What is leukoplakia?

If you have noticed that there are white patches in your mouth that don’t seem to go away, that could be due to a mouth disease called leukoplakia. Leukoplakia tends to occur where there are mucous membranes in the mouth, such as in the gums, on the inside of your cheek and on your tongue. This disease causes a thickening of the skin in the mouth and causes white patches to occur within the mouth.¹

Leukoplakia is a mouth disease that impacts roughly 1% to 2% of the population.² It usually affects people over the age of 40, with most cases occurring in men over 50 years old.³ It’s rare for anyone under 30 to be diagnosed with leukoplakia. It can be difficult for doctors to diagnose leukoplakia because the symptoms of leukoplakia overlap the symptoms of some other common mouth diseases and conditions. But, getting a correct diagnosis of leukoplakia is important so a biopsy can be done. The lesions that are symptomatic of leukoplakia can produce cancerous cells that can cause mouth cancer and oral cancer.⁴

What are the types of leukoplakia?

There are several different types of leukoplakia:⁵

• Homogenous Leukoplakia – All white lesions with no red mixed in. Homogenous Leukoplakia has a very low risk of oral cancer or mouth cancer and the cells in a homogenous lesion rarely are pre-cancerous.

• Non-Homogenous Leukoplakia – A mixture of white and red lesions with an uneven texture. The red patches have a greater risk of being pre-cancerous or becoming cancerous if they are not treated.

• Proliferative Verrucous Leukoplakia – This variant of leukoplakia is rare and usually occurs only in older women. In this variant the lesions are found all over the mouth instead of in limited areas like the cheek and tongue, which can cause tongue cancer as well as oral cancer.

• Hairy Leukoplakia – With this type of leukoplakia the lesions have a folded or ridged appearance with thin hair like filaments growing from the lesion. 

What are the symptoms of leukoplakia?

Leukoplakia symptoms can be similar to the symptoms of other disorders. The primary symptom of leukoplakia is white patches in the mouth, especially inside the cheek or on the tongue, that are raised or have a hardened texture. These patches or lesions are usually painless, and people often don’t realize the patches are there until they are pronounced. There also may be red scaly patches, or a mix of rough red and white raised bumps in the mouth. The distinguishing characteristics of these white or red and white patches are that they have a textured appearance and that they don’t disappear when the mouth is rinsed or scraped with an appropriate dental tool. It’s impossible to tell by sight if the patches are Leukoplakia or another condition like oral thrush. A doctor will need to test the patches to determine what is causing them.⁶

Leukoplakia vs. oral thrush

Leukoplakia can be mistaken for oral thrush or vice versa because the primary symptom for both conditions is white patches on the tongue and in the mouth. Oral thrush is an overgrowth of the candida fungus that is naturally found in the mouth and skin. It’s a fungal infection that is relatively easy to treat and is not pre-cancerous. People who have dentures, people with diabetes, and people with HIV/AIDS often have bouts of thrush that can be cleared up with medication.⁷

To determine if the white patches in your mouth are due to leukoplakia or oral thrush, a doctor will need to remove or swab one of the lesions in your mouth and have it tested. 

What causes leukoplakia?

There are both behavioral and genetic factors that can cause someone to develop leukoplakia. A person with a weakened immune system, like someone who has a chronic autoimmune disorder or someone who has HIV/AIDS, is more likely to develop leukoplakia. Someone with a family history of cancer, specifically oral cancer or tongue cancer, has a higher chance of coming down with leukoplakia.

But the primary causes of leukoplakia are excessive use of tobacco through smoking or chewing and excessive use of alcohol.⁸

Diagnosing leukoplakia

Before giving a diagnosis of leukoplakia, a doctor will attempt to wipe off or remove the lesions in your mouth. If the lesions won’t wipe off and a dental tool won’t remove them, then the doctor may take a swab of the patch to see if the material is fungal. If it’s fungal, the doctor will prescribe medication to treat oral thrush.⁹

However, if the lesion isn’t due to thrush, or if the lesion is red and white instead of just white, the doctor will need to do a biopsy to check for pre-cancerous or cancerous cells.

Leukoplakia and oral cancer

Leukoplakia is one of the best indicators of oral cancer. Getting a diagnosis of leukoplakia early enough to prevent oral cancer could make it much easier to avoid oral cancer altogether. It can also mean catching oral cancer early enough that it can be treated before it does any major damage or spreads through the body. That’s why it’s important to see your doctor as soon as you notice that there are white patches in your mouth that won’t go away.¹⁰

Treating leukoplakia

If the lesions from leukoplakia are not cancerous, they can be removed with a laser or surgically if necessary, but often they will improve on their own when the source of the irritation that is causing them disappears.¹¹ Regular follow up visits with your doctor will be necessary to make sure they don’t come back.

Preventing leukoplakia

The best way to prevent leukoplakia is not smoke, chew, or use any tobacco products and reduce alcohol consumption. 

Regular dental checkups are important because often a dentist or hygienist is the first person to notice white or white and red patches in your mouth and on your tongue. And your dentist or hygienist can pinpoint how long they have been there if you are seeing the dentist on a regular basis.¹²

Leukoplakia and dental insurance

If you don’t have dental insurance the cost of regular dental visits can add up, even just for routine exams and cleanings. Investing in dental insurance is the smart way to make sure that you are getting the oral care that you need.

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Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice. This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.