Oral Leukoplakia: Symptoms, Diagnosis, and Treatment Options

Oral leukoplakia

Thank you, doctor, for taking the time to respond.
The first three points were evaluated by an oral surgeon or an oral medicine specialist at a large hospital (I can't quite remember which).
However, the doctor did not provide me with a diagnosis, so I still have many questions.
I would appreciate it if you could provide me with a diagnosis and treatment options.
Currently, I consume about 5-6 betel nuts daily and have abstained from alcohol for about 4 years, with a drinking history of around 4 years, often consuming high-concentration alcohol (58%).
I have been abstaining for a few months.
The first image: https://imgs.cc/image/8ilDqhV
The second image: https://imgs.cc/image/YdevdxY
The third image: https://imgs.cc/image/DlYrcDf
The fourth image: https://imgs.cc/image/GcMVakT
Firstly, the symptoms (the first three symptoms were diagnosed by an oral surgeon about three years ago, but I did not receive medication or surgery, and my condition feels unchanged).

1.
In the first image, there is a small area on my tongue that appears slightly white, and the texture seems a bit deep.
It is not painful or itchy, and there is no noticeable worsening compared to three years ago.
The doctor's comment three years ago was, "It's okay."
2.
In the second image, there are oral leukoplakia lesions that are not painful or itchy, but the tongue feels a bit rough when touched.
There is no noticeable worsening compared to three years ago.
The doctor diagnosed it three years ago and advised me to rest and take B vitamins for six months, after which we could reassess.
If it did not resolve, a minor surgical procedure could be considered, with stitches to be removed in one to two weeks.
However, I have been taking B vitamins, but I have not noticed any improvement or worsening.
3.
In the second image, there is a slightly dark area with a small white spot.
It is not painful or itchy and feels rougher than the oral leukoplakia mentioned in the second question.
There has been no significant change compared to three years ago.
The doctor's comment three years ago was, "It's okay."
4.
In the second image, there are noticeable bite marks on my oral mucosa, particularly on both sides.
If there are cavities on the surfaces where my teeth contact my cheeks, those areas are more pronounced.
I am unsure if this is due to my habit of pooling saliva while sleeping (I tend to press my tongue against the roof of my mouth, creating a slight vacuum sensation, which likely only happens when I am asleep) or if it is due to the effects of smoking, alcohol, and betel nut.
I apologize for the lengthy message.
I have searched online and looked at images, as well as consulted Taiwan's e-hospital, but as a non-professional, I truly do not understand.
Many people on Taiwan's e-hospital also do not have images to share, which is why I am posting here.
I hope you can provide me with a diagnosis, an understanding of my condition, and suggestions for improvement.
Thank you for reading this lengthy message!

bù, 20~29 year old female. Ask Date: 2017/04/25

Dr. Zeng Guanghui reply Dentistry

Changes in the surface mucosa of the tongue, including atrophy of the lingual papillae, geographic tongue, and even discoloration leading to blackened papillae, suggest that it is advisable to consult an oral surgeon for further examination.

Reply Date: 2017/04/25

More Info

Understanding oral leukoplakia is crucial for anyone experiencing symptoms related to oral health, especially if there are persistent white patches or lesions in the mouth. Oral leukoplakia is characterized by white patches on the oral mucosa that cannot be scraped off and may be associated with various underlying conditions, including irritation, tobacco use, and even precancerous changes.

Symptoms
The symptoms of oral leukoplakia can vary, but they typically include:
- White patches: These patches can appear on the tongue, gums, or inside of the cheeks. They are often painless and may feel rough or thick.

- Changes in texture: The affected areas may feel different from the surrounding tissue, often described as "coarse" or "rough."
- No associated pain: Most individuals do not experience pain or discomfort unless there is an underlying condition causing irritation.

- Potential for dysplasia: In some cases, leukoplakia can be a precursor to oral cancer, particularly if the patches are associated with risk factors such as tobacco use or heavy alcohol consumption.

Diagnosis
Diagnosis typically involves a thorough clinical examination by a dentist or oral specialist. The following steps may be taken:
1. Visual Inspection: The healthcare provider will examine the oral cavity for white patches and other abnormalities.

2. Medical History: A detailed history of tobacco and alcohol use, as well as any other risk factors, will be taken into account.

3. Biopsy: If there is any concern about the nature of the lesions, a biopsy may be performed to rule out dysplasia or malignancy. This involves taking a small sample of tissue from the affected area for laboratory analysis.

Treatment Options
The treatment for oral leukoplakia depends on the underlying cause and the presence of any dysplastic changes. Here are some common approaches:
- Lifestyle Changes: If tobacco or alcohol use is contributing to the condition, cessation is strongly advised. This can significantly reduce the risk of further complications.

- Nutritional Support: Some studies suggest that vitamin deficiencies, particularly B vitamins, may play a role in oral lesions. A healthcare provider may recommend dietary changes or supplements.

- Monitoring: If the leukoplakia is not associated with dysplasia, regular monitoring may be sufficient. This involves periodic check-ups to assess any changes in the lesions.

- Surgical Intervention: In cases where leukoplakia is persistent or shows signs of dysplasia, surgical removal of the lesions may be necessary. This is often done under local anesthesia and can provide both diagnostic and therapeutic benefits.

Conclusion
Given your history of tobacco and alcohol use, as well as the presence of white patches and changes in your oral mucosa, it is essential to follow up with an oral health specialist. They can provide a definitive diagnosis and recommend appropriate treatment options tailored to your specific situation. Regular dental check-ups and maintaining good oral hygiene are also vital in managing and preventing further complications. If you have concerns about potential underlying conditions, discussing these with your healthcare provider can help address any anxiety and ensure comprehensive care.

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