Leukoplakia is a disease of the mucous membranes that is rarely encountered in Germany and manifests symptomatically by means of atypical white, nonwipeable changes in the affected cell tissue. Because of the high risk of degeneration, leukoplakia should be diagnosed and treated early.
What is leukoplakia?
Leukoplakia (also known as white callus disease) refers to nonwipeable, white changes in the mucosa. In this condition, the cells of the outermost mucosal layer become keratinized and swell due to the moist tissue environment, giving them a white coloration. Leukoplakia is most frequently found in the area of the oral mucosa, on the lips, palate and tongue (oral leukoplakia). Leukoplakia is divided into different stages. In homogeneous, simple leukoplakia, the affected tissue areas are regularly discolored and have a smooth, locally well-defined surface. In contrast, in warty (verrucous) leukoplakia, the surface is rough, while open (erosive) leukoplakia is characterized by an irregular boundary as well as red areas of mucus due to injury. Here, the affected cells, especially in the verrucous and erosive forms of leukoplakia, have an increased risk of degeneration and may progress to squamous cell carcinoma (malignant tumor of the skin and mucosa).
Causes
Leukoplakia is usually due to prolonged exogenous irritant effects. These irritant effects can be mechanical or physical in nature and can be caused by poorly fitted dentures, braces, as well as decayed teeth. In addition, leukoplakia can be caused by chemical noxae (pathogenic substances), especially nicotine and alcohol. Poor dental and oral hygiene, deficiency of vitamins A and B and iron also promote leukoplakia. In addition, leukoplakia is associated with genetic diseases such as dyskeratosis congenita (Zinsser-Cole-Engman syndrome) and Darier’s disease (disease with skin and mucous membrane changes), as well as acquired diseases such as lichen ruber (flat nodular lichen), the cutaneous form of lupus erythematosus (autoimmune disease). However, infectious diseases such as tertiary syphilis, HIV, or fungal diseases (Candida albicans) can also cause leukoplakia.
Symptoms, complaints, and signs
Leukoplakia does not usually cause definite symptoms. Therefore, the disease is usually discovered by the dentist during a routine examination. The medical professional diagnoses leukoplakia by the white spots on the mucosa that cannot be wiped off. The spots usually occur in large numbers and can be localized in various places on the mouth and lips. The external features provide information about the stage of the disease. The homogeneous form shows a whitish discoloration that is sharply demarcated. The surface is usually smooth and regular, but in individual cases small elevations appear at the edges. The inhomogeneous forms can be recognized by the rough, wart-like surface. In addition, pain, burning and other symptoms occur in the area of the mucosa. In the erosive subtype, red areas form in the oral cavity, which on closer inspection represent lesions of the mucosa. Erosive leukoplakias are blurred and painful to the touch. In the course of the disease, the spots multiply and also spread to the neighboring areas. This is accompanied by the development of a malignant tumor, which, if left untreated, can cause further discomfort and complications throughout the body.
Diagnosis and progression
Leukoplakia can usually already be diagnosed by the characteristic changes in the mucosa. Since in the vast majority of cases leukoplakia does not manifest itself with any other symptoms, the disease is often detected by chance during a check-up by the general practitioner or dentist. The diagnosis is confirmed by a sample excision (tissue removal) from the affected region followed by microscopic analysis, which may reveal the underlying disease (infection or hereditary disease). Leukoplakia is easily treatable with adequate therapy.However, if left untreated, advanced-stage leukoplakia has an increased risk of degeneration and may develop into squamous cell carcinoma (malignant tumor of skin and mucosal tissue), so atypical changes in the mucosal area should always be examined by a physician for possible leukoplakia.
Complications
As a rule, affected individuals suffer from white patches due to leukoplakia, which occur mainly on the mucous membranes. This results in aesthetic discomfort, especially on the face, around the mouth and lips. It is not uncommon for those affected to feel uncomfortable and suffer from inferiority complexes and lowered self-esteem. Furthermore, discomfort or pain in the teeth may also occur. In children, leukoplakia can therefore lead to bullying or teasing, so that psychological complaints or depression may develop. Furthermore, leukoplakia can also cause a tumor, which can lead to a reduction in the life expectancy of the affected person. The patient’s quality of life is significantly reduced by this complaint. Treatment of leukoplakia must begin early to prevent various complications. Therefore, early treatment by the dentist is necessary, especially in children. Usually, no complications occur and the complaints can be alleviated relatively well. The patient’s life expectancy is also not affected or reduced if treatment is successful.
When should you see a doctor?
When changes in the mucosa are noticed, a visit to the doctor is indicated. Whitish, conspicuously hardened areas on the lips or in the mouth indicate a serious condition such as leukoplakia and must therefore be examined without fail. In case of injuries of the mucous membrane, increasing pain and other symptoms, medical advice is required. People who wear dentures or braces or suffer from tooth decay do not always need to see a medical professional in case of leukoplakia. These types of growths often disappear on their own once the condition that caused them has been corrected. Smokers, alcoholics and generally unhealthy people belong to the risk groups for malignant leukoplakias and should immediately present described symptoms to a doctor. If the symptoms occur after a bacterial infection or a fungal infection, it is also necessary to see a family doctor. If the tumors degenerate, a doctor’s office should be consulted immediately. In particular, warty leukoplakia must be well observed and, if in doubt, medically clarified. If the mucosal changes recur, the physician must be informed. The same applies if accompanying symptoms such as numbness or pain in the area of the mucous membranes appear some time after recovery. The right medical professional is the dentist, dermatologist or an internist.
Treatment and therapy
Treatment of leukoplakia primarily targets the underlying causes. For example, an ill-fitting denture should be adjusted accordingly by the dentist, or decayed teeth should be treated. Likewise, any infectious diseases that cause the leukoplakia must be treated. Often, leukoplakia heals on its own within a few weeks after the causative factors have been eliminated. If this is not the case, the areas of the mucosa affected by leukoplakia are usually surgically removed in a minimally invasive procedure. The surgical techniques used here are electrocaustic ablation and a cryosurgical procedure. Within an electrocaustic ablation, the affected tissue areas are precisely heated and destroyed with the help of a small needle, loop or ball attached to the tip of a device operated with low current. Although postoperative pain may occur, which must be treated appropriately, the wound resulting from the procedure heals well within one to three weeks. In addition, tissue areas affected by leukoplakia can be destroyed by local icing during a cryosurgical procedure (physical destructive method, cryonecrosis) by cooling them to below -40 C° using liquid nitrogen.
Outlook and prognosis
The prognosis of leukoplakia depends on the presenting cause.If the dentures are not well fitted, in many cases freedom from complaints can be achieved by appropriate correction. Likewise, diseased teeth must be treated and, if necessary, removed. Without an improvement of the conditions in the area of the mouth, no relief of the complaints can be achieved. Medications can be administered for support, but clarification of the cause must take place in order to achieve permanent freedom from symptoms. Consumption of harmful substances must be completely refrained from in order to improve the prognosis. In addition, oral hygiene must be optimized and adapted to the needs of the human organism. Otherwise, the prognosis will worsen. If the patient has a chronic viral disease, the prognosis worsens. In the case of an infectious disease, long-term therapy is usually necessary, which triggers relief of the symptoms, but has no cure option. If the cause of the symptoms is due to a fungal disease, recovery can often be achieved. This depends on the present disease triggers as well as the general state of health of the affected person. The worse the body’s immune system is, the more difficult it is to treat against fungi. If an autoimmune disease is present, the prognosis is also unfavorable. In these patients, treatment is also aimed at alleviating symptoms.
Prevention
Leukoplakia can be prevented by avoiding the factors that trigger it. Risk factors for leukoplakia include nicotine and alcohol consumption, inadequate oral hygiene, and poorly fitted dentures and braces. Because the disease has a comparatively high recurrence (relapse) rate, those already affected by leukoplakia should have regular follow-up examinations.
Follow-up
Follow-up care of leukoplakia primarily includes preventive measures – especially in view of the high recurrence rate. These include careful and increased oral hygiene as well as regular visits to a dentist. It is also advisable to lead a healthy lifestyle with a balanced diet and to largely abstain from alcohol and nicotine consumption. Affected persons are well advised to pay a little more attention to dental care in general; if necessary, the attending physician can provide appropriate tips and advice to reduce the suffering.
What you can do yourself
In the case of leukoplakia, those affected can take various measures to support medical treatment. In general, the first step is to determine the cause of the symptoms. If the leukoplakia is due to caries, the decayed teeth must be extracted. This is a routine procedure, after which the affected person must not eat solid food for several hours to days. Accompanying the dental treatment, dental hygiene must be improved in order to reduce the risk of further complaints. If the leukoplakia has been triggered by chemical noxae such as nicotine or alcohol, the lifestyle must be changed. The triggering substances must be strictly avoided. In most cases, those affected must start therapy for this or turn to a self-help group. A causal vitamin or iron deficiency is easier to treat. In this case, it is sufficient to change the diet and supply the body with the necessary substances. If the illness is caused by a serious infectious disease such as HIV, syphilis or a fungal disease, the most important measure is to have it diagnosed and treated immediately. The patient can best aid recovery by following the physician’s instructions and informing the physician of any unusual symptoms.
