Leukoplakia of the oral cavity: symptoms, causes, treatment
The incidence of mucous membranes of the oral cavity, a considerable part falls on the diagnosis of «leukoplakia of the mouth», given the diversity of its manifestations. More prone to this disease men, especially those aged 50 years and older. The main danger of leukoplakia of the oral cavity in its ability to turn into malignant form. Treatment of leukoplakia of the oral cavity in its initial manifestations, usually is not difficult if the patient is self-disciplined, result-oriented and carefully observes the doctor’s orders.
- Smoking, use of drugs in the mouth;
- Food which can mechanically injure the mucosa, and overly acidic, salty, spicy, etc.;
- The effects of some medicines;
- A malformed bite, deviation of the position or absence of natural teeth;
- The consequences of inefficient dental treatment and prosthetics, including a malformed bite, the presence of sharp edges;
- Galvanism, the resulting potential difference of the metal structures in the mouth;
- Occupational hazards, exposure to chemicals.
- A deficiency of vitamins, responsible for the regeneration of the mucous membrane of the mouth;
- Pathology of metabolism;
- Predisposition to leukoplakia of the mouth of genetically;
- Immune deficiencies;
- Gastrointestinal pathology;
- Chronic processes in the oral mucosa of an inflammatory nature.
Forms of leukoplakia
- Simple (flat);
- Verrucous (warty or plaque);
- Smoker’s leukoplakia (leukoplakia of Tappeiner);
Usually in this form of leukoplakia can be noticed only visually subjective sensations in the mouth are either absent or limited to a small burning sensation at the site of lesion. The mucous membrane of the mouth or on the tongue can detect the lesion of keratosis (i.e. keratinization) whitish color. It is formed exactly by a layer of cells, unlike plaque, for example, candidiasis, and not removed by the tools. Leukoplakia on the tongue in the form usually looks like an oval or round shaped spots, usually on the lateral surface. The mucosa of the cheeks is affected in the form of the dash line, coinciding with the line of occlusion.
Such a white line is found in patients constantly and many doctors accepted as the norm. However, in reality, is a manifestation of a simple leukoplakia, and if not treated, to observe its development is a must! The chamber in the form of sprocket may be located where the ends of the tooth row, typically due to injury retromolar region of the wisdom tooth.
In addition to these forms, the lesions can have any other, often wrong pattern to branch out. Around whitish lesion inflammatory signs — redness, you may experience swelling.
This form is the development of a simple leukoplakia. In addition to the presence of the lesion can be symptoms such as dry mouth, roughness of the mucosa, felt by tongue, cause discomfort, especially when talking. Also there is the symptom of a burning sensation.
When plaque form foci rise above the surface, rough, have clearly defined boundaries. Warty species is lumpy formations on the mucosa of the mouth.
Typically, this lesion is located near the traumatic factor, feels very dense, it is impossible to collect mucous in the crease. Color can be a white to be bright, straw-yellow color. Pearlescent sheen that is present early in the disease, gradually lost the plot becomes cloudy, which means the progression of the process. If the lesion leukoplakia darkened — the probability of transition to the malignant form is very high.
Under the microscope it is possible to determine the marked thickening of the epithelial sheath. In the study under the fluorescent light emission is yellowish in benign course, with malignancy, it becomes purple. In the study of cellular material is determined by the degeneration of the nuclei. Histology shows thickening, expansion of the surface layers with a high content of keratohyalin protein, contributing to cornification. Deep layer of connective tissue extends considerably into the damaged epithelial layers, manifests inflammation, friability, swelling.
Ulcerative and erosive leukoplakia
Expressed clinical picture is of great concern to patients, forcing them to go to the doctor with complaints of pain, burning, soreness, enhanced by the irritation of the mucous membranes. Bleeding can also occur, although not always.
In the language or mucous of visible erosion, usually up to 5 millimeters in diameter. Under the action of the sun or in the cold leukoplakia on the red border of the lips of the long-term healing, particularly as a result of self-medication. Lymph nodes usually without pathology.
Erosive-ulcerative leukoplakia of the oral cavity with the luminescent study has a brown glow. Under the microscope, keratinized alternate with defects of the epithelium. On Cytology, there are many young, immature cellular elements. On histology, significantly thickened layers, including through the expansion of intercellular spaces. The loose epithelium, in cells on multiple cores. Formed strands jutting out into the deep to be connective tissue. In place of the erosion areas of the epithelium are absent. Blood cells responsible for immune response, are present in the lesion in large numbers.
As a rule, the development of this variant of the disease triggered by common factors such as nervous exhaustion, depression, overload, injury, mental health and similar problems. Contribute to the emergence of foci of leukoplakia bad habits — Smoking, biting of the lips, cheeks, drinking too hot beverages, alcohol. The occurrence of these factors is most typical for people young and middle age, that distinguishes this variant from that described above. Leukoplakia of the mucous membrane is manifested by failure of the compensatory mechanism, in which degenerative processes drastically predominate over regeneration. Histological analysis revealed that the most affected epithelial layer, in which cells lose the basic structural elements, vacuolated, that is filled with liquid.
Foci of keratinization appear as a result painless susiana mucous, you may feel a roughness, a slight thickening of the fabric. A number of patients may note the reduction of taste or temperature sensitivity, as an incidental symptom. Distinguish between limited and diffuse form, depending on the volume and distribution of lesions. White foci of keratinization in this form can be removed with a spatula, they can be easily separated from the surface. Another difference from the typical forms lack the inflammatory component.
If a typical picture of the main complaints of dryness in the affected area. Affects the cheeks, corners of the mouth, lips (mostly the bottom), the side surface on the tongue, the bottom of the cavity, palate, gums. In the study of smears of epithelial cells are present in large numbers, as nucleated and non-nuclear. Glow bluish, irregular. Somatoscope epithelium reveals a grayish-white color, located in a thin layer, resembles a sponge.
Diffuse loss gives a sense of discomfort when wybuchowa rough areas of thickening interfere with conversation. The manifestations of both are found in all typing for the disease places on the mucosa. Comparison with a washcloth can be applied to the appearance of the mucosa, even to the naked eye. Lips diffuse form affects virtually always flakes of exfoliated epithelium constantly.
The atypical form is misleading in the absence of patient complaints characteristic of leukoplakia. As a rule, appears a little atypical leukoplakia raised white line in the diffuse variant of total defeat of mucous membranes, severe clouding. Connective tissue under study has a marked vasodilatation, stasis, swollen collagen fibers and thickened, fragmented elastic.
In 1949, this form was first described, although mention of the symptoms was found a century earlier. Smoking causes disease by a combination of chemical and thermal influences. The most dangerous substance in the destruction of nicotinic resin is pyridine is the strongest carcinogen. The main impact falls on the mucous membrane of the hard and soft palate, this peculiar localization of leukoplakia Tappeiner. Initially, white spots, gradually becoming brown, then black color due to constant exposure to tobacco smoke. The excretory ducts of the salivary glands in this form are similar to the bumps, soft in consistency, hyperemic.
If leukoplakia of the mouth is not moved in the malignant form, the cessation of Smoking will gradually reduce, and then complete disappearance of lesions.
In the histological picture is not marked changes in the connective tissue, that is, the pathology is superficial. Structural changes of the epithelium of the excretory ducts in advanced cases are transformed into squamous cell carcinoma.
Differentiation of leukoplakia
|Lichen planus.||Papules, creating drawings that resemble the leaves, the branches of the trees. On the skin are a characteristic itchy rash, from pink to sinusnogo color. Isomorphic response is also typical of lichen planus.|
|Lupus erythematosus.||Erythema on the face, ears exposed to the sun’s rays. Rays wood provoke white-blue glow of fires.|
|Hyperkeratosis border of the lips.||Areas do not rise, covered with thick scales, the damage does not extend beyond the vermillion border and the line separating it from the mucosa (the Klein line). Damage is usually limited to a thin white cushion.|
|Candidiasis.||Grey or white film that does not have a specific shape are removed with a tool, exposing bleeding surface. Cytologically detected the fungal pathogen.|
|Secondary syphilis.||Data history significantly help in diagnosis, but the papules in these diseases should be able to differentiate by their appearance. Is no inflammatory rim, plaque is easy to remove by pokalyvanie. The study of the collected material can easily be found Treponema.|
|Cheilitis, Manganotti.||A precancerous condition that affects the red border of the lips. Around the lesion is tightly attached crust shrivelled the blood, their removal causes bleeding, healing does not occur.|
Erosive and verrucous forms have the greatest propensity to transition to tumor malignancy. Leukoplakia is the greatest danger to the development of cancer and requires urgent treatment. Some patients notes the presence of the disease for many years, which is not bothering and does not transformirovalsya since the advent of. Unfortunately, there are patients, the appearance of leukoplakia which fairly quickly moved to the stage of malignancy.
Symptoms of malignant transformation: increased keratinization, the seal at the base, erodirovannoj informed holistic the surface. Papillary growths, the rapid increase in size, the development of bleeding — all these alarming symptoms that require immediate medical intervention. To cure leukoplakia in benign condition much easier both physically and psychologically. The lack of effect of treatment requires consultation of an oncologist.
If any of the forms of the disease, whether the leukoplakia of the red border, mucous membranes or tongue, treatment should be integrated, only then will it be effective. When the diagnosis of a leukoplakia treatment, as a rule, given more time.
- The first and foremost step is to eliminate all triggers and irritants. For this adjusted diet of the patient, conducted a comprehensive reorganization — elimination of inflammatory lesions, cavities, unsound fillings and dentures. New dentures done after the treatment of the mucous membranes, carefully trying it on and adjusting the design.
- If there is suspicion about the presence of common factors that lead to the disease, should consult a physician and a specialist, e.g. endocrinologist or gastroenterologist.
- Useful when any of the forms of leukoplakia to conduct vitamin therapy, paying special attention to vitamins A, E and group B. Often justified the use of sedatives, such as Valerian root, motherwort tincture and the same.
- With a flat form of local treatment is limited to applications oil solutions of vitamins.
- Verrucous form is treated by use of application or injection solutions of the anesthetic and surgical excision. Successfully used the method of cryoablation.
- Erosive-ulcerative form is treated depending on stage and lesion size, as a rule, and keratinization anti-inflammatory drugs (such as solcoseryl dental), the ineffectiveness also resorting to cryotherapy.
- A mild form of leukoplakia requires a comprehensive approach, possibly with the use of psychotherapy. Locally applied the same means as when the erosive form, sometimes with the use of acid mucopolysaccharides (e.g., Moronic).
In some cases, effective treatment by helium-neon laser.