Leukoplakia: Causes, Clinical Features, and Treatment Options for Oral White Patches

Oral Cavity, Lip, And Palate

Question.1. Write note on leukoplakia.

Or

Write briefly leukoplakia.
Or
Answer briefly on leukoplakia.
Or

Write in brief about leukoplakia.

Answer. Leukoplakia is defined as a white patch or plaque that cannot be characterized clinically or pathologically as any other disease and is not associated with any physical or chemical causative agent except use of tobacco.
First International Conference on Oral Leukoplakia Malmo, Sweden (1984) or modified WHO definition (1984).

Leukoplakia Etiology

1. Tobacco: Tobacco is widely used in two forms

• Smokeless tobacco: Chewable tobacco and snuff When tobacco is chewed, various chemical constituents leach out such as nitrosonornicotine, nicotine, pyridine and N picoline.
  Alkaline ph: 8.2–9.3 acts as local irritants and leads to alterations of mucosa.
• Smoked tobacco: Cigar, cigarette, beedi and pipe.
  Smoking tobacco is harmful as this smoke contains polycyclic hydrocarbons, beta naphthylamine,nitrosoamines, carbon monoxide, nicotine, all of which acts as source of irritation.
  Heat also plays a major role.
  Heat induces alterations in tissues increasing reddening and stippling of mucosal surface.

Read And Learn More: General Surgery Question And Answers

2. Alcohol: Whether the use of alcohol itself is an independent etiological factor in the development of leukoplakia is still questionable.
Its effect, at best may be synergistic to other well-known etiological factors (physical irritants).
Alcohol leads to irritation and burning sensation of oral mucosa.
Alcohol facilitates entry of carcinogen in exposed cells of oral mucosa and alters the oral epithelium as well as its metabolism.

3. Chronic irritation: Continuous trauma or local irritation in the oral cavity leads to leukoplakia. Irritation or trauma can be caused by malocclusion, ill-fitting dentures, sharp tooth or broken tooth, hot spicy food and root piece.

4. Candida albicans: As a possible etiological factor in leukoplakia and its possible role in malignant transformation is still unclear.
About 10% of oral leukoplakias satisfy the clinical and histological criteria for chronic hyperplastic candidiasis.

5. Viruses: The possible contributory role of viral agents such as human papillomavirus 16 and 18 in the pathogenesis of oral leukoplakia particularly with regard to exophytic verrucous leukoplakia.

6. Vitamin deficiency: Serum levels of vitamin A, B12, C, beta-carotene and folic acid were significantly decreased in patients with oral leukoplakia than compared to normal patients.

7. Genetic factor: Relatively little is known yet with regard to possible genetic factors in the development of leukoplakia.

Leukoplakia Clinical Features

• Usually, the lesion occurs in 4th, 5th, 6th and 7th decades of life.
• Buccal mucosa and commissural areas are most frequent affcted sites followed by alveolar ridge, tongue, lip, hard and soft palate, etc.
• Oral leukoplakia often present solitary or multiple white patches.
• The size of lesion may vary from small well localized patch measuring few millimeters in diameter.
• The surface of lesion may be smooth or fiely wrinkled or even rough on palpation and lesion cannot be removed by scrapping.
• The lesion is whitish or grayish or in some cases, it is brownish yellow in color due to heavy use of tobacco.
• Inmostofthe cases, these lesionare asymptomatic, however in some cases, they may cause pain, feeling of thickness and burning sensation, etc.

Leukoplakia Differential Diagnosis

• Lichen planus: Shows Wickham’s straie
• Syphilis: Split papule or condyloma latum is seen
• Leukoedema: Shows faint milky appearance with folded and wrinkled pattrn. Most commonly seen on buccal mucosa.

Leukoplakia Treatment

Removal of etiological factors may lead to the reversal or elimination of disease.

Leukoplakia Conservative treatment

• Vitamin therapy is given to patient. Vitamin A should be given to apply topically.
• Along with vitaminA, vitamin E should be given this leads to inhibit metabolic degeneration.
• Nystatin therapy is given to eliminate candidal infection.
• Vitamin B complex can be given as supplemental therapy.

Leukoplakia Surgical treatment

Leukoplakia Conventional Surgery

• Incision is made around the lesion including the safe margins.
• Incision is deep and wide.
• Affected area is undermined and is dissected from underlying tissue.
• Sliding mucosal flp should be prepared for covering the wound.
• Fine iris scissors and skin hook is used for decreasing trauma.
• Extensive undermining of mucosal flp should be carried out so that when flp is advanced into its position, amount of tension will be minimum.
• As mobilization of mucosal flap is completed, it is advanced and free edges are approximated by multiple interrupted silk sutures.

Leukoplakia Fulguration

It is a technique in which there is destruction of tissues by high voltage electric current and the action is controlled by movable electrode.
This is done by electrocautery and electrosurgery.

Leukoplakia Laser

Laser peel: It is used to remove the lesion which involves relatively large surface area.

Leukoplakia Procedure

• Beam of laser is highly defocussed and should be kept at distant from the tissue.
• Initially, not any effct is seen on the tissue plane.
• Beam of laser should be gradually brought closer in focus,but remains in defocussed mode until tissue have white appearance and it begins to blister.
• Blistering usually occur at the basement membrane.
• The technique is extended over the rest of the lesion to be peeled.
• White area is then grafted with tissue forcep or hemostat.