Dr. Sonia BhattBDS

May 22, 2020

May 22, 2020


According to the World Health Organization (WHO), tobacco kills around eight million people each year. It is a well-established fact that the consumption of tobacco in any form, smokeless or smoked, can create irreversible damage to the body—the most deadly being cancer.

However, before reaching that stage where the body develops cancer, it gives us many signs and symptoms which should not be ignored. For example, our oral cavity presents with precancerous lesions. If diagnosed early, these precancerous lesions can be completely reversed—taken back to normal in no time. One of the most common precancerous lesions seen in tobacco consumers is leukoplakia.

Leukoplakia is a white patch or plaque that is not associated clinically or pathologically with any underlying disease. It is not caused by any physical or chemical agents, but only due to the continuous use of tobacco. It is usually seen in men during adulthood. The lesion of leukoplakia is usually white in colour and does not scrape off on rubbing. It is painless and can be present anywhere in the oral cavity (mouth).

Though the main reason for leukoplakia is the use of tobacco, the risk factors include oral candidiasis (a fungal infection), radiation therapy, alcohol consumption and ill-fitted dentures (read more: artificial teeth). If the person visits their dental surgeon early enough, this lesion can be treated and reversed completely. If the person does not pay attention to the lesion in the primary stages, the lesion may become firm, speckled and would start bleeding, which is a sign of cancer.

Read more: White-coated tongue

After the diagnosis, the doctor may prescribe vitamin A and beta carotene supplements to reduce the size of your lesion. The more aggressive lesions and the suspected cancerous lesions would require surgical treatment. 

Read on to know more about leukoplakia.

Types of leukoplakia

There are four types of leukoplakia:

  • Homogenous leukoplakia: The patch appears uniformly white, muddy and is slightly raised from the surface. It is either present as a single patch or multiple patches. The lesion can appear as ulcerated, smooth or fissured (cracked).
  • Non-homogenous leukoplakia: The patch appears white and red in colour and is medically called erythroplakia. The lesion appears as a white nodule with a red base and shows proper markings.
  • Granular or nodular leukoplakia: The patch is completely white in colour but does not have a smooth base. The base is granular and nodes (speckles) may be present.
  • Verruciform leukoplakia: The patch is white in colour but has a deep cleft in it. The lesion grows outward beyond the base. It is the most aggressive form of leukoplakia. 

There is one other kind of leukoplakia called hairy leukoplakia, which is not associated with the use of tobacco. Hairy leukoplakia is caused due to the Epstein-Barr virus. It has been reported in people with a poor immune system. It looks like white towel-like patches on the sides of the tongue. The lesion appears folded and ridged.

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Leukoplakia symptoms

Leukoplakia is usually seen in the third or fifth decade of life and is more prevalent in men. The symptoms of leukoplakia are:

  • A white patch that can be present on the mucosa (inner side) of the cheeks, tongue, commissure (corner) of the lips or roof of the mouth.
  • The patch is slightly raised from the surface
  • The patch does not scrape off on rubbing
  • The lesion is painless
  • The patch can be a little red sometimes 

A person should immediately consult a doctor if any of the following happen:

  • The patch starts growing outwards
  • The patch gets hard and firm
  • Nodules start appearing on the patch
  • There is ulceration on or around the patch
  • There is bleeding from the patch

Leukoplakia causes

Leukoplakia usually occurs due to the consumption of tobacco. It is usually seen in people who chew and smoke various forms of tobacco. The other causes that can lead to leukoplakia are:

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Prevention of leukoplakia

You can prevent leukoplakia in the following ways:

  • Completely quit the use of both chewable and smoked tobacco, as it is the major cause of leukoplakia in people.
  • Reduce your alcohol consumption to prevent leukoplakia.
  • Brush your teeth regularly to keep the bad bacteria away from your mouth. (Read more: Oral hygiene tips)
  • Gently massage your gums with your fingers to keep them clean and also to help the blood circulation get better.
  • If you wear dentures, make sure that they are properly fitted. If not, then contact your dentist and get them fixed.
  • Eat a balanced diet rich in vitamin C, vitamin A and minerals to maintain the health of the oral cavity.
  • Visit your dentist every six months to make sure that your oral cavity is healthy.

Leukoplakia diagnosis

Leukoplakia can be diagnosed in the following ways:

  • Oral examination: Your dentist will be able to diagnose the lesion just by doing a regular oral examination. The doctor would take your detailed medical history and would ask about the duration and frequency of consuming tobacco.
  • Biopsy: If your doctor suspects that the patch may have cancerous cells, then they may recommend a biopsy of the patch.
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Leukoplakia treatment

The first step in treating leukoplakia would be to stop using tobacco. Recovery can only be seen if the person quits the habit.

Read more: How smoking affects your teeth, gums and mouth

The treatment of leukoplakia can be done in one of these ways:

  1. Drug treatment for leukoplakia
  2. Surgical treatment for leukoplakia

Drug treatment for leukoplakia

Drug treatment involves the following:

  • Retinoid supplements: Your doctor may recommend retinoid gels to apply on the lesion and capsules to reduce the lesion. However, the lesions may return once the patient stops taking the medicine.
  • Vitamin A and beta-carotene supplements: Vitamin A and beta-carotene supplements help in clearing the patch of leukoplakia. They are available in the form of capsules.
  • Isotretinoin supplements: These supplements can help in reducing the size of the leukoplakia more effectively than beta carotene.

Surgical treatment for leukoplakia

Surgical treatment is usually given to patients who do not respond to the drug treatment or have an aggressively large lesion of leukoplakia. The lesion is not removed using a conventional scalpel. The surgical treatments involve the following:

  • Laser treatment: The surgeon uses a carbon dioxide laser to remove the lesion. It is a bloodless surgery with faster healing time.
  • Cryosurgery: Cryosurgery is a method in which extremely cold temperature is used to destroy the targetted area. The liquid used in this procedure can be liquid nitrogen, carbon dioxide or argon.
  • Electrocauterization: Electrocauterization is a procedure in which the doctor used an electrically heated needle-like instrument to remove the lesion.


  1. World Health Organization [Internet]. Geneva (SUI): World Health Organization; Tobacco
  2. Cleveland Clinic. [Internet]. Cleveland, Ohio. Leukoplakia: Outlook / Prognosis
  3. National Health Service [Internet]. UK; Leukoplakia