Leukoplakia

Page last reviewed: 13/07/2011

Leukoplakia is a single painless white patch in the mouth. It usually develops on the:

  • floor of the mouth
  • inside of the cheek
  • tongue (occasionally)
  • gums

The exact cause of leukoplakia is unknown, but the use of tobacco, including chewing tobacco products, is a risk factor. Heavy alcohol consumption has also been linked to an increased risk of developing leukoplakia. See Leukoplakia - causes for more information about the risk factors.

How common is leukoplakia?

Leukoplakia is a common condition. It is estimated that 1 in 100 people will develop the condition at some point in their life. However, rates of leukoplakia are higher in parts of the world where the use and chewing of tobacco and related products is widespread, such as India and Taiwan.

Men are more likely than women to develop leukoplakia. Most cases affect older adults aged 50 to 70 years.

Outlook

Leukoplakia usually causes no symptoms, and the condition should not affect your quality of life. However, in a few cases leukoplakia turns cancerous, often many years or sometimes decades after it first appears.

An estimated five in 100 people with leukoplakia will get mouth cancer (oral cancer) later in life. However, the risk of mouth cancer is much higher in people with leukoplakia who continue to smoke heavily or chew tobacco.

One study estimated that the number of heavy tobacco users with a history of leukoplakia who later develop mouth cancer may be as high as one in seven.

Evidence suggests that the most effective way of preventing leukoplakia from causing oral cancer is to stop using tobacco and drinking alcohol, or to drink alcohol in moderation.

Other treatment options for leukoplakia include a type of medication called retinoids, or surgery. See Leukoplakia - treatment for more information.

Regardless of the treatment that you receive, it is important that your mouth is regularly examined by a dentist or suitable specialist to ensure that any leukoplakia is not growing or changing, and that no new areas of leukoplakia are developing.

Tissues
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Hairy leukoplakia

Hairy leukoplakia is a particular type of leukoplakia that affects people with a weakened immune system (the body’s natural defence against infection and illness), particularly those who have HIV disease.

Hairy leukoplakia does not give rise to any symptoms but, unlike other types of leukoplakia, it almost always occurs on the side or top of the tongue. It does not cause pain or any change in your sensation of taste. It usually resolves when the ineffective immune system is corrected.

Hairy leukoplakia is actually caused by the Epstein-Barr virus, although specific antiviral medicines rarely improve this disorder. Unlike ‘traditional’ leukoplakia, hairy leukoplakia does not carry a risk of oral cancer.

However, it should be taken as an important warning sign that your immune system may be weakened. Visit your GP or specialist as soon as possible if you develop hairy leukoplakia and you have HIV or any other condition, or are on medication (such as immunosuppressives) that is known to weaken the immune system.

Page last reviewed: 13/07/2011

The main feature of leukoplakia is the appearance of a white or grey patch (plaque) on the:

  • floor of the mouth
  • inside of the cheek
  • tongue (occasionally)
  • gums

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.

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 fungal infection.

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 that your leukoplakia can be carefully monitored.

Page last reviewed: 13/07/2011

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

Despite the lack of scientific evidence to confirm the causes of leukoplakia, research has identified a number of risk factors for the condition's development. These are described below.

Tobacco

Tobacco use is the leading risk factor for 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 type preparations, such as paan.

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

Alcohol

After tobacco, the second leading risk factor for leukoplakia is heavy alcohol use. 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 standard drinks for men and 14 for women.

A standard drink of alcohol is approximately half a pint of normal-strength beer, a small glass of wine or a single measure of spirits.

Other possible risk factors

There are no other consistent risk factors for 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. These white patches are not considered to be leukoplakia as they have a clearly identifiable cause - local trauma - and do not have a risk of causing mouth cancer. 

Tissues
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  

Page last reviewed: 13/07/2011

Your dentist should be able to diagnose leukoplakia by examining the white or grey patch on the inside of your mouth.

Biopsy

Your dentist may take a small sample of cells from the patch using a procedure called a biopsy. The cells will then be sent to a specialised laboratory for closer examination. Alternatively, your dentist may refer you to a specialist who will do the biopsy.

See the A-Z pages about Biopsy for more information about the procedure.

Following the biopsy, laboratory tests will be able to determine whether there are any abnormal cells present in the patch. If abnormal cells are detected, it can suggest that you have an increased chance of developing oral cancer and will require regular check-ups.

Exactly what that risk is will depend on how abnormally the cells inside the patch are behaving (the medical term for this level of abnormality is dysplasia).

See the A-Z topic about Mouth cancer for more information about the condition.

Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.

Page last reviewed: 13/07/2011

Even though leukoplakia does not usually cause any pain, removing the patch (plaque) that forms in the mouth is an important goal of treatment as it should reduce your risk of developing mouth cancer.

Even if the biopsy finds no abnormal cells, everyone with leukoplakia should consider the below advice.

Giving up smoking

If you smoke or use other tobacco products, the most effective form of treatment for leukoplakia is to give up smoking or stop using tobacco products. Avoiding tobacco may cause a leukoplakia to slowly disappear. It may also significantly reduce any risk of developing oral cancer.

If you smoke, it is strongly recommended that you quit as soon as possible. Your GP can advise you about giving up, and prescribe medication to help you quit. The HSE QUIT website also provides information, support and advice about giving up smoking.

The A-Z page Quitting smoking - treatment also provides information and advice about quitting.

Reducing alcohol

Giving up alcohol or reducing your alcohol consumption may reduce the size of a leukoplakia or cause it to disappear entirely. As with quitting 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, at least stick to the recommended weekly amounts of alcohol consumption:

  • 21 standard drinks a week for men
  • 14 standard drinks a week for women

A standard drink of alcohol is equal to about half a pint of normal-strength beer, a small glass of wine or a pub measure of spirits.

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

See the A-Z topic about Alcohol misuse - treatment for more information and advice.

Surgical treatment

Some experts have suggested that surgically removing the leukoplakia patch could reduce the risk of oral cancer developing. There is currently no clear evidence that this is the case. However, surgical removal would seem sensible as it removes any abnormal cells that might later cause cancer.

The leukoplakia is usually removed using a scalpel or laser. The procedure is typically done using a local anaesthetic (where the area is numbed). A general anaesthetic (where you are put to sleep) may be required if the area is large.

Medical treatments

There is currently limited evidence that medical treatment will cause leukoplakia to disappear. Medications such as retinoids or vitamin A agents have been proposed, but these agents can have adverse side effects, and there is no consistent evidence that they are effective. Treatments such as radiotherapy or conventional chemotherapy (anti-cancer drugs) are of no benefit. 

Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Lesion
A lesion is an abnormal change in an organ or body tissue because of injury or disease.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Ulcerated
An ulcer is a sore break in the skin, or on the inside lining of the body.

Importance of regular check-ups

Regardless of the treatment that you receive, it is important that your mouth is regularly examined by a dentist or suitable specialist to ensure that any leukoplakia is not increasing in size or changing, or that new areas of leukoplakia are developing.

Page last reviewed: 13/07/2011

Tobacco and alcohol

The most effective way of preventing leukoplakia is to avoid using any form of tobacco and to stop drinking alcohol, or at least ensure that you stick to the recommended weekly allowance for alcohol consumption.

See the A-Z pages on Quitting smoking and Alcohol misuse for information and advice about how to achieve this.

Mediterranean-style diet

Eating a Mediterranean-style diet may also reduce your risk of developing leukoplakia and oral cancer.

A Mediterranean-style diet is high in fresh vegetables, particularly tomatoes, citrus fruits (such as oranges, grapefruit and lemon), olive oil and fish oil.

Eating five portions of fruit and vegetables a day will also help to prevent leukoplakia, oral cancer and other types of cancers. Fruit and vegetables contain chemicals known as antioxidants, which are thought to help protect human cells from damage.

Leafy vegetables, such as lettuce, spinach and cabbage are thought to provide the most protection against cancer. Your diet should also be low in fat and high in starchy foods, such as wholemeal bread, wholegrains and potatoes.

 

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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