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Unidentified white patches inside the mouth are usually detected during a routine visit to the dentist. Under most circumstances these patches are asymptomatic and, in fact, nothing to worry about. In a small percentage of cases, though, these patches signify pre-cancerous changes and serve as a warning of further more damaging consequences.
The medical term used to signify these white patches is leukoplakia. This Greek word literally translates as "white patch". The reasons behind the appearance of these white patches can be many. Here are some of the most common ones.
Smoking is by far the most likely external cause for the development of leukoplakia. Every time cigarette smoke is inhaled in the mouth it causes damage, both through its chemical constituents and through the physical heat produced.
In normal conditions the membrane inside the mouth is pink and the topmost layer of this membrane is almost colorless. As a response to the repeated insults, the membrane is being subjected to, it starts to proliferate and start becoming thicker.
This process of thickening is called keratinization and is accompanied by a change in color, appearing clinically as whitish discolorations.
In the case of cigarette smoking, these changes are not limited to the top layer of the membrane only and in fact, affect all the layers from top to bottom. There is an increase in the number of errors in cell multiplication and even mutations that take place at the genetic level.
All of these changes add up to a diagnosis of pre-cancer. Not all patients with pre-cancerous lesions will develop cancer, however, the chances of doing so are quite high.
The most common areas where leukoplakic patches are found in the mouth are the insides of the cheek and the palate. Other symptoms associated with the development of these patches include a burning sensation on eating anything spicy, a reduced mouth opening (also called oral submucous fibrosis) and altered taste sensation.
Of all the causes being discussed, chronic trauma from an improperly erupting tooth, a pointed edge or a poorly adjusted prosthesis is likely to be the most common reason for the development of leukoplakia.
It is important to keep in mind that, even though recurrent trauma will end up being a non-threatening form of leukoplakia in most cases, it is not always the case. For this reason, no factor causing repeated injury is left unattended inside the mouth.
Typically the white lesions will be along the level at which the teeth meet each other. Frequent complaints of ulceration, pain, and even bleeding are associated with recurrent trauma as well.
Squamous cell carcinoma, which is a pretty aggressive kind of cancer, has shown to have a higher chance of occurrence in areas subjected to repeated trauma.
If patients do not exhibit any symptoms apart from the presence of a white patch, then the dentist may not decide to investigate it further and just lay out the steps to correct the chronic trauma while marking the leukoplakic patch as something to be kept under observation on subsequent visits.