Leukoplakia: More than just White Patches in the Mouth

White patches in the mouth can mean many different things. They might be caused by ulcers, fungal infections, irritation or injury, or even allergies.

Leukoplakia is another condition that can lead to white patches anywhere in the mouth. Because these patches often look similar to those caused by other issues, a biopsy is usually needed to confirm the diagnosis.

This article is your complete guide to understanding leukoplakia—what it is, how to recognize it, the risks involved, treatment options, and how to keep it from getting worse.

Understanding Leukoplakia

Leukoplakia is a medical term that describes those white patches or plaques you might notice inside your mouth. "Leuco" means 'white color,' and "Plakia" refers to 'tissue changes.'

These white patches can appear anywhere in the mouth—on the inside of the cheeks, tongue, lower lip, or gums. They can’t be scraped off and are not caused by something building up. Instead, they develop due to deeper changes in the mouth’s lining.

Leukoplakia happens when the mouth’s lining thickens and starts producing too much keratin—the same tough protein found in your hair and nails. This buildup of keratin is also what gives the patches their white appearance.

What Triggers Leukoplakia?
It's often the same factors that lead to oral cancer, especially tobacco use. Other irritants, like alcohol or chronic trauma, can also contribute.

While leukoplakia is not cancer, and most of the time is harmless and may not require treatment, it can sometimes carry a precancerous potential. That’s why it’s classified as a “potentially malignant disorder.”

In some cases, it may lead to abnormal changes in the cells—known as dysplasia—which closely resemble the early stages of oral cancer.

The Main Characteristics of Leukoplakia

How leukoplakia appears and develops can vary from person to person. Here are the main features you should be aware of:

1. The Primary Feature:

White patche inside your mouth, which can be flat or slightly raised. You can't scrape it off. It’s deeply embedded within the lining of the mouth.

2. Size, Shape, and More:

• Size: The white patches can range from just a few millimeters to larger, more widespread areas.


• Shape: The borders of these patches are usually irregular and uneven.


• Texture: Lesions can be smooth, thin, and uniform—or rough, thick, and grooved.


• Color: Leukoplakia plaques are typically grayish-white. They may also appear with red spots or small ulcers. In smokers or heavy coffee drinkers, the patch might look brownish-yellow.


• Symptoms: Leukoplakia is usually painless, but thicker patches can become easily irritated or injured, leading to discomfort.

What Causes Leukoplakia?

Leukoplakia has several potential causes, but the best-known trigger is tobacco in its various uses.

Leukoplakia can also occur without any clear reason, which we call Idiopathic Leukoplakia. But most of the time, there's something specific constantly irritating your mouth, such as infections, alcohol, or chronic irritation.

1. Tobacco: The Main Culprit

Tobacco, whether smoked or smokeless, is the major contributor to leukoplakia. Smokers run about 4 to 6 times more risks than non-smokers.

The reason is that tobacco and its by-products actually have a toxic effect on your mouth cells. Plus, the heat from smoking can irritate your mouth tissues over time, possibly setting the stage for those precancerous and cancerous changes.

2. Other Risk Factors

Aside from tobacco, other factors can increase the risk even more. These include:

1. Alcohol: When combined with tobacco, alcohol raises the risk of leukoplakia, as well as cancer. If you do both, it's even more important to keep a close watch on these lesions.


2. Chronic Irritation: Constant small injuries to the lining of your mouth can, over time, affect cell function and cause various changes in the mouth.


3. Nutritional Deficiency: Certain vitamin and mineral deficiencies can affect your mouth in different ways. A lack of iron may lead to tongue inflammation and soreness. Low levels of B-complex vitamins are often linked to repeated mouth ulcers. And if you’re low on vitamin A, your body might produce too much keratin—the same protein found in leukoplakia patches.


4. Mouth Infections: Certain infections, such as oral thrush (caused by the yeast Candida albicans) or Human Papillomavirus infection (HPV), can affect the lining of your mouth and cause changes similar to leukoplakia.

Who's Most Prone to Leukoplakia?

Leukoplakia affects about 1.5% to 4.1% of people. It’s more common in middle-aged and older adults, mostly appearing in people in their 40s, 50s, and 60s. It’s rare before age 30, making up only about 5% of cases.

Men are more prone to develop leukoplakia than women—mainly because smoking is more common among men. However, as more women are taking up smoking, this gap is beginning to narrow.

There is a specific type called hairy leukoplakia. This rare form looks like tiny white hairs, usually found on the sides of the tongue. It’s most common in people with weakened immune systems, especially those who are HIV-positive, have had an organ transplant, or take long-term corticosteroids.

Leukoplakia and Its Link to Oral Cancer:

Leukoplakia is often a harmless, benign condition that poses no threat to health. However, as we've seen, lesions with dysplasia carry a high risk of malignant transformation.

About 1% to 30% of leukoplakia lesions show dysplasia (precancerous changes), and 11% to 36% of those can eventually develop into oral cancer.

There's no way to tell from appearance whether the lesion is dysplastic, cancerous, or benign. So, even if the risk is low, don’t ignore white spots in your mouth. See your dentist or doctor as soon as you notice them. If leukoplakia is suspected, a biopsy will be needed to confirm the diagnosis and rule out other similar conditions.

As with any precancerous condition, eliminating risk factors—such as quitting smoking or removing sources of irritation—is crucial to reducing the risk of malignant transformation.

If leukoplakia does develop into cancer, it's called squamous cell carcinoma, the most common form of oral malignancy.



What factors increase the risk of malignant transformation?

• Location: The floor of the mouth (under your tongue) holds a higher risk, while patches on the roof of your mouth or gums have a lower risk.


• Time and Risk Factors: The longer your mouth is exposed to risk factors like smoking, the greater the potential for cancer.


• Size and Shape: Larger and more irregular patches pose a higher risk of cancer development.


• Nature of the Lesion: Only a microscopic examination can reveal the true precancerous nature of the disease. If cells appear abnormal (dysplastic), the precancerous potential is there.


• Age: Overall, oral cancer risk increases with age.

Does Leukoplakia Require Treatment?

The answer depends on the biopsy results. A biopsy is a simple procedure where a small tissue sample is taken from the affected area and examined under a microscope.

This helps confirm if the patch is truly leukoplakia and whether there’s any risk of it becoming cancerous.

• If the cells look normal (no dysplasia), you might not need treatment. In this case, removing risk factors like quitting smoking and having regular check-ups every six months may be enough.


• But if the cells appear suspicious or show signs of precancerous changes, surgical removal of the patches is usually recommended to eliminate the risk of cancer.

Preventing Leukoplakia: Some Strategies

Some strategies to prevent leukoplakia from worsening or recurring include:

• Remove the Risks: Get rid of all the risk factors that may be involved in leukoplakia. Stop smoking and limit alcohol consumption. Treat any mouth infection and address any nutritional deficiencies.


• Stop any Source of Irritation: If something is causing constant irritation in your mouth, it needs to be addressed. It could be a dental crown that doesn’t fit properly or a sharp tooth edge that’s constantly rubbing against your cheek or tongue. Even habits like teeth clenching and grinding should be checked.


• Protect Yourself: Because some STDs may contribute to the condition, always protect yourself during high-risk sexual activities.


• Follow-up: Regular check-ups with your dentist or doctor are important. Sometimes, these visits may include biopsies to watch for any changes or progression.