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- Oral leukoplakia is a white plaque or patches on the oral mucosa, generally precancerous.
- System(s) affected: gastrointestinal
- Hyperplasia of squamous epithelium
- Develops in middle age, increases with age
- Most common in India, where more people smoke and chew tobacco and areca nuts
- 1–3% of the worldwide population is affected (1).
- Age of onset is >40 years old with peak in the 60s (1).
- Males 3 times more likely to be affected as females (1)
- Smokers 6 times more likely to be affected than nonsmokers (1)
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
- Candida albicans infection may induce dysplasia and increase malignant transformation.
- Human papillomavirus, types 16 and 18
- Vitamin deficiency
- 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
- Dyskeratosis congenital and epidermolysis bullosa increase the likelihood of oral malignancy.
- P53 overexpression, PTEN allelic loss correlates with leukoplakia and particularly squamous cell carcinoma.
- 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
- Socioeconomic status
- Risk factors for malignant transformation of leukoplakia
- Long duration of leukoplakia
- Nonsmoker (idiopathic leukoplakia)
- Located on tongue or floor of mouth
- Size >200 mm2
- Nonhomogenous type
- Presence of epithelial dysplasia
- 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.