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The word Leukoplakia can be broken down into leuko – which is Greek for white and Plakia, which refers to a flat patch. This basically means that Oral Leukoplakia is a white, flat patch or plaque that can have a risk of becoming oral cancer. Generally, it cannot be characterized clinically or pathologically as any other disease. These patches are generally not easily removed, they can vary in size and shape, and they may also be smooth or rough in texture. They can be painless but have the potential to evolve into a serious health concern if not managed appropriately. The exact cause of oral leukoplakia is not fully understood, but Several risk factors often contribute to its development. Most commonly, it is tobacco use, and that includes smoking or chewing tobacco. Additionally, Heavy alcohol consumption, UV exposure, Human papillomavirus infection, and poor oral hygiene have been linked to oral leukoplakia. There are two main types of oral leukoplakia: Homogeneous and nonhomogenous type Homogenous Leukoplakia is generally thin, Uniform, and smooth white patches which are usually demarcated, which means that its borders are clear. On the other hand Non-homogeneous Leukoplakia represents more thick, Irregular and rough white patches with less demarcated borders, meaning that the external edges are less easily defined. If a non homogenous patch is bumpy and has nodules, then it’s called nodular leukoplakia, if it has speckles of red within it, then it is called speckled leukoplakia, which is interchangeable with erythroleukoplakia, with erythro meaning red. if it becomes wart-like, then it’s called verrucous leukoplakia (with the term verrucous referring to a wart-like appearance) These non-homogenous lesions are generally at a higher risk of malignant transformation into oral cancer. A dangerous version of nonhomogenous leukoplakia is Proliferative Verrucous Leukoplakia (PVL). Which is a rare form of Leukoplakia and is characterised by a multifocal appearance affecting different or contiguous areas. It is usually aggressive and has a high rate of malignant transformation to oral cancer. Diagnosing oral leukoplakia requires a thorough examination by a dentist or a specialist. It includes taking thorough medical, dental and social histories, with consideration of risk factors for leukoplakia. This is followed by a careful inspection of the area affected as well as surrounding areas of the head and neck. A biopsy is considered the gold standard for accurately diagnosing leukoplakia. The tissue sample is then sent to a laboratory for microscopic examination to determine whether the cells show any signs of dysplasia. Which refers to the presence of abnormal cells that signify a potentially precancerous lesion. If you have a white leukoplakic lesion on the tongue that is not attributed to any other cause, however, when a biopsy is taken, it shows candida species under the microscope, it is now candidiasis rather than leukoplakia. In addition to oral candidiasis, Some differential diagnoses for leukoplakia include: Oral lichen planus Frictional keratosis Tobacco pouch keratosis Nicotine stomatitis Leukoedema White sponge nevus Malignant transformation depends on the patient’s risk factors, the level of dysplastic changes on histological examination, and the clinical type of leukoplakia. for example, if you have PVL then the chance of malignant transformation can be at least 70%. However, if you have uniform, thin, homogenous leukoplakia and minimal dysplastic changes, then the malignant transformation can be as small as 3%. The management of oral leukoplakia depends on the biopsy results for the degree of dysplasia present. For mild dysplasia cases, the first step is often to remove the source of irritation, such as advising the patient to quit smoking or using tobacco. In cases where dysplasia is moderate to severe or when the lesions show signs of malignant transformation, more aggressive treatments like surgical removal or laser therapy may be recommended to prevent the progression to oral cancer. To summarise: Oral leukoplakia is a condition characterized by white patches or plaques on the mucous membranes of the mouth. These patches cannot be attributed to any other specific cause and carry an increased risk of developing cancer in the oral cavity or head-and-neck region. The condition is often associated with tobacco use, alcohol consumption, UV, poor oral hygiene, and HPV infection. There are two main types of leukoplakia: homogeneous and non-homogeneous, with the latter having a higher risk of malignant transformation. Generally, A biopsy is the gold standard for diagnosis, and management depends on the degree of dysplasia present, ranging from lifestyle changes for mild cases to more aggressive treatments for significant dysplasia or signs of malignant transformation. Regular monitoring and follow-up are crucial to detect any potentially cancerous changes early.