-Homogeneous Leukoplakia: Appears red-white with nodules with an irregular surface and spread, and carries a high risk of malignancy.

2. Important Subtypes:

• Speckled (Erythroleukoplakia): A mix of red and white lesions, slightly raised above the skin, and appears granular.
• Nodular Leukoplakia: Appears as white, small, nodular-like outgrowths
• Verrucous Leukoplakia: Appears as a thick, rough, and corrugated patch
• Proliferative Leukoplakia: An aggressive form that appears white, and comes back at high rates and malignant transformation.
• Oral Hairy Leukoplakia: Also known as true idiopathic leukoplakia, which appears on the side of the tongue as “hairy”.
• Sublingual Keratosis: Located on the floor of the mouth or under the tongue.

How to Treat Leukoplakia Symptoms?

Leukoplakia treatment involves removing the primary irritant (irritants) and using medicinal or surgical interventions, based on the lesion type and cancer risk, to eliminate patches, thereby providing the best possible symptom control and cancer prevention.

For underlying causes, treatments & rehabilitative strategies include:

• Stop tobacco chewing or smoking
• Avoid betel nut or areca nut chewing
• Reduce alcohol consumption
• Improve oral hygiene
• Remove the source of mechanical irritation, like poorly fitting dentures
• Topical agents (vitamin A and B derivatives) alongwith a major surgery for a longer period as a supportive measure
• Antiviral medication
• Photodynamic therapy (PDT)
• Surgical excision: Conventional, laser, or cryosurgery, nd electrocauterization
• Regular dental check-up after the surgery to check for any recurrence or malignant transformations.

What if Leukoplakia is Left Untreated?

If left untreated, leukoplakia has a high likelihood of progressing to mouth cancer (squamous cell carcinoma), with 1% to 30% of lesions undergoing malignant transformation depending on the lesion type and dysplasia. Therefore, prompt professional diagnosis and treatment are crucial for reducing these risks, along with ongoing follow-up due to the potential for recurrence and progression.

Some possible complications of an untreated Leukoplakia include:

• Cancer development at the affected site
• Increased risk of near or recurrent leukoplakia lesions
• Local tissue changes, including ulceration, irritation, and thickening
• Non-homogeneous leukoplakia that are larger in size may risk of causing cancer
• Lesions that are persistent over a long period of time may lead to cancer formation
• Presence of untreated candidal infection
• Possible difficulty eating or speaking as the lesions grow in size

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