With leukoplakia (loo-koh-PLAY-key-uh), thickened, white patches form on your gums, the insides of your cheeks, the bottom of your mouth and, sometimes, your tongue. These patches can't be scraped off.

Doctors don't know what causes leukoplakia but consider chronic irritation from tobacco — whether smoked, dipped or chewed — to be the main culprit in its development.

Most leukoplakia patches are noncancerous (benign), though some show early signs of cancer. Cancers on the bottom of the mouth can occur next to areas of leukoplakia. And white areas mixed in with red areas (speckled leukoplakia) may indicate the potential for cancer. So it's best to see your dentist or primary care professional if you have unusual, persistent changes in your mouth.

A type of leukoplakia called hairy leukoplakia, sometimes called oral hairy leukoplakia, primarily affects people whose immune systems have been weakened by disease, especially HIV/AIDS.

Leukoplakia usually occurs on your gums, the insides of your cheeks, the bottom of your mouth — beneath the tongue — and, sometimes, your tongue. It isn't usually painful and may go unnoticed for a while.

Leukoplakia may appear:

• White or grayish in patches that can't be wiped away
• Irregular or flat-textured
• Thickened or hardened in areas
• Along with raised, red lesions (speckled leukoplakia or erythroplakia), which are more likely to show precancerous changes

Hairy leukoplakia

Hairy leukoplakia causes fuzzy, white patches that resemble folds or ridges, usually on the sides of your tongue. It's often mistaken for oral thrush, an infection marked by creamy white patches that can be wiped away, which is also common in people with a weakened immune system.

When to see a doctor

Even though leukoplakia doesn't usually cause discomfort, sometimes it can indicate a more serious condition.

See your dentist or primary care professional if you have any of the following:

• White plaques or sores in your mouth that don't heal on their own within two weeks
• Lumps or white, red or dark patches in your mouth
• Persistent changes in the tissues of your mouth
• Ear pain when swallowing
• Progressive reduction in the ability to open your jaw

Although the cause of leukoplakia is unknown, chronic irritation, such as from tobacco use, including smoking and chewing, appears to be responsible for most cases. Often, regular users of smokeless tobacco products eventually develop leukoplakia where they hold the tobacco against their cheeks.

Other causes may include chronic irritation from:

• Jagged, broken or sharp teeth rubbing on tongue surfaces
• Broken or ill-fitting dentures
• Long-term alcohol use

Your dentist can talk with you about what may be causing leukoplakia in your case.

Hairy leukoplakia

Hairy leukoplakia results from infection with the Epstein-Barr virus (EBV). Once you've been infected with EBV, the virus remains in your body for life. Normally, the virus is dormant, but if your immune system is weakened, especially from HIV/AIDS, the virus can become reactivated, leading to conditions such as hairy leukoplakia.

Tobacco use, particularly smokeless tobacco, puts you at high risk of leukoplakia and oral cancer. Long-term alcohol use increases your risk, and drinking alcohol combined with smoking increases your risk even more.

Hairy leukoplakia

People with HIV/AIDS are especially likely to develop hairy leukoplakia. Although the use of antiretroviral drugs has reduced the number of cases, hairy leukoplakia still affects a number of HIV-positive people, and it may be one of the first signs of HIV infection.

Leukoplakia usually doesn't cause permanent damage to tissues in your mouth. However, leukoplakia increases your risk of oral cancer. Oral cancers often form near leukoplakia patches, and the patches themselves may show cancerous changes. Even after leukoplakia patches are removed, the risk of oral cancer remains.

Hairy leukoplakia

Hairy leukoplakia isn't likely to lead to cancer. But it may indicate HIV/AIDS.

You may be able to prevent leukoplakia if you avoid all tobacco products or alcohol use. Talk to your doctor about methods to help you quit. If you continue to smoke or chew tobacco or drink alcohol, have frequent dental checkups. Oral cancers are usually painless until fairly advanced, so quitting tobacco and alcohol is a better prevention strategy.

Hairy leukoplakia

If you have a weakened immune system, you may not be able to prevent hairy leukoplakia, but identifying it early can help you receive appropriate treatment.

Most often, your doctor diagnoses leukoplakia by:

• Examining the patches in your mouth
• Attempting to wipe off the white patches
• Discussing your medical history and risk factors
• Ruling out other possible causes

Testing for cancer

If you have leukoplakia, your doctor will likely test for early signs of cancer by:

• Oral brush biopsy. This involves removing cells from the surface of the lesion with a small, spinning brush. This is a non-invasive procedure, but does not always result in a definitive diagnosis.
• Excisional biopsy. This involves surgically removing tissue from the leukoplakia patch or removing the entire patch if it's small. An excision biopsy is more comprehensive and usually results in a definitive diagnosis.

If the biopsy is positive for cancer and your doctor performed an excisional biopsy that removed the entire leukoplakia patch, you may not need further treatment. If the patch is large, you may be referred to an oral surgeon or ear, nose and throat (ENT) specialist for treatment.

Hairy leukoplakia

If you have hairy leukoplakia, you'll likely be evaluated for conditions that may contribute to a weakened immune system.

Leukoplakia treatment is most successful when a lesion is found and treated early, when it's small. Regular checkups are important, as is routinely inspecting your mouth for areas that don't look normal.

For most people, removing the source of irritation ― such as stopping tobacco or alcohol ― clears the condition.

When this isn't effective or if the lesions show early signs of cancer, the treatment plan may involve:

• Removal of leukoplakia patches. Patches may be removed using a scalpel, a laser or an extremely cold probe that freezes and destroys cancer cells (cryoprobe).
• Follow-up visits to check the area. Once you've had leukoplakia, recurrences are common.

Treating hairy leukoplakia

Usually, you don't need treatment for hairy leukoplakia. The condition often causes no symptoms and isn't likely to lead to mouth cancer.

If your doctor recommends treatment, it may include:

• Medication. You may take a pill that affects your whole system (systemic medication), such as antiviral medications. These medications can suppress the Epstein-Barr virus, the cause of hairy leukoplakia. Topical treatment may also be used.
• Follow-up visits. Once you stop treatment, the white patches of hairy leukoplakia may return. Your doctor may recommend regular follow-up visits to monitor changes to your mouth or ongoing therapy to prevent leukoplakia patches from returning.

You're likely to start by seeing your dentist or primary care professional. However, you may be referred to an oral surgeon or an ear, nose and throat (ENT) specialist for diagnosis and treatment.

What you can do

To get ready for your appointment, make a list of:

• Your symptoms, even if they seem unrelated to your condition
• Key medical and dental information, such as prior instances of symptoms and treatment, if any
• All medications, vitamins, herbal remedies and other supplements that you regularly take
• Questions to ask your doctor to make the most of your appointment time

Some basic questions to ask your doctor include:

• What is likely causing my condition?
• Are there other possible causes for my condition?
• Do I need special tests?
• Is my condition likely temporary or long term (chronic)?
• What treatments are available? Which do you recommend?
• What are the alternatives to the primary approach you're suggesting?
• Are there any restrictions I need to follow?
• Do you have any printed materials that I can take with me? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did you first notice these changes?
• Do you have any pain or bleeding from the problem area?
• Are you a smoker?
• Do you use chewing tobacco?
• How much alcohol do you drink?
• Do you have any difficulty swallowing?
• Have you noticed any lumps or bumps in your neck?
• Do you have any pain?
• Have you developed any areas of numbness on your tongue or lip?