White lesions in the mouth are common and can cause concern. These spots or patches arise from various factors, from minor irritations to conditions needing medical evaluation. While many are benign and resolve on their own, understanding their origins helps determine when professional attention is needed. This article explores common causes, characteristics, and implications of these lesions.
Common Benign Causes of White Lesions
One frequent cause of white patches in the mouth is oral thrush, also known as oral candidiasis. This fungal infection typically presents as creamy white, cottage cheese-like lesions on the tongue, inner cheeks, roof of the mouth, and sometimes the tonsils or back of the throat. These patches may be gently scraped off, often revealing red, tender tissue underneath. Oral thrush is more prevalent in infants, individuals who wear dentures, those with compromised immune systems, or people who have recently completed a course of antibiotics.
Canker sores, medically termed aphthous ulcers, are another common source of oral discomfort presenting with a white appearance. These small, round or oval ulcers feature a white or yellowish center surrounded by a distinct red border. Canker sores are typically painful, particularly when eating or speaking, but they are not contagious and usually heal spontaneously within one to three weeks.
Frictional keratosis and linea alba represent responses to chronic mechanical irritation within the mouth. Frictional keratosis appears as a white, thickened patch on the mucous membrane, similar to a callus on the skin, forming in response to persistent rubbing or friction from rough teeth, dental appliances, or habitual cheek biting. Linea alba is a specific type of frictional keratosis, characterized by a harmless white line that runs along the inside of the cheek at the level where the upper and lower teeth meet, caused by biting or sucking on the cheek.
Oral lichen planus is an inflammatory condition that can manifest as white, lacy, web-like patterns on the inside of the cheeks, known as Wickham’s striae. It can also appear as red, swollen patches or open sores. The exact cause of oral lichen planus is often unknown, though it is thought to involve an abnormal immune response. This condition may cause discomfort or burning sensations, particularly with certain foods.
Potentially Precancerous Oral Lesions
Leukoplakia is a white lesion that needs attention due to its potential for malignant transformation. It is characterized by thick, white or grayish patches on the tongue, gums, or inside of the cheeks that cannot be easily scraped off. While many leukoplakia patches are benign, a small percentage may show dysplastic changes, meaning they contain abnormal cells that could eventually become cancerous.
A precancerous lesion has the potential to develop into cancer over time, but is not cancerous at the current stage. Regular monitoring is advised. The primary risk factors associated with the development of leukoplakia include chronic irritation from tobacco use, both smoking and smokeless forms, and heavy alcohol consumption.
When to Consult a Doctor or Dentist
Professional evaluation is recommended if a white lesion in the mouth persists or exhibits concerning characteristics. Consult a doctor or dentist if:
A lesion does not heal within two weeks.
The lesion progressively increases in size.
It is accompanied by pain, bleeds easily, or has a rough or irregular texture.
You experience difficulty chewing, swallowing, or moving the tongue.
There is a persistent lump in the neck or unexplained, ongoing hoarseness alongside the oral lesion.
The Diagnostic and Treatment Process
When evaluating a white lesion, a doctor or dentist begins with a visual examination, assessing its size, location, texture, and other characteristics. They also review the patient’s medical and dental history, including lifestyle habits like tobacco and alcohol use. In many cases, a definitive diagnosis requires a biopsy, which involves taking a small tissue sample from the lesion for microscopic analysis in a laboratory.
Treatment depends on the diagnosis. For instance, oral thrush is commonly treated with antifungal medications, which may be prescribed as lozenges, liquids, or pills. Oral lichen planus, an inflammatory condition, might be managed with topical corticosteroids. Lesions like frictional keratosis often resolve once the source of irritation is removed.
In cases of leukoplakia, particularly those showing abnormal cell changes, treatment options can range from careful monitoring with regular follow-up visits to surgical removal of the patch. The approach is tailored to the specific findings from the biopsy and the patient’s individual risk factors.