How common is leukoplakia?. 

by Kristina Okolisan-Mulligan, RDH, BS

	photo: Getty Images

Oral leukoplakia (leuko = white; plakia = patch) is defined by the World Health Organization (WHO) as, “a white patch or plaque on the oral mucosa that can neither be scraped off nor classified as any other diagnosable disease.”1 This is purely a clinical term used to denote a variety of white mucosal conditions that may produce a whiter than normal coloration of the mucous membranes.2 Knowing this, leukoplakia is a much abused term, often confused with a diagnosis.

It is not a true diagnosis because it does not represent any one disease; it is a description of a white patch or plaque of unknown origin, and is not associated with a specific histopathology diagnosis until a biopsy is obtained.
Misuse aside, leukoplakia is more common than you think, and when found, is typically considered to be a precancerous or premalignant lesion.3 About 85% of oral cancer starts as leukoplakia, making it by far the most common oral precancer, according to researchers. Unexplained white areas are seen in the mouth in as many as 3% of adults.3

Leukoplakia can be found in multiple areas of the mouth such as the buccal mucosa, floor of the mouth, labial mucosa, commissures, lateral borders of the tongue and alveolar ridges.

LED Dental’s VELscope uses a specialized filter technology to allow real-time detection of abnormal lesions. www.velscope.com
CDX Laboratories’ OralCDx brush biopsy is a simple chairside test used to identify oral lesions that may need further evaluation; accuracy levels are exceptionally high. www.oralcdx.com
Zila’s ViziLite Plus w/ TBlue630 uses chemiluminescent light technology and toluidine blue to detect and mark lesions. www.zila.com

A 40-year-old Caucasian female comes in for her 6-month recall. You have seen her for almost all prophy appointments during the past 10 years. She is in the medical field and understands the importance of maintaining good oral health. A complete medical history is updated and is unremarkable; she takes Motrin occasionally. Your patient does, however, mention that she has noticed a white growth on the side of her tongue, which has increased slightly in the past three weeks. She is negative toward smoking and drinking, and always has been. She claims to have “mild pain” with the lesion and avoids chewing on that side.

It is extremely important that each patient receive a thorough extra/intraoral exam where abnormalities or deviations from normal are detected. Many pathological conditions are first detected in the oral cavity. Therefore, performing an oral cancer screening is one of the most important things you can do for your patient.

In our example patient’s case, the extraoral examination revealed no obvious facial asymmetry or lymphadenopathy. There is no numbness or trismus, which are all good signs indicating that the lesion most probably is benign. A benign condition/lesion usually is nonulcerated, but may be elevated, soft, and movable with sharply demarcated borders; benign lesions usually have a direct cause and effect relationship.4 A malignancy may exhibit a change in speech, persistent cough, trouble swallowing, paraesthesia, spontaneous sharp or stabbing pain, and loss of motor function.

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