WHAT IS LEUKOPLAKIA

Leukoplakia: Pre-Cancer’s White Warning:

Persistent white patches in the mouth are not something to ignore. Known medically as leukoplakia, these lesions may be harmless in some cases, but they are also one of the most common oral potentially malignant disorders (OPMDs) — meaning they can turn into oral cancer over time.



What is Leukoplakia?

Definition:

Leukoplakia is defined as a persistent white patch or plaque that develops on the oral mucosa and cannot be rubbed off. Importantly, it cannot be classified clinically or histologically as any other disease (Warnakulasuriya et al., 2007).

Leukoplakia is defined by the World Health Organization (WHO) as “a white plaque of questionable risk having excluded (other) known diseases or disorders that carry no increased risk for cancer.”


In simpler terms, leukoplakia is a white patch in the mouth that cannot be rubbed off and cannot be attributed to another cause.

Unlike temporary irritation or fungal infections like oral thrush, leukoplakia often persists for months or years. While some forms remain benign, up to 20% of leukoplakia cases may undergo malignant transformation into oral squamous cell carcinoma if left untreated (Warnakulasuriya et al., 2018).

 


Causes & Risk Factors:

Leukoplakia develops due to chronic irritation of the oral mucosa. The most common culprits are:

1. Tobacco Use:

Both smoking and chewing tobacco are major causes. Carcinogens in tobacco directly damage the DNA of epithelial cells in the mouth.

Research shows tobacco users are 6 times more likely to develop leukoplakia (Gupta et al., 1980).

2. Alcohol Consumption:

Alcohol acts synergistically with tobacco, increasing the permeability of oral mucosa and allowing carcinogens to penetrate more deeply.

3. Betel Nut (Areca Nut) Chewing:

Common in parts of Asia, betel nut contains arecoline, a compound that induces fibrosis and precancerous lesions.

4. Mechanical Irritation:

Ill-fitting dentures, sharp teeth edges, or constant biting of the cheek/tongue may also contribute.



Leukoplakia and Oral Cancer Risk:

Leukoplakia is considered a precancerous lesion because of its ability to undergo malignant transformation.
Transformation rates vary depending on lesion type:

  • Homogeneous leukoplakia (uniform, thin white patches) has a lower risk (1–7%).
  • Non-homogeneous leukoplakia (speckled, nodular, or verrucous) carries a much higher risk (up to 25%) (Napier & Speight, 2008).

Microscopic examination often reveals dysplasia — abnormal cell changes — which is a warning sign that cancer could develop.

 

 

Symptoms & Identification:

Leukoplakia is usually painless in its early stages, which makes it more dangerous — people often ignore it.
Common locations:

  • Inner cheeks (buccal mucosa)
  • Tongue
  • Floor of the mouth
  • Gums

Appearance:

  • White or grey patches
  • May have thickened, hardened areas
  • Cannot be scraped off (unlike fungal infections)

 

Diagnosis:

A definitive diagnosis requires:

  1. Clinical Examination by a dentist or oral medicine specialist.
  2. Biopsy – essential to rule out oral cancer or severe dysplasia.
  3. Histopathological Analysis – to assess cellular changes.


Current Treatment Options:

1. Removal of Risk Factors:

  • Quit tobacco and alcohol
  • Treat ill-fitting dental appliances

2. Surgical Removal:

For lesions showing high-grade dysplasia or suspicion of malignancy.

3. Pharmacological Approaches:

  • Retinoids (vitamin A derivatives)
  • Anti-inflammatory agents
  • Natural protease inhibitors like Bowman-Birk Inhibitor (BBI)

 

Bowman-Birk Inhibitor: A Scientific Breakthrough:

BBI, derived from soybeans, is a serine protease inhibitor that has shown remarkable potential in preventing malignant transformation of leukoplakia.
A landmark clinical trial by University of California, Irvine (2000) demonstrated that oral administration of BBI concentrate reduced lesion size and improved tissue appearance in leukoplakia patients (Armstrong et al., 2000).

Mechanisms include:

  • Inhibition of proteases that promote tumor progression
  • Reduction of oxidative stress
  • Modulation of inflammatory pathways

 

Role of Phospholipids in Healing Oral Mucosa:

The oral mucosa acts as a barrier and a site of absorption.
Phospholipids — such as phosphatidylcholine, phosphatidylethanolamine, phosphatidylserine, phosphatidylinositol, phosphatidylglycerol, and phosphatidic acid — help:

  • Restore cell membrane integrity
  • Promote mucosal regeneration
  • Reduce fibrosis in submucous tissues

 

Preventing Leukoplakia:

Lifestyle Modifications:

  • Avoid tobacco and alcohol entirely
  • Eat a diet rich in antioxidants (fruits, vegetables)
  • Maintain excellent oral hygiene

Therapeutic Innovations:

Localized oral treatments like Orocap™ — a chewable capsule releasing BBI and phospholipids directly into the mouth — allow targeted mucosal healing and cancer prevention.

 

Why Early Detection Matters:

Detecting leukoplakia early can be life-saving.
Once it progresses to cancer, treatment becomes more complex and survival rates drop significantly.

 

References:

  • Warnakulasuriya S, et al. Oral potentially malignant disorders: A consensus report. Oral Oncol. 2018; 75: 68–77. Link
  • Gupta PC, et al. An epidemiologic study of oral cancer. Br J Cancer. 1980; 42(1): 84–92. Link
  • Napier SS, Speight PM. Natural history of potentially malignant oral lesions. Oral Oncol. 2008; 44(4): 307–316. Link
  • Armstrong WB, et al. Clinical modulation of oral leukoplakia. Cancer Epidemiol Biomarkers Prev. 2000; 9(12): 1289–1296. Link

 

Leukoplakia is not just a cosmetic oral condition—it’s a potential gateway to oral cancer. Understanding its risks, causes, and modern preventive measures can save lives. With targeted interventions like Orocap™, supported by robust scientific evidence, it’s possible to halt its progression and restore oral health.