What Is That White Patch Inside Your Mouth?

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.

Cigarette Smoking

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.

Recurrent Trauma

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.

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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.

Other Causes For White Patches In The Mouth And Their Management

Fungal Infection

A certain kind of fungal infection called candidiasis can also be responsible for the development of white patches inside the mouth. The fungus in question is present in a large majority of individuals without causing any harm whatsoever. When it does find conditions that are suited to it, though, it starts to populate quickly and can take over large parts of the mouth.

Such an infection is called an opportunistic infection. A reduced immunity level as seen in illness and immunosuppressive diseases like HIV or even old age is perfect for the fungus to grow unchecked. Candidal infections are also seen in some individuals who are on long-term steroid therapy or strong antibiotics.

This infection is also commonly known as oral thrush and is quite easily treatable. Its presence, however, should alert the doctor to the possible presence of a deeper underlying systemic disease.

The kind of white patches that appear in candidiasis are also different from those in other conditions since they are easily scrapeable. A soft wet cloth can be used to remove most of the white patches which are almost curd-like in their appearance and texture.

Lichen Planus

Lichen planus is a disease that has many different clinical presentations and can have lesions all over the body. In some cases, these lesions are present only in the mouth and nowhere else. Such a conditions is also called oral lichen planus.

The defining clinical characteristic is the formation of whitish striations that seem to radiate outwards from a central point, almost like spokes of a wheel.

A weak link has been established between lichen planus and the further development of oral cancer. Lichen Planus is an autoimmune condition so there are no real causative factors to be discussed here and nor is it completely treatable. It can only be managed.

The use of topical and systemic steroids is a good option to help manage the symptoms which may include a burning sensation, ulceration, peeling away of the oral mucosa and pain.

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Management Of White Lesions Of The Oral Cavity

Each of these common conditions has their own particular causative factors which need to be treated first. Once the offending habit, tooth, or prosthesis has been taken care of, the clinical symptoms need to be evaluated.

The doctor will most likely ask for a biopsy to confirm the clinical diagnosis since the symptoms and appearance can be very similar to each other. The process of taking a biopsy is not very difficult and is done under local anesthesia. It involves taking a small piece of affected tissue with a small margin of normal tissue.

The treatment offered is a combination of topical ointments and systemic drugs and includes the use of antioxidants, vitamin supplements, placental extracts, pain reducing ointments and steroids. A lifestyle change to cut out smoking, alcohol and even spicy food is recommended.

Long-term periodic observation to ensure no further changes are taking place forms an integral part of the treatment plan.