Leukoplakia: white patches in the mouth, causes and treatment

The NHS says treatment for leukoplakia is not always needed, but you will have regular check-ups to make sure the patch is not getting bigger. The patch may get smaller or go away if you stop smoking, stop drinking alcohol or reduce the amount you drink, and do not chew tobacco, paan or betel nuts.

Oral Health Foundation says many patches improve without treatment once the cause is removed, including by fixing sharp teeth or adjusting dentures.

The NHS says surgery is sometimes used to remove patches if there is a chance they could become cancerous. This may be done after numbing the area with local anaesthetic, or sometimes under general anaesthetic. The patch can be removed with a laser or surgical scalpel, and the mouth should heal quickly afterwards. Oral Health Foundation also mentions minor surgery and freezing treatment.

The NHS says leukoplakia patches are white, usually not painful, an irregular shape, and may be slightly raised or have red areas within the patch. The key feature is that they cannot be rubbed or scraped away. Patches that can be removed could be oral thrush.

Oral Health Foundation describes patches that are often white or grey, thick or hard, slightly raised and rough in texture. A type called hairy leukoplakia may look fuzzy or hair-like.

Leukoplakia is the name for white patches inside the mouth. They can appear anywhere in the mouth but are most often found on or under the tongue, inside the cheeks and on the gums.

The NHS says there are several types. Oral Health Foundation says most patches are not dangerous and may go away once the irritation is removed, but that having leukoplakia can increase your risk of oral cancer, especially if you smoke or drink heavily.

The NHS says the exact cause is not known, but smoking and chewing tobacco are thought to increase the chance of getting it. Oral Health Foundation says it is strongly linked to mouth irritation and lists smoking or using tobacco, drinking a lot of alcohol, biting the inside of the cheek, sharp or rough teeth, poorly fitting dentures and long-term inflammation.

Oral Health Foundation says some studies have looked at a possible link with HPV (human papillomavirus), but there is not enough strong evidence yet.

The NHS says a dentist or GP will look at the patches and rule out other possible causes, such as oral thrush or cheek biting. You may be referred to a specialist for a biopsy, where a small piece of the patch is removed and checked for abnormal cells.

Oral Health Foundation says a biopsy helps check for oral cancer and other infections or conditions, and that a patch that looks unusual may need one.

Leukoplakia is not itself cancer. The NHS says there is a small chance it could progress to mouth cancer over time, and the NHS lists having leukoplakia among the things that may make mouth cancer more likely.

The NHS mouth cancer symptoms page lists a red or white patch inside the mouth, a mouth ulcer that lasts more than 3 weeks, a lump, pain, difficulty swallowing or speaking, a hoarse voice that does not go away and a lump in the neck as reasons to see a GP or dentist. Hairy leukoplakia is different: the NHS says it does not carry a risk of mouth cancer.

The NHS says hairy leukoplakia is caused by the Epstein-Barr virus, which also causes glandular fever, and is more likely if you have a weakened immune system, for example with HIV or after an organ transplant. It causes fuzzy white patches, often on the sides of the tongue, that look folded or ridged, are not painful and cannot be brushed or scraped away.

Antiviral medicines, or treatments put on the patch, are sometimes used. The NHS says see a dentist or GP for a white patch on the tongue if you have a weakened immune system.

The NHS says to see a dentist or GP if you have a white patch in your mouth that does not go away, a white patch on your tongue and a weakened immune system, or pain or discomfort in your mouth that is not going away.

Oral Health Foundation suggests seeking help if a white or grey patch lasts more than two weeks, becomes sore or changes in appearance, or if you have mixed red and white patches.

The NHS says you can lower your chances of leukoplakia and mouth cancer by taking care of your teeth and gums, having regular dental check-ups, making sure dentures fit properly, eating a balanced diet with plenty of fresh fruit and vegetables, not smoking, not chewing tobacco, paan or betel nuts, and staying within 14 units of alcohol a week.

You can usually start with an NHS or private dentist, or with your GP. If a patch looks suspicious you may be referred to a hospital oral medicine, oral surgery or ear, nose and throat service for examination and biopsy.

Private dental and oral surgery services can also assess patches and take biopsies. Ask how results will be given to you and who will arrange ongoing monitoring, since leukoplakia is normally followed up with regular checks over time.