White patches in the mouth-Part II

Why should I be concerned?

White patches could be due to a multiple of causes as discussed in the article “white patches in the mouth”. It is important that the underlying cause is identified because of the following reasons:

i) can cause unwanted effectssuch as pain and discomfort and even altered taste sensation. by knowing the cause, the lesion can be treated accordingly and thus ease the patient of all these negative effects.

White patches on the tongue

ii) can be indications of a disease or infection that was previously undetected. For example, hairy leukoplakia may be suggestive of a HIV infection.

ii) some lesions can be early signs of tumours, and if not treated promptly, can turn cancerous and spread. Early detection and prompt treatment can increase the chance of total healing or even patient survival rate, and improve the quality of life of the patient.

What I should do if I find one of the findings as mentioned above in my mouth?

First and foremost, do not panic! Not all lesions are harmful or cancerous. However, it is important that you seek dental attention as soon as possible so that the cause may be identified and treated respectively.

What would a dental practitioner do in dealing with such a finding?

Dental officers will firstly take a history of the lesion by asking questions such as:

-are you a denture wearer? if yes, do you leave your dentures out at night?

-do you have the habit of smoking or chewing betel nuts/quids?

-is there any pain or burning mouth sensation?

-is there any difficulty talking, chewing, eating, drinking, or swallowing?

-is it aggravated or relieved by any drugs or food, eg spicy food?

-do you have any skin rashes on any part of your body recently? etc

However, some patients do not realize they have a white patch in the mouth until they go for a regular dental check up (this emphasizes the need for regular dental check-ups, as some of these lesions can be potentially harmful if found at a later stage). The dental officer will then examine your mouth for:

-whether it can be scraped away

-the areas affected

-the size of the patch

-the appearance and characteristics of the lesion etc

-whether it is associated with any skin lesions

Investigations that can be done to identify the cause:

1. Taking a thorough medical and dental history based on the finding, as mentioned above.

2. Scrape test: Basically the dental officer attempts to scrape the patch with his gloved hands or some plastic dental instruments. If the lesion can be scraped off leaving a raw, red and often bleeding surface, it is quite certainly “oral thrush”, which is a form of fungal infection.

3. Blood test including blood glucose test to rule out systemic diseases such as diabetes mellitus, anemia, or leukemia, diseases which can lead to decreased immune defense of the body and hence candidal infection

4. Biopsy: which is basically removing a small portion of the involved oral tissue so that they can be viewed under microscope to look out for characteristic features that can give a definite diagnosis.

Biopsied oral tissues viewed under microscope

What are the treatment options?

Basically treatment is based upon the etiology, or the cause.

1. If the lesion is due to a habit such as smoking or betel nut chewing, the patient should be advised to stop the habit.

2. If the white patch is due to fungal infection, the patient should be treated with antifungal medications. Denture wearers should be advised to maintain the hygiene of their denture and mouth. Dentures shold not be worn to sleep, but to be left out at night, rinsed in either water, or diluted hydrochorite (bleach) or chlorhexidine mouthwash. If bleach were used, it would be better to get those with artificial smells such as lemon, so that your denture does not smell of bleach the following morning. Wash your dentures under running tap water and rinse it in a cup of water before wearing that denture again the following morning.

3. If there is a systemic condition or disease, that should be attended to, by referring the patient to a related specialist or physician.

4. In cases that the white patch turns out to be a cancerousgrowth, it will then have to be removed either under surgery, or through radiotherapy or chemotherapy. The earlier the growth is identified, i.e. the earlier the stage in which the lesion is in, the better the prognosis.

Tumour on the tongue

5. The patient may have to be under observation to watch out for any changes in the lesion which may suggest a cancerous growth or new signs and symptoms, or of the healing.