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Leukoplakia, Oral

Leukoplakia, Oral is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Oral leukoplakia is a white plaque or patches on the oral mucosa, generally precancerous.
  • System(s) affected: gastrointestinal
  • Hyperplasia of squamous epithelium

Epidemiology

  • Develops in middle age, increases with age
  • Most common in India, where more people smoke and chew tobacco and areca nuts

Prevalence
  • 0.1–0.5% of the adult population is affected.
  • Usual age of onset is >40 years old with peak in the 60s.
  • Males twice as often as females

Geriatric Considerations
Malignant transformation to carcinoma is more common in older patients.

Etiology and Pathophysiology

Hyperkeratosis or dyskeratosis of the oral squamous epithelium

  • Tobacco use in any form
  • Alcohol consumption/alcoholism
  • Periodontitis
  • Candida albicans infection may induce dysplasia and increase malignant transformation.
  • Human papillomavirus, types 16 and 18
  • Sunlight
  • Vitamin deficiency
  • Syphilis
  • Dental restorations/prosthetic appliances
  • Estrogen therapy
  • Chronic trauma or irritation
  • Epstein-Barr virus (oral hairy leukoplakia)
  • Areca nut/betel (Asian populations)
  • Mouthwash preparations and toothpaste containing the herbal root extract sanguinaria
Genetics
  • Dyskeratosis congenital and epidermolysis bullosa increase the likelihood of oral malignancy.
  • P53 overexpression, PTEN allelic loss correlates with leukoplakia and particularly squamous cell carcinoma.

Risk Factors

  • 70–90% of oral leukoplakia is related to tobacco, particularly smokeless tobacco or areca/betel nut use.
  • Similar to risk factors for squamous cell carcinoma
  • Alcohol increases risk 1.5-fold.
  • Repeated or chronic mechanical trauma from dental appliances or cheek biting
  • Chemical irritation to oral regions
  • Diabetes
  • Age
  • Socioeconomic status
  • Risk factors for malignant transformation of leukoplakia
    • Female
    • Long duration of leukoplakia
    • Nonsmoker (idiopathic leukoplakia)
    • Located on tongue or floor of mouth
    • Size >200 mm2
    • Nonhomogenous type
    • Presence of epithelial dysplasia

General Prevention

  • Avoid tobacco of any kind, alcohol, habitual cheek biting, tongue chewing.
  • Use well-fitting dental prosthesis.
  • Regular dental check-ups to avoid bad restorations
  • Diet rich in fresh fruits and vegetables may help to prevent cancer.
  • HPV vaccination may be preventive.

Commonly Associated Conditions

  • HIV infection is closely associated with hairy leukoplakia.
  • Erythroplakia in association with leukoplakia, “speckled leukoplakia,” or erythroleukoplakia is a marker for underlying dysplasia.
  • 1–20% of lesions will progress to carcinoma within 10 years.

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Citation

Stephens, Mark B., et al., editors. "Leukoplakia, Oral." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116350/all/Leukoplakia__Oral.
Leukoplakia, Oral. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116350/all/Leukoplakia__Oral. Accessed April 25, 2019.
Leukoplakia, Oral. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116350/all/Leukoplakia__Oral
Leukoplakia, Oral [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 25]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116350/all/Leukoplakia__Oral.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Leukoplakia, Oral ID - 116350 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116350/all/Leukoplakia__Oral PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -