Leukoplakia of Oral Mucosa: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic and therapeutic steps.

Extraoral examination

  • Inspection
    • Facial asymmetries
    • Soft tissue swelling
    • Parafunctions (lip/cheek sucking or biting, etc.) [morsicatio (habitual cheek chewing)]
  • Palpation
    • Bimanual (symmetry comparison)
    • Lymph node
      • [accompanying inflammatory reactions; tumor activity]

Intraoral examination

  • Mucosa – changes on lips, cheeks, tongue, tongue edge, palate, floor of mouth:
    • Predominantly white, uniformly flat, thin, shallow furrows if any, surface smooth, wrinkled or wavy, texture largely consistent [homogeneous leukoplakia].
    • Predominantly white or white and red [erythroleukoplakia] with loss of surface integrity, irregularly flat, nodular/nodular [inhomogeneous leukoplakia]
    • Exophytic [verrucous leukoplakia]
    • Multifocal, extended, initially homogeneous, later exophytic [proliferative verrucous leukoplakia].
    • Erosions (superficial substance defects confined to the epidermis, without scarring) [erythroplakia (sharply circumscribed, red lesion of the mucosa); carcinoma in situ]
    • Ulceration (ulceration) [carcinoma in situ]
    • Induration indurations) [accompanying inflammatory reaction; carcinoma in situ]
    • Oral candidiasis [Candida-infected leukoplakia]
  • Dental findings (general dental findings).
    • Check for causes of mechanical irritation:
      • Sharp-edged teeth or restorations [mechanical-irritation-induced leukoplakia].
    • Oral hygiene situation:
      • Plaque infestation
      • Tartar supra- and subgingival (“above and below the gingival margin”).
      • Bleeding gums

Square brackets [ ] indicate possible pathological (pathological) physical findings.