Leukoplakia of Oral Mucosa: Causes

Pathogenesis (development of disease)

The clinical finding of predominantly white mucosal change correlates histopathologically with hyperkeratosis (increased keratinization) and dyskeratosis of the squamous epithelium. The white color results from swelling of the keratinized cells. Genetic mutations are assumed to be the cause of the dysplastic changes. The more pronounced the dysplasia (deviation of the tissue structure from the normal picture), the greater the probability of malignant (malignant) transformation. This is especially true for erythroplakia (sharply demarcated, red lesion of the mucosa).

Etiology (causes)

The etiology of leukoplakia of the oral mucosa is not fully understood. Smoked tobacco is thought to be the main factor. Alcohol is considered to be a cofactor, causing a permeability change in the oral epithelium and promoting the penetration of tobacco carcinogens into subepithelial compartments.

Nevertheless, the association is not present in all cases of disease: Idiopathic leukoplakia. Even in the aggressive course of proliferative verrucous leukoplakia, there are often no known risk factors.

In Candida-infected leukoplakia, it is unclear whether candidiasis is causative or whether it is a superinfection of the lukoplakic mucosa.

Biographic causes

• Genetic factors – under discussion
• Socioeconomic factors – low socioeconomic status.

Behavioral causes

• Nutrition
  • Poor dietary habits (malnutrition and malnutrition).
  • Vitamin deficiency (A, C) or risk group for folic acid deficiency.
• Consumption of stimulants
  • Tobacco
    • Smoking tobacco
    • Chewing tobacco
  • Alcohol
  • Arecanut (betel nut; betel chew)
• Oral hygiene
  • Insufficient
  • Insufficient use of dental checkups.
  • Indolence with regard to chronic traumatic irritation.
  • Different mouth rinses
• Psycho-social situation
  • Morsicatio (habitual cheek chewing).

Causes related to disease

• Candidiasis (oral thrush) [Candida-infected leukoplakia] in reduced general condition:
  • Antibiosis (antibiotic therapy).
  • Diabetes mellitus
  • Immunodeficiencies
• Epstein-Barr virus [oral hairy leukoplakia in AIDS]
• Human papillomavirus (HPV) under discussion; other viruses under discussion.
• Leukoplakia over protruding mucosal tumors (e.g., fibromas).
• Mechanical irritation due to malocclusion of the teeth

Other causes

• Galvanism (electrical mouth currents) – under discussion.
• Mechanical irritation due to
  • Defective teeth
  • Damaged restorations
  • Ill-fitting dentures/clasps