Leukoplakia

1 What is Leukoplakia?

Leukoplakia is the thickened, white or gray patches that develop on your gums, the insides of your cheeks, the bottom of your mouth , and sometimes under the tongue. These patches can't be scraped off. The actual cause of leukoplakia is unknown till date, but tobacco, whether smoked, dipped or chewed is considered to be the main culprit in its development. 

Leukoplakia patches can occur at any time in your life, but it is most common in senior adults. Leukoplakia usually is not dangerous, but it can sometimes be serious. Although most leukoplakia patches are noncancerous (benign), some show early signs of cancer

Many cancers on the floor of the mouth, beneath the tongue, occur next to the areas of leukoplakia patches. Thus, it is highly recommended that you see your dentist if you have unusual, persistent changes in your mouth.

2 Symptoms

The presence of white or gray colored patches on your tongue, gums, the roof of your mouth, or the inside of the cheeks of your mouth could be a symptom of leukoplakia. Leukoplakia patches can have various appearances. The patches may have developed slowly over weeks to months and become thick and slightly raised which may eventually take on a hardened and rough texture. 

They are usually is painless, but  could be sensitive to touch, heat, spicy foods, or other irritations. "Hairy" leukoplakia of the mouth is an unusual form of leukoplakia (caused by the Epstein-Barr virus) that is seen only in persons who are infected with HIV, have AIDS or AIDS-related complex. It consists of fuzzy, white patches on the tongue and, less frequently, elsewhere in the mouth. 

It may resemble thrush, an infection caused by the fungus Candida which usually occurs in adults if the immune system is not working properly. Mouth sores can be annoying and painful without being harmful. But in other cases, these mouth problems can indicate a more serious condition. 

Thus, consult your dentist if you have any of the following: 

  1. White plaques or sores in the mouth that don't heal on their own within two weeks
  2. Lumps or white, red or dark patches in your mouth 
  3. Persistent changes in the tissues of your mouth.
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3 Causes

The causes of leukoplakia depend on its type, i.e. whether it is standard or hairy. The common symptoms are:

  1. Irritation from rough teeth, fillings, or crowns, 
  2. Ill-fitting dentures that rub against your cheek or gum
  3. Regular use of tobacco, alcohol, smoking
  4. Prolonged sun exposure to the lips
  5. Diseases like oral cancer (although rare), HIV or AIDS

4 Making a Diagnosis

Your dentist may diagnose leukoplakia during examination.

First and foremost, the thing a patient can do is to consult a dentist or a general practitioner. However, you may also be referred to an oral surgeon or an ear, nose and throat (ENT) specialist for diagnosis and treatment. 

Your dentist will want to know about your medical history and details of the signs and symptoms, the severity of the symptoms, etc. So making a detailed list about your condition and symptoms helps a doctor to clearly diagnose and identify the indications of any serious disease and to understand the severity of your problem better.

The doctor is likely to ask you the following questions:

  1. When had you first noticed these changes? 
  2. Do you have any pain or bleeding from the problem area? 
  3. Are you a smoker? 
  4. Do you chew tobacco? 
  5. How much alcohol do you drink? 
  6. Do you have any difficulty swallowing?
  7. Have you noticed any lumps or bumps in your neck?
  8. Do you have any pain? 
  9. Have you developed any areas of numbness on your tongue or lip? 

The dentist then diagnoses your condition by examining your mouth for any kind of patches and ruling out other possible causes. The dentist may perform a biopsy (Removal of the tissue sample) for analyzing any early sign of cancer

This procedure includes removal of cells from the surface of the lesion with a small, spinning brush (oral brush biopsy) or surgically removing the entire leukoplakia patch (excisional biopsy) if the patch is small. He may further send the sample for lab analysis where a highly specialized imaging system allows a pathologist to detect any abnormality in the cells. 

If the biopsy is positive and your dentist performed an excisional biopsy that removed the entire leukoplakia patch, you may not need further treatment. If the patch is large, your dentist may refer you to an oral surgeon or ENT specialist for the treatment.

5 Treatment

Leukoplakia treatment is most successful when a lesion is found and treated early when it's small.

If leukoplakia is caused by smoking, consumption of tobacco or alcohol you have to stop using it. When this isn't effective or if the lesions show early signs of cancer, your dentist may recommend you the treatment involving removal of leukoplakia patches. Patches may be removed using a scalpel, a laser or an extremely cold probe that freezes and destroys cancer cells (cryoprobe). 

Recurrence of leukoplakia patches is very common, so, regular checkups and routine inspection of your mouth for areas that don't look normal  are highly recommended. 

Treating hairy leukoplakia: 

Usually, you don't need treatment for hairy leukoplakia. The condition often causes no symptoms and isn't likely to lead to mouth cancer. If your doctor or dentist recommends treatment, you may take a pill that works on the entire system (systemic medication), such as the antiviral medicine acyclovir (Zovirax) or antiretroviral medicine zidovudine (Retrovir).

Or you may be prescribed to use a medication solution that can be applied directly to the lesions in your mouth (topical medication), such as podophyllum. Once you stop the treatment, the white patches of hairy leukoplakia may return. 

Hence, your doctor or dentist may recommend follow-up visits every three months to monitor changes to your mouth or ongoing therapy to prevent leukoplakia patches from returning.

6 Prevention

You may be able to prevent leukoplakia if you:

  • avoid using any form of smoking, tobacco products,
  • avoid using alcohol or at least ensure that you stick to the recommended daily allowance for alcohol consumption. 

You can ask your doctor about methods to help you quit these products. If any of your friends or family members continue to smoke or chew tobacco, encourage them to have frequent dental checkups. Oral cancers are usually painless until fairly advanced.

7 Alternative and Homeopathic Remedies

Homeopathic remedy is also an effective method for treatment of leukoplakia as they target the altered immunity of the body and bring it back to normalcy over a period of time. 

The homeopathic remedies help in slowing down the progress of the disease and the development of complications. It slowly removes the lesion of leukoplakia and help in the proper absorption of various vitamins, which are required for healthy oral cavity by improving the disturbed digestion.

The treatment eradicates the chances of lesions developing into cancer and also controls and treats the initial stages of the cancerous lesions.

8 Risks and Complications

Consumption of Tobacco can increase the risk of leukoplakia and oral cancer. Drinking alcohol combined with smoking can further increase your risk. Leukoplakia usually doesn't cause permanent damage to tissues in your mouth. However, oral cancer is a potentially serious complication of leukoplakia. 

Oral cancers often form near leukoplakia patches, and the patches themselves may show cancerous changes. Even after leukoplakia patches are removed, the risk of oral cancer remains. Hairy leukoplakia, on the other hand, isn't painful and isn't likely to lead to cancer. But it may indicate HIV infection or AIDS.

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