Distinguishing Between Oral White Spots and Leukoplakia: A Guide

Q: Distinguishing Between Oral White Spots and Leukoplakia: A Guide

Dear Xiao P： Oral leukoplakia is mostly caused by chronic irritation, such as smoking or betel nut chewing. <br>Generally, it appears as a localized area or is scattered in multiple places in the oral cavity. <br>Small white spots may indicate ulcers or candidiasis. <br>As for Fo

How to differentiate between leukoplakia and white spots in the oral cavity?

Hello, doctor.
I would like to ask about the difference between white spots and leukoplakia in the oral cavity.
Are white spots similar to pimples, protruding from the surface? And is leukoplakia a flat area? I found online that white spots are referred to as "Fordyce spots." How can these be distinguished from leukoplakia associated with oral cancer? My father has four small raised white spots on the inner side of his right cheek.
Initially, they were small white spots, but he poked them, causing bleeding.
Now that area has swollen and turned into two larger white spots, resembling the emergence of wisdom teeth.
We noticed this last week, and he visited an ENT clinic where the doctor said it was nothing to worry about and suggested monitoring it.
However, after he poked it, it feels swollen now.
I am really concerned and would appreciate your clarification.
He used to chew betel nut but has quit for about three years.
He does not drink alcohol and still smokes.
He was recently diagnosed with type 2 diabetes just a couple of days ago and has started treatment only three days ago.

Xiao P, 20~29 year old female. Ask Date: 2013/05/02

Dr. Zheng Jueyi reply Otolaryngology

Dear Xiao P: Oral leukoplakia is mostly caused by chronic irritation, such as smoking or betel nut chewing.
Generally, it appears as a localized area or is scattered in multiple places in the oral cavity.
Small white spots may indicate ulcers or candidiasis.
As for Fordyce spots, they refer to sebaceous glands in the oral cavity and are considered benign changes, appearing as yellowish spots.
If an ulcer has developed due to trauma, you can apply ointment or take medication along with frequent rinsing.
After the ulcer improves, monitor the area.
If the wound does not heal after two weeks, it is advisable to seek medical attention for a biopsy.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the ENT Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2013/05/02

More Info

When it comes to distinguishing between oral white spots and leukoplakia, it's essential to understand the definitions and characteristics of these conditions. Oral white spots can manifest in various forms and may be caused by a range of factors, including infections, irritations, or benign conditions. On the other hand, leukoplakia is a specific condition characterized by white patches that cannot be easily wiped away and may be considered precancerous in some cases.

Oral White Spots:
Oral white spots can appear as small, raised lesions or flat patches on the mucous membranes of the mouth. They can be caused by several factors, including:
1. Fordyce Spots: These are small, painless, pale bumps that are actually sebaceous glands and are completely normal. They are not harmful and do not require treatment.

2. Candidiasis (Oral Thrush): This fungal infection can lead to white patches in the mouth that may be painful and can be wiped away, revealing red, inflamed tissue underneath.

3. Mucous Membrane Pemphigoid: This autoimmune condition can cause white spots or blisters in the mouth, often accompanied by pain and discomfort.

4. Irritation or Trauma: Repeated trauma to the oral mucosa, such as from biting or aggressive brushing, can lead to white spots or patches.

Leukoplakia:
Leukoplakia, on the other hand, is a more serious condition. It presents as thickened, white patches on the oral mucosa that cannot be scraped off. The exact cause of leukoplakia is often unknown, but it is associated with chronic irritation, tobacco use (including chewing betel nut), and sometimes viral infections. It is crucial to monitor leukoplakia closely because it can potentially progress to oral cancer.
Differentiating Factors:
1. Appearance: Oral white spots can be raised or flat, while leukoplakia typically appears as a thickened, white patch that is flat and cannot be wiped away.

2. Symptoms: White spots may or may not be painful, depending on their cause. In contrast, leukoplakia may not cause any symptoms initially but can be associated with discomfort or pain if it becomes irritated.

3. Duration and Change: If a white spot persists for more than two weeks or changes in appearance, it is essential to seek medical evaluation. Leukoplakia patches can also change over time, and any changes should be assessed by a healthcare professional.

In your father's case, the presence of small white spots that have changed in size and appearance after being manipulated raises concern. The fact that he has a history of betel nut use and is a smoker adds to the risk factors for developing leukoplakia or other oral lesions. Given that the spots have become swollen and have bled, it is crucial to have them evaluated by a dental or oral health specialist. They may recommend a biopsy to rule out any precancerous changes or malignancy.

In summary, while oral white spots can be benign and caused by various factors, leukoplakia is a condition that requires careful monitoring due to its potential to develop into cancer. If there are any concerns about changes in the mouth, especially with a history of irritants like tobacco, it is always best to consult with a healthcare provider for a thorough examination and appropriate management.

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