Sunday, 6 November 2011

leukoplakia

The term Leukoplakia orignates from 2 greek words-Leuko i.e white & plakia i.e patch


Leukoplakia is a disorder of the mouth where in there are white patches inside the mouth and on the tongue. It is white patch on the mucous membrane that is gums and the inside of the cheeks. These patches cannot be scarped off easily as they are quite thick. The diagnosis of Leukoplakia is one of exclusion that is first it is made sure that the white spots are not because of any other disease like lichen planus or candidiasis. It affects even less than one percent of population. The causes of this disease is not known and but it is considered that it can happens because of chewing or smoking tobacco though there are times when patients feel a certain irritation due to other reasons also like the consumption of alcohol also.


Definition

Acc. to WHO

It is a whitish patch or plaque that can not be characterized clinically or pathologically as any other disease & which is not associated with any other physical or chemical causative agent except the use of tobacco

Etiopathogenesis/cause of Leukoplakia 

Local Factors

Tobacco
it refers to dried leaves of nicotina tobaccum
tobacco is widely used in 2 forms:-

Smokeless tobacco

Such as chewable tobacco & oral use of snuff

when tobacco is chewed, various materials leach out of it, such as tobacco tars & resins. These are the extracts of tobacco, containing various chemical constituents such as nitrosonornicotine, nicotine, pyridine, picoline & collidin.All these act as local irritants and are related to alterations in mucosa
  • Smokeless tobacco is believed to result in chemical damage that produces sub-lethal cell injury within the deeper layers of oral epithelium.This in turn, includes concomitant epithelial hyperplasia

Smoking tobacco

such as cigar, cigarette, bidi & pipe

Smoking tobacco is harmful as this smoke contains polycyclic hydrocarbons,beta-naphthylamine, nitrosamines, carbon monoxide, nicotine etc which act as source of irritation.
  • Heat produced by smoking tobacco also plays a major role.heat result in alteration of tissue.

Alcohol

The prevalance is higher among the regular drinkers than the non- drinkers

Causes Irritation & burning sensation in oral mucosa
  • alcohol facilitates the entry of carcinogens in to exposed cells & thus alters the oral epithelium & its metabolism

Chandidiasis

The presence of candida albicans has been reported very frequently in association with leukoplakia

Electromagnetic reaction or galvanism

Galvinism is a generation of current due to difference in the electrical potential of two dissimilar metela

Galvanic current may arise in mouth between dissimilar, opposing or adjacent metallic restorations

Chronic Irritation

Continuous trauma is suspected cause

The usual site of irritation is buccal mucosa.source of irritation may be
  • malocclusion
  • Ill fitting denture
  • sharp broken teeth
  • hot spicy food
  • root piece

Regional & systemic Factors

Syphilis

It is regarded as predisposing factor for development of leukoplakia

    Vitamin Deficiency

    Vitamin B complex deficiency has also been suggested as a predisposing factor. it might be related to oxidation pattern of the epithelium, making it more susceptible to irritation.

    idiopathic leukoplakia

    in a small proportion of cases, no underlying cause has been found. such lesions are termed as idiopathic leukoplakia

    Clinical feature

    occurs most commonly in older age group i.e 35-45 yrs and above.
    males are affected more frequently than females
    prevalence in India is 0.2-4.9 %

    Symptoms of Leukoplakia

    Leukoplakia has various symptoms but the primary symptom is the appearance of plaque that is generally on the gums or on the insides of the mouth. It can also be seen on the tongue of the patient. Over a long period of time patches can be seen which are white, thick and rough and at times the surface of these patches are hard. The symptoms of hairy Leukoplakia are much the same.multiple location of involvement are not uncommon.

    management

    Elimination of etiological factor
    • Prohibition of smoking
    • remove sharp, broken down teeth
    • replace faulty metal restorations & metal bridge
      .
    • Elimination of other etiological factors like syphilis, alcohol etc

    suppliments

    • Vitamin therapy- It has protective effect on epithelium. vitamin A may be used tropically after painting the lesion with podophyllin solution( inhibit mitosis).Daily requirement is 4000 IU
    • Vitamin A+ E- this therapy is given to inhibit metabolic degradation.
    • 13-cis-retinoic acid
    • Antioxident therapy- B- carotene suppliment
    • Nystatin therapy for candidal infection
    • Vitamin B complex
    • Antimycoyic prepration
    • Panthenol in case of tongue lesion
    • Estrogen

    surgical

    • Conventional surgery
    • cryosurgery
    • Fulguration
    • LASER
    • Ablation

    Miscellaneous

    • Radiation therapy
    • Topical chemotherapy

    Malignant potential

    The term malignent potential trasformation is used to denote development of oral cancer from pre-existing leukoplakia

    it occurs in 0.3-10% cases
    Leukoplakia associated with chewing habit of tobacco shows higher rate of transformation as compared to others
    Nodular dysplasia has got higher risk of malignant transformation
    Higher in women6% than men 0.9% due to involvement of endogenous factors.

    Prevention

    The most important preventive factor is removal of any irritants that may cause leukoplakia to develop. The most important of these is to stop smoking or chewing tobacco.

    Excellent oral hygiene is important to prevent recurrence of leukoplakia.

    Regular dental treatment will ensure that any rough teeth, fillings or other restorations are treated promptly before leukoplakia can develop.

    Eating plenty of fresh fruit and vegetables that are rich in antioxidants may reduce the risk of leukoplakia.

    Prognosis

    the prognosis is quite fair.
    Rate of regression is higher when tobacco habit is discontinued

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