Leukoplakia

What is leukoplakia?

White patch or plaque that cannot be characteristized clinically or pathologically as any other disease and is not associated with any other physical or chemical causative agent except the use of tabacoo.

Predisposing factors :-

1.Tabacoo:-tabacoo end products associated with heat irritation to oral mucous membrane.

2.Alcohol:Alcohol leads to enter to carcinogen into exposed cells n thus alters oral epithelium and its metabolism.

3.candidias 

4.hereditary deficiency :vitamin A deficiency causes metalplasia and hyperkertinization.

5.syphilis 

6.hormonal imbalance :dysfunction of male and female sex hormones leads to keratogenic changes in oral epithelium and thus leads to leukoplakia.

Staging system :

Stage 1 :L1P0

Stage 2:L2P0

Stage 3:L3P0 or L1L2P1

Stage 4:L3P1

Clinical features 

Age :4th 5th 6th 7th decade of life 

Sex:more often in males 

Site:buccal mucosa and commisure areas 

Leukoplakia is often present as solitary or multiple white patches. 

Size of lesion:well localised patch measuring few millimeters in diameter. 

May cause pain, feeling of thickness and burning sensation. 

Symptoms :Thickened, white patches form on the gums, the insides of the cheeks, the bottom of the mouth and, sometimes, the tongue. The patches can't be scraped off.

What are the types of leukoplakia?

There are two main types of leukoplakia:

• Homogenous: A mostly white, evenly colored thin patch that may have a smooth, wrinkled, or ridged surface that is consistent throughout.
• Non-homogenous: A mainly white or white-and-red, irregularly shaped patch that may be flat, nodular (having protrusions), or verrucous (elevated). Additional sub-classifications, such as ulcerated and nodular (speckled), may also be made, and can help predict the likelihood that a patch will become cancerous.

Non-homogenous leukoplakia is seven times more likely to become cancerous than the homogenous type.

Proliferative verrucous leukoplakia(PVL) (also called florid papillomatosis) is a rare but especially aggressive form of oral leukoplakia. Studies show it is strongly associated with the presence of Epstein-Barr virus, a type of herpes virus. Nearly all cases will eventually become cancerous at a number of different sites. PVL is usually diagnosed late in the development of leukoplakia, as it takes time to spread to multiple sites. It also has a high rate of recurrence.

There is also a condition called oral hairy leukoplakia, which also happens as a result of having the Epstein-Barr virus, which stays in your body throughout your life. People with weak immune systems, like people with HIV/AIDS, can develop oral hairy leukoplakia. This condition looks like its name—white hairy patches, often with folds so it looks like hair is growing out of the folds. These spots mostly happen on the tongue, but might be found in other parts of the mouth. Oral hairy leukoplakia doesn’t become cancer, but if you have it, you will probably want to talk to your provider about checking for HIV/AIDS.

What is the prognosis (outlook) for patients who have leukoplakia?

Anyone who has leukoplakia should follow up with a doctor every three to six months, with biopsies as needed, to watch for possible changes in the condition.

Even if patches are surgically removed, an examination every six to 12 months is recommended, because leukoplakia frequently returns. Treatment sites that remain free of abnormalities for three years may not need to be observed any more.

If leukoplakia returns after treatment, you should continue to have follow-up examinations for as long as your healthcare provider recommends.