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By Mayo Clinic staff
Leukoplakia is a condition in which thickened, white patches form on your gums, on the inside of your cheeks, the bottom of your mouth and sometimes on your tongue. These patches can't easily be scraped off. The cause of leukoplakia is unknown, but tobacco, either smoked or chewed, is considered to be the main culprit in its development. Leukoplakia usually isn't dangerous, but it can sometimes be serious. Although most leukoplakia patches are benign, a small percentage show early signs of cancer, and many cancers of the mouth 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. Symptoms
Leukoplakia can have various appearances. Changes usually occur on your gums, the insides of your cheeks, the bottom of your mouth and sometimes on your tongue, and may appear as:
„ White or grayish patches that can't be wiped away Sometimes you may also have 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 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. For that
reason, 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 „ Lumps or white, red or dark patches in your mouth „ Persistent changes in the tissues of your mouth The cause of leukoplakia is unknown. Many possible causes have been linked to leukoplakia, including tobacco, long-term alcohol use and other chronic irritants. Though mechanical irritants, such as rough fillings or dentures, were once felt to be a cause of leukoplakia, they're no longer believed to lead to this condition. Smoking appears to be responsible for most cases of leukoplakia. Chewing tobacco and snuff also play a key role — as many as three out of four regular users of "smokeless tobacco" products eventually develop leukoplakia where they hold the tobacco against their cheeks.
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, it can become
reactivated, leading to conditions such as hairy leukoplakia.
People living with HIV/AIDS are especially likely to develop hairy leukoplakia. Although the use of anti-retroviral drugs has reduced the number of cases, hairy leukoplakia still may affect as many as one-fourth of HIV-positive people, and may be one of the first signs of HIV infection. The appearance of oral hairy leukoplakia may also be an indication that anti-retroviral therapy is failing. Risk factors
Tobacco use puts you at high risk of oral cancer as well as leukoplakia, and drinking alcohol together with smoking further increases your risk. Complications
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 in the vicinity of leukoplakia patches, and the patches themselves may show cancerous changes. Even when leukoplakia patches are removed, the risk of oral cancer is still elevated. Hairy leukoplakia, on the other hand, isn't painful and isn't likely to lead to cancer. But it may indicate the presence of HIV infection or AIDS. Preparing for your appointment
You're likely to start by first seeing your dentist or a general practitioner. However, you may also be referred to an oral surgeon or an otolaryngologist for diagnosis and treatment. Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared in advance. Here's some information to help you get ready for your appointment, and what to expect from your doctor. What you can do
„ Write down any symptoms you're experiencing, including any that may
seem unrelated to the reason for which you scheduled the appointment. „ Make a list of all medications, as well as any vitamins or supplements,
„ Write down questions to ask your doctor.
Your time with your dentist or doctor is limited, so preparing a list of questions will help you make the most of your time together. For leukoplakia, some basic questions to ask your doctor include: „ Are there any other possible causes for my condition? „ Is my condition likely temporary or chronic? „ What treatments are available? Which do you recommend? „ What are the alternatives to the primary approach that you're suggesting? „ Are there any restrictions that I need to follow? „ Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting? In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something. What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer
them may reserve time to go over any points you want to spend more time on.
Your doctor may ask:
„ When did you first notice these changes?
Your doctor may discover leukoplakia during a normal screening examination, which is part of most routine oral examinations. If the diagnosis of leukoplakia is made as a result of a normal screening examination, you'll likely be asked the same questions. What you can do in the meantime
Quitting smoking or chewing tobacco may reduce or eliminate your leukoplakia.
Tests and diagnosis
Most often, your dentist diagnoses leukoplakia by examining the patches in your
mouth and ruling out other possible causes for your signs and symptoms. To help
ensure that no early signs of cancer exist, your dentist may remove a tissue
sample (biopsy) for analysis. This can involve either removing the entire lesion
(excisional biopsy), or a portion of the lesion, removing cells from the
leukoplakic patches with a small, spinning brush (oral brush biopsy).
The tissue is then analyzed in a laboratory using a highly specialized imaging system that allows a pathologist to detect abnormal cells. A negative report means no abnormal cells are present. If the report is positive, your dentist is likely to either perform an excisional biopsy, which removes the entire leukoplakia patch if it's small, or refer you to an oral surgeon if it's large. Because your prognosis is better when leukoplakia is found and treated when it's small, regular checkups are important, as is routinely inspecting your mouth for areas that don't look normal. Treatments and drugs
For most people, stopping smoking or alcohol consumption clears the condition. When this isn't effective or if the lesions show early signs of cancer, your dentist may refer you for removal of the leukoplakic patches using a scalpel, a laser, or an extremely cold probe that freezes and destroys cancer cells (cryoprobe). Follow-up is necessary after removal because recurrences are frequent.
Researchers have investigated the effects of retinoids — derivatives of vitamin A that are used to treat severe acne and other skin conditions — on leukoplakia. Although they appear effective against leukoplakia, retinoids may cause side effects, even when used topically. Beta carotene, an antioxidant that's converted to vitamin A in your body, also may completely or partially reduce leukoplakic patches. Treating hairy leukoplakia
Not all cases of hairy leukoplakia need treatment, and your doctor or dentist may
take a wait-and-watch approach. If you need treatment, several options are
„ Systemic medications. These include antiviral drugs such as valacyclovir
and famciclovir, which prevent the Epstein-Barr virus from replicating, but don't eliminate it from your body. Treatment with antivirals can clear leukoplakic patches, but symptoms often return once therapy stops. „ Topical medications. These include podophyllum resin solution and
tretinoin (retinoic acid). When applied topically, these therapies can improve the appearance of leukoplakic patches, but once the medication is stopped, they may return. Prevention
Most often, you can prevent leukoplakia by following these suggestions: „ Stop using tobacco products. Avoiding all tobacco products is one of the
best steps you can take for your overall health as well as one of the main ways to prevent leukoplakia. Talk to your doctor about methods that can help you quit. And if friends or family members continue to smoke or use spit tobacco, encourage them to have frequent dental checkups. Oral cancers are usually painless until fairly advanced. „ Avoid or limit alcohol consumption. Alcohol is a factor in both
leukoplakia and oral cancer. Combining alcohol and smoking may make it easier for the harmful chemicals in tobacco to penetrate the tissues in your mouth. „ Eat plenty of fresh fruits and vegetables. These are rich in antioxidants
such as beta carotene, which reduce the risk of leukoplakia by deactivating harmful oxygen molecules before they can damage tissues. Rich food sources of beta carotene include dark yellow, orange, and green fruits and
vegetables, including carrots, pumpkin, squash, cantaloupe and spinach. 1998-2009 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "," "EmbodyHealth," "Reliable tools for healthier lives," "Enhance your life," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.


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