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Peeling off of oral mucosal lining spontaneously is a condition which is termed as oral epitheliolysis in medical terminology. This is harmless in most instances but can be quite alarming for the patient.

In a clinical setting, epithelial peeling is seen as superficial plaques or dots, which are painless, and can be easily lifted from the lining covering the inside of the mouth. The lesions disappear spontaneously when the incriminating factor is removed. The diagnosis is made solely on the basis of history and clinical features.

Let us look at some of the common causes of epitheliolysis:

  • Volatile acids present in toothpastes and mouthwashes: One of the most common causes of peeling or sloughing off of the buccal mucosa is the use of toothpaste or a mouth wash which may be containing some ingredient that does not suit the user. The non-active ingredients, like the carrier base or the flavorings, are the common culprits. Certain toothpastes, especially the organic ones, contain wintergreen, cinnamon and peppermint, which are volatile acids. Frequent contact of these acids with the buccal mucosa may cause contact dermatitis which, in turn, may lead to peeling off of the oral mucosa.
  • Sodium Lauryl Sulfate (SLS): Sodium lauryl sulfate is a type of surfactant used in almost 99% of the toothpastes. It basically acts as a foaming agent. However, certain people may be sensitive to it and using toothpastes containing sodium lauryl sulfate may cause contact irritation. This may cause superficial desquamation of the buccal mucosa or epitheliolysis. In case you are sensitive to SLS, ask your dentist to recommend you SLS-free toothpaste.
  • Alcohol present in mouthwash: Mouthwashes often contain a high percentage of alcohol in order to deal with gingivitis. However, when kept in mouth for a prolonged time, this alcohol may lead to a chemical burn which may cause the oral mucosa to peel off. One should avoid using mouthwashes which contain a high percentage of alcohol. If, however, you have been advised to use a mouthwash by your dentist, take care not to keep it in your mouth for more than 30 seconds.
  • Smoking: Although most of the people associate smoking with heart disease and lung cancer, oral cancer is an important disease which is associated with smoking. Both smoking and chewing tobacco containing products can lead to oral keratosis, a condition in which patches of buccal mucosa turn white and ultimately peel off.

White lesions of the oral mucosa are also seen in conditions like:

  • Lichen planus: It is a chronic inflammatory disease of the oral mucosa characterized by white papules which coalesce to form lines called as Wickman's striae. Middle aged women are commonly affected. Prognosis is usually good and the condition responds well to topical steroids.
  • Candidiasis: It is the most common oral fungal infection caused by Candida albicans. Poor oral hygiene, ill-fitting dentures, mouthwashes containing antibiotics, iron deficiency anemia, HIV infection and broad spectrum antibiotics, steroids or immuno-suppressive drugs may all lead to candidiasis. Creamy white, slightly elevated lesions, which can be easily removed, are seen on the oral mucosa, tongue, soft palate and lips. Candidiasis is often accompanied with Xerostomia, or a burning sensation in the mouth.

If switching your toothpaste or mouthwash isn't providing any respite from the peeling off of the buccal mucosa, then you should consult your doctor to rule out other oral diseases.

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