What is Benign Chronic White Lesions of the Oral Mucosa?
Chronic, harmless white spots in the mouth cover a range of conditions, both harmless and potentially dangerous. They’re usually found during regular dentist visits. Their causes, appearances, and treatment plans can vary widely. Some of the most common harmless white spots, like pseudomembranous candidiasis, erythema migrans, morsicatio buccarum, linea alba, leukoedema, and lichen planus often show up on the top side of the tongue or the inside of the cheeks. To manage these spots effectively, a proper understanding of their nature is essential. This will allow doctors to correctly diagnose the issues, provide personalized care to patients, and collaborate with other experts in oral pathology.
What Causes Benign Chronic White Lesions of the Oral Mucosa?
Pseudomembranous Candidiasis
This is a type of fungal infection that usually occurs when there’s an imbalance in your mouth’s normal mix of bacteria. This allows the fungus “Candida” to grow too much. It’s easy to spot because it creates a thick, white coating that can be scraped off, often showing red and irritated tissue underneath.
Erythema Migrans
This is an inflammatory condition, the exact cause of which is not known. But it has been found more commonly in people with a skin condition called psoriasis. The condition may exhibit signs that are similar to psoriasis. These signs can include inflammatory changes, like the loss of normal tissue on the tongue, leading to a red color.
Morsicatio Buccarum
Colloquially known as “cheek biting,” this condition shows up on the inner cheeks or sides of the tongue. It’s caused by repeated biting or chewing of the inner cheek or tongue.
Linea Alba
This can occur either on one side or both sides, and it’s caused by the sucking of the cheeks. The sucking pressure makes the tissue stretch and appear less blood-filled, which gives the white color. This usually happens without us even realizing it, especially during stressful times.
Leukoedema
This condition appears on either the inner cheeks or lips. The exact cause is not known, but it is suspected to show up in areas of irritation. The affected tissue has excessive fluid within, making it look pale or white. But when stretched, it returns to its normal appearance.
Oral Lichen Planus
This is a long-term inflammation condition impacting the mucous membrane of the mouth. It’s a disorder related to the immune system, but we don’t quite know why it happens. However, stress, infections, or an immune system attack on the mouth cells can lead to oral lichen planus. Long-standing inflammation can potentially turn these tissues malignant if left untreated.
tongue.
Risk Factors and Frequency for Benign Chronic White Lesions of the Oral Mucosa
Pseudomembranous candidiasis is a condition that can affect anyone, but it’s more frequently found in patients with weakened immune systems. It affects both men and women equally.
Erythema migrans is a condition that affects 1 to 2 percent of people, commonly seen in younger individuals. There is a slightly higher occurrence in females than in males.
- Morsicatio buccarum is a condition that can occur in anyone, especially those dealing with stress or have certain habits. It was found that 4.7% of teenagers between 13 to 18 years old have this condition.
- This condition does not have a gender preference, meaning it can affect both males and females equally.
Linea alba is a condition that can be present in anyone, particularly those dealing with stress. It is seen in roughly 5.3% of teenagers aged 13 to 18 and in 33.9% of adults, with females being more prone to it.
Leukoedema’s occurrence varies widely among different ethnic and racial groups. It was found to affect up to 58% of Black individuals, with no preference for gender, meaning both males and females are equally affected.
- Oral lichen planus is a condition affecting 1 to 2 percent of people, which is most common in middle-aged females. Globally, it occurs in about 0.5 to 1.5 percent of the population.
- Most of the people with systemic lichen planus have oral involvement, which ranges from 70% to 77%.
Signs and Symptoms of Benign Chronic White Lesions of the Oral Mucosa
Pseudomembranous candidiasis, often referred to as “thrush,” is a condition that can create white or red patches in the mouth. Typically, these patches are white, heavy, and located on the tongue and inside the cheek. Sometimes, the patches can be wiped off easily and, if removed, will reveal a red surface beneath.
Erythema migrans, in contrast, shows up as ring-like temporary patches on the tongue that are either white or red. The patches can be raised or smooth and are usually found on the top or sides of the tongue. Over time, these patches may change in size and position.
Morsicatio buccarum, another oral condition, is characterized by ripped oral tissue in the mouth, particularly on the cheek or tongue. This damaged tissue line typically matches the biting pattern of the teeth.
Linea alba can be seen as a white line on the inside of the cheek area. Depending on personal habits, this line may show up on one or both sides of the mouth.
Unlike the other conditions, Leukoedema is commonly regarded as a normal variation rather than a disease. It shows up as a greyish-white spot on the inside areas of the mouth. The related tissues usually look swollen but will revert to normal when stretched or manipulated.
Lastly, Oral Lichen Planus usually presents as white lines, also known as Wickham’s striae, on the inside of the mouth or tongue. However, it can also appear as white bumps, plaques, or sores. A variety of common medications, including nonsteroidal anti-inflammatory drugs and antihypertensive agents, can cause a reaction that looks similar to lichen planus.
Testing for Benign Chronic White Lesions of the Oral Mucosa
Examining benign chronic white oral mucosa lesions is a detailed process that requires a wholesome approach from medical professionals. This starts by taking a complete history of the patient, including any habits that can cause cancer, like smoking. A thorough physical check of the mouth is essential to spot the white lesions’ specific features and positions. If needed, diagnostic methods such as biopsies may be used to confirm the type of the lesion. Doctors need to distinguish between benign and potentially cancerous conditions, given the wide variety of possible lesions. The purpose of this evaluation is to guide the medical professional in determining an accurate diagnosis quickly and create appropriate management plans unique to each patient.
Pseudomembranous candidiasis, a type of yeast infection, can be easily managed once diagnosed clinically. Since it can occur in people with other underlying health problems, a full medical history should be collected to exclude any possible causes.
Erythema migrans, a condition often associated with psoriasis, but which can also be a normal variation, needs careful evaluation. Anyone with this condition should see their primary care provider to exclude possible systemic disease.
Morsicatio buccarum often results from specific habits, neurological dysfunction, or stressful situations such as adolescence or pregnancy.
Linea alba usually occurs due to the habit of sucking on one’s cheeks. A discussion with the patient about possible habits plays a significant role in making a diagnosis.
Leukoedema is an unexplained condition possibly linked to local irritation, smoking, or diabetes. Diagnosing it can include stretching the tissue around the lesion because it tends to disappear when stretched.
Oral Lichen Planus is identified through a histological examination and a diagnostic method known as DIF (Direct Immunofluorescence) to obtain a definitive diagnosis. A negative DIF differentiates oral lichen planus from other lesions, like pemphigus or pemphigoid.
Treatment Options for Benign Chronic White Lesions of the Oral Mucosa
Pseudomembranous candidiasis, a type of oral infection, is typically treated with antifungal medicines like fluconazole or clotrimazole. It’s important for patients to maintain regular oral hygiene, especially if they wear removable dental prosthetics like dentures, to prevent a return of the infection.
Erythema migrans doesn’t have a specific treatment recommended. This condition can sometimes indicate other underlying health issues, so it’s usually advised that the patient sees their primary care doctor to check for these.
Morsicatio buccarum doesn’t have a specific treatment either. It’s often seen in people who have a habit of biting their cheek or tongue. For these patients, trying to change the biting habit or reducing stress levels may help improve the condition.
Linea alba also doesn’t have a specific treatment. Similar to Morsicatio buccarum, patients might find it helpful to change certain habits or reduce stress levels.
Leukoedema is generally considered a variation of normal and doesn’t need a specific treatment. However, it’s often related to smoking and diabetes, so managing these lifestyle factors and health conditions might help to resolve the condition.
Oral lichen planus is mostly treated with topical corticosteroids. If the condition arises as a reaction to certain drugs, then it should clear up once the patient stops taking the offending medication. However, if the condition is persistent, other treatments like hydroxychloroquine, calcineurin inhibitors, and retinoids might be used.
What else can Benign Chronic White Lesions of the Oral Mucosa be?
When diagnosing chronic white spots in the mouth that are not harmful, the doctor may consider a variety of possibilities. These include:
- Pseudomembranous Candidiasis: Could be due to oral hairy leukoplakia, nutritional deficiencies, lichen planus, or trauma.
- Erythema Migrans: Conditions such as psoriasis, lichen planus, a fissured tongue, herpes simplex infection, or candidiasis could be the cause.
- Morsicatio Buccarum: This could be due to oral lichen planus, candidiasis, leukoplakia, a chemical burn, or white sponge nevus.
- Linea Alba: The cause could be leukoedema, morsicatio buccarum, or lichen planus.
- Leukoedema: This could be caused by leukoplakia, Hyperkeratosis, white sponge nevus, or morsicatio buccarum.
- Oral Lichen Planus: Lesions could be due to pemphigus, pemphigoid, leukoedema, or leukoplakia.
Therefore, a doctor must examine these possibilities to make an accurate diagnosis for white lesions on the mouth mucosa.
What to expect with Benign Chronic White Lesions of the Oral Mucosa
Pseudomembranous candidiasis is usually not life-threatening and has a good outlook as long as the patient follows the prescribed antifungal treatment plan and continues with good oral hygiene.
Erythema migrans also has a great outlook and can be managed effectively with comfort-focused treatment.
Morsicatio buccarum, on the other hand, has a good outlook if the patient can manage their stress or become aware of their habits.
This is the same situation for Linea alba, where the prognosis is good if managed with stress reduction or increased habit awareness.
Leukoedema has an excellent prognosis as it is considered a standard variation.
Lastly, oral lichen planus typically has a good prognosis. However, it can last for several years, and may leave scars as it heals. It’s important to note that oral lichen planus can potentially turn into cancer.
Possible Complications When Diagnosed with Benign Chronic White Lesions of the Oral Mucosa
Benign white spots on the lining of the mouth (oral mucosa) are generally not dangerous. However, they still pose some potential challenges and issues, so proper diagnosis and treatment plans are vital for managing these complications.
Specific complications for certain conditions include:
- Issues with pseudomembranous candidiasis, typically caused by untreated candidiasis, can lead to constant discomfort, swallowing difficulties, and a change in the sense of taste. In extreme cases, the false membranes created by the overgrowth of Candida can result in widespread damage to the mouth’s tissue, leading to bleeding and ulcers. People with compromised immune systems, such as HIV/AIDS patients or those going through chemotherapy, have a higher risk of system-wide candidiasis.
- Continued morsicatio buccarum, or the habit of cheek biting, can lead to long-term irritation and possible secondary infections.
- Lichen planus, characterized by chronic oral lesions, can cause scarring and is potentially pre-cancerous, necessitating close monitoring. Long-standing lesions, particularly those that are erosive or atrophic, have a marginally increased chance of developing into oral squamous cell carcinoma. Even though the risk is relatively low, patients should be informed about the possibility of this transformation. Therefore, proper clinical documentation, histological examination, and direct immunofluorescence (DIF) are key to confirming the diagnosis and determining the right course of treatment.
Preventing Benign Chronic White Lesions of the Oral Mucosa
People with pseudomembranous candidiasis are advised to maintain excellent oral care, especially those who have other health problems like diabetes or a weak immune system. This advice is particularly important for individuals with removable dentures.
Erythema migrans is an inflammation that doesn’t usually require treatment unless there is another underlying health condition. It’s still good to record its occurrence for future reference.
Morsicatio buccarum, a condition often caused by a person’s unaware habit, should be brought to the patient’s notice. Encouraging them to avoid the habit that causes this and documenting the condition are key steps to take.
Similarly, if someone has linea alba, it might be because they’re unconsciously sucking on their cheeks. Helping them find methods to cut down on stress and noting the condition is important.
Leukoedema isn’t dangerous but should still be noted and the patient should be informed.
With lichen planus, it’s important that the patient knows about it due to the potential impact on their overall health and quality of life. It’s the doctor’s job to refer the patient to the right specialist for further evaluation.
