Leukoplakia

DEFINITION

With leukoplakia (loo-koh-PLAY-key-uh), thickened, white patches form on your gums, the insides of your cheeks, the bottom of your mouth and, sometimes, your tongue. These patches can’t be scraped off.

Doctors don’t know what causes leukoplakia but consider tobacco — whether smoked, dipped or chewed — to be the main culprit in its development.

Leukoplakia usually isn’t 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 areas of leukoplakia. For that reason, it’s best to see your dentist if you have unusual, persistent changes in your mouth.

CAUSES

The cause of leukoplakia depends on whether you have the standard or hairy variety.

Leukoplakia

Although the cause of leukoplakia is unknown, tobacco use, including smoking and chewing, appears to be responsible for most cases. Often, regular users of smokeless tobacco products eventually develop leukoplakia where they hold the tobacco against their cheeks. Long-term alcohol use and other chronic irritants also may contribute to leukoplakia.

Hairy leukoplakia

Hairy leukoplakia, sometimes called oral hairy leukoplakia, results from infection with the Epstein-Barr virus (EBV). Once you’ve been infected with EBV, the virus remains in your body for life. Normally, the virus is dormant, but if your immune system is weakened, either from disease or certain medications, the virus can become reactivated, leading to conditions such as hairy leukoplakia.

People with HIV/AIDS are especially likely to develop hairy leukoplakia. Although the use of antiretroviral drugs has reduced the number of cases, hairy leukoplakia still affects a number of HIV-positive people and it may be one of the first signs of HIV infection. The appearance of oral hairy leukoplakia may also be an indication that antiretroviral therapy is failing.

SYMPTOMS

Leukoplakia can have various appearances. Changes usually occur on your gums, the insides of your cheeks, the bottom of your mouth and, sometimes, your tongue.

Leukoplakia may appear:

• White or grayish in patches that can’t be wiped away
• Irregular or flat-textured
• Thickened or hardened in areas
• Along with raised, red lesions (erythroplakia), which are more likely to show precancerous changes

A type of leukoplakia called hairy leukoplakia primarily affects people whose immune systems have been weakened by medications or disease, especially HIV/AIDS. Hairy leukoplakia causes fuzzy, white patches that resemble folds or ridges on the sides of your tongue. It’s often mistaken for oral thrush — an infection marked by creamy white patches, which can be wiped away, on the area that extends from the back of your throat to the top of your esophagus (pharynx) and the insides of the cheeks. Oral thrush also is common in people with HIV/AIDS.

When to see a doctor

Sometimes mouth sores can be annoying or painful without being harmful. But in other cases, mouth problems can indicate a more serious condition.

See your dentist if you have any of the following:

• White plaques or sores in your mouth that don’t heal on their own within two weeks
• Lumps or white, red or dark patches in your mouth
• Persistent changes in the tissues of your mouth