Leukoplakia

What is leukoplakia?

Leukoplakia is a white patch that develops in the mouth.

The condition is usually painless, but is closely linked to an increased risk of

.

Places where the patch can develop include the:

• lips
• floor or roof of the mouth
• inside of the cheek
• gums
• tongue

Read more about the

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You should see a dentist if you notice a white patch or lump in your mouth that hasn't healed after about 14 days.

As there is no specific test for leukoplakia, your dentist will need to rule out other conditions before they can diagnose it. They may refer you to a specialist for a

, which involves removing a small sample of tissue from the patch. The tissue will be sent to a specialised laboratory to see if it is abnormal and potentially cancerous.

Why does leukoplakia happen?

The exact cause of leukoplakia is unknown, but the use of tobacco, both smoking and chewing tobacco products, is thought to increase the risk of developing it.

Heavy alcohol consumption is also believed to increase the risk of leukoplakia.

Read more about the

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How is leukoplakia treated?

Leukoplakia usually causes no symptoms, and the condition should not affect your quality of life, however, it should be investigated to assess your risk of developing mouth cancer.

Evidence suggests the most effective way of controlling leukoplakia is to stop using tobacco and to drink alcohol in moderation.

Although estimates for people with leukoplakia from different population groups who will develop mouth cancer vary considerably – from around 0.5% to almost 20% – the risk of mouth cancer is thought to be much higher in people who continue to smoke heavily or chew tobacco.

If you are thought to be at high-risk, leukoplakia can be surgically removed to ensure any abnormal cells don't later become cancerous.

Regardless of the treatment you receive, it is important to have your mouth regularly examined by a dentist or suitable specialist to ensure the condition is not progressing.

Read more about

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Preventing leukoplakia

The most effective way of preventing leukoplakia is to avoid using any form of tobacco and to reduce alcohol consumption. However, it is not always possible to prevent the condition developing, as it sometimes has no identifiable cause (known as idiopathic leukoplakia).

Read more about stopping smoking and

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A diet high in fresh fruit and vegetables may also help prevent leukoplakia and mouth cancer.

How common is leukoplakia?

Leukoplakia is a common condition. It is estimated that slightly fewer than one in 100 people will develop the condition at some point in their life. However, occurrence of leukoplakia is higher in parts of the world where the use of chewing of tobacco and related products is widespread, such as India and Taiwan.

Men are more likely than women to develop leukoplakia and most cases affect adults who are over 50 years old.

Leukoplakia symptoms

The main feature of leukoplakia is the appearance of a white patch in the mouth that cannot be scrubbed off.

The patch can occur on the:

• floor of the mouth
• soft palate (the back of the roof of the mouth)
• inside of the cheek
• lower lip
• gums
• tongue (usually the sides)

There is usually only one clearly defined patch, but there can sometimes be more than one spread over a larger area.

The patch is almost always painless and often slightly raised, with a thickened or irregular feel to it. The patch is often persistent and cannot be removed by brushing or scraping. There may be some redness associated with the patch.

When to seek medical advice

Visit your dentist if you notice a white patch or lump in your mouth that does not heal within 14 days.

Leukoplakia does not usually cause pain or discomfort, but your dentist will be able to rule out other causes of the white patch, such as a

.

Your dentist may also be able to assess your risk of developing oral cancer in later life. As part of this risk assessment, you may have to attend regular follow-up appointments or see a specialist so your leukoplakia can be carefully monitored.

Leukoplakia causes

The exact cause of leukoplakia is unknown, but may be the result of substances irritating the tissue inside the mouth.

Scientific evidence, though weak, has identified a number of things that can increase your risk of developing the condition. These are described below.

Tobacco

Tobacco significantly increases your risk of developing leukoplakia. Smokers are much more likely to get leukoplakia than non-smokers.

There is an even higher risk for people who use smokeless tobacco products, such as chewing tobacco, or betel nut preparations, such as paan.

Studies have shown regular users of betel nuts are 25 times more likely to develop leukoplakia than non-users.

Alcohol

After tobacco, heavy alcohol use is the second most important reason for increased risk of leukoplakia. Heavy drinkers are eight times more likely to develop leukoplakia than non-drinkers.

Heavy drinking is defined as drinking more than the recommended weekly limit for alcohol consumption, which is 21 units for men and 14 units for women.

A unit of alcohol is approximately half a pint of normal-strength lager, a small glass of wine or a single measure (25ml) of spirits.

Binge drinking may also increase your risk of developing leukoplakia or

.

Other possible risk factors

There are no other consistent risk factors for leukoplakia.

However, infection with the [human papilloma virus (HPV)] has been suggested as a possible risk factor for leukoplakia. Any link between these two conditions is currently being investigated.

A long-lasting (chronic) infection of the mouth with a type of fungus called Candida can also increase the risk of leukoplakia. Cases where the condition is associated with this infection are often called Candidal leukoplakia.

White patches may sometimes occur if people have a habit of biting their cheeks or dragging their lips across the teeth. Similarly, poorly fitting dentures that rub the lining of the mouth can cause thickened areas that appear as white patches.

However, these white patches are not considered to be leukoplakia as, unlike leukoplakia, they have a clear cause and do not have a risk of developing into mouth cancer.

Leukoplakia treatment

Treating leukoplakia is important as it should reduce your risk of developing mouth cancer.

Everyone with leukoplakia should consider the advice below, even if their biopsy finds no abnormal cells.

Stopping smoking

If you smoke or use other tobacco products, the most effective form of treatment for leukoplakia is to stop. Avoiding tobacco can cause a leukoplakia patch to slowly disappear and may also significantly reduce any risk of developing mouth cancer.

If you smoke, it is strongly recommended you stop as soon as possible. Your doctor can advise you about stopping, and prescribe medication to help you quit.

Read more about stopping smoking and

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Reducing alcohol

Giving up alcohol or reducing your alcohol consumption may reduce the size of a leukoplakia patch or cause it to disappear entirely. As with stopping smoking, avoiding alcohol or limiting your intake will reduce your risk of developing oral cancer.

If you do not want to stop drinking alcohol altogether, you should ensure you don't drink any more than the recommended daily limits, which are:

• three to four units a day for men
• two to three units a day for women

A unit of alcohol is equal to about half a pint of normal-strength lager, a small glass of wine or a pub measure (25ml) of spirits.

Visit your doctor if you are finding it difficult to moderate your drinking. Counselling services and medication are available to help you reduce your alcohol intake.

Surgical treatment

Surgically removing the leukoplakia patch may reduce the risk of mouth cancer developing by removing any abnormal cells.

The leukoplakia is usually removed using a scalpel or laser. The procedure is typically done using a

, though a may be required if the area is large.

Medical treatment

There is currently limited evidence that medical treatment will cause leukoplakia to disappear. Medications such as retinoids or substances made from vitamin A have been proposed, but these treatments can have adverse side effects, and there is no consistent evidence that they are effective.

Treatments such as

or are of no benefit.

Medical treatment may be used in cases where leukoplakia is associated with an infection by a fungus called Candida. In these cases, treatment with antifungal medicines may be used to get rid of the infection within the white patches. However, this is not a specific treatment for leukoplakia.