Leukoplakia is a condition in which thick, white patches develop on the tongue, gums, inner cheek, or other areas inside the mouth. These patches are usually benign (non-cancerous), but in some cases, they may be precancerous and require further evaluation and treatment.

The exact cause of leukoplakia is not fully understood, but it is often associated with tobacco use, both smoking and smokeless tobacco. Other risk factors may include heavy alcohol use, poor oral hygiene, and irritation from ill-fitting dentures or other dental appliances.

Symptoms of leukoplakia may include white or grayish patches inside the mouth, a burning or itching sensation in the mouth, and difficulty swallowing. Diagnosis is typically made through a visual examination of the mouth, along with a biopsy of the affected tissue.

Treatment for leukoplakia depends on the severity of the condition and may include cessation of tobacco use, improvement of oral hygiene, and in some cases, removal of the affected tissue. In cases where the patches are found to be precancerous or cancerous, more aggressive treatment such as surgery, radiation therapy, or chemotherapy may be necessary.

Overall, the prognosis for leukoplakia varies depending on the extent of the lesions and the presence of any underlying precancerous or cancerous changes. Early detection and treatment are important for reducing the risk of progression to cancer.

Although the cause of leukoplakia is unknown, chronic irritation, such as from tobacco use, including smoking and chewing, appears to be responsible for most cases. Often, regular users of smokeless tobacco products eventually develop leukoplakia where they hold the tobacco against their cheeks.

Other causes may include chronic irritation from:

• Jagged, broken or sharp teeth rubbing on tongue surfaces
• Broken or ill-fitting dentures
• Long-term alcohol use

Your dentist can talk with you about what may be causing leukoplakia in your case.

Hairy leukoplakia

Hairy leukoplakia results from infection with the Epstein-Barr virus (EBV). Once you've been infected with EBV, the virus remains in your body for life. Normally, the virus is dormant, but if your immune system is weakened, especially from HIV/AIDS, the virus can become reactivated, leading to conditions such as hairy leukoplakia.

You may be able to prevent leukoplakia if you avoid all tobacco products or alcohol use. Talk to your doctor about methods to help you quit. If you continue to smoke or chew tobacco or drink alcohol, have frequent dental checkups. Oral cancers are usually painless until fairly advanced, so quitting tobacco and alcohol is a better prevention strategy.

Hairy leukoplakia

If you have a weakened immune system, you may not be able to prevent hairy leukoplakia, but identifying it early can help you receive appropriate treatment.

Leukoplakia treatment is most successful when a lesion is found and treated early, when it's small. Regular checkups are important, as is routinely inspecting your mouth for areas that don't look normal.

For most people, removing the source of irritation ― such as stopping tobacco or alcohol ― clears the condition.

When this isn't effective or if the lesions show early signs of cancer, the treatment plan may involve:

• Removal of leukoplakia patches. Patches may be removed using a scalpel, a laser or an extremely cold probe that freezes and destroys cancer cells (cryoprobe).
• Follow-up visits to check the area. Once you've had leukoplakia, recurrences are common.

Treating hairy leukoplakia

Usually, you don't need treatment for hairy leukoplakia. The condition often causes no symptoms and isn't likely to lead to mouth cancer.

If your doctor recommends treatment, it may include:

• Medication. You may take a pill that affects your whole system (systemic medication), such as antiviral medications. These medications can suppress the Epstein-Barr virus, the cause of hairy leukoplakia. Topical treatment may also be used.
• Follow-up visits. Once you stop treatment, the white patches of hairy leukoplakia may return. Your doctor may recommend regular follow-up visits to monitor changes to your mouth or ongoing therapy to prevent leukoplakia patches from returning.