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
  • 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)

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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