Oral & Maxillofacial Surgery

Support Group - Facts - Mouth Patches

White Patches

White patches in the mouth

Consultant Maxillofacial Surgeons deal with all kinds of facial and oral lesions, one of which is white patches in the mouth.

What is a white patch?

A white patch is an area of thickening in the mucosa (or the skin) that lines the mouth.

A white patch can be situated anywhere in the mouth and may be of any size. Usually they cannot be 'scraped' away.

What causes a white patch?

White patches are almost always due to some form of irritation.

• Infection
• Trauma and friction
• e.g. ill-fitting dentures
• cheek biting
• sharp teeth or fillings
• Chemical irritation
• e.g. aspirin burns
• smoking

There are also some types of white patches that may develop without any easily identifiable cause.

Types of white patches

Lichen planus

Lichen planus is a common condition which can affect the skin lining of the mouth, especially the cheeks and gums. It can also sometimes occurs on the skin of the arms and legs.

There are different types of lichen planus, but the commonest appears as a white lace-like pattern. Sometimes it can look like a white patch, red patch, or even like an ulcer.

Occasionally, the lichen planus changes in colour, size and shape. In about 20% of cases, it will simply disappear on its own, but will usually take many years. Commonly, it never goes away, but does not cause any problems.

Frictional keratosis

This is very common within the mouth and is due to regular friction mostly from teeth and dentures. It may appear as a thin white line across the side of the cheek (called linea alba), or as a discrete white patch anywhere in the mouth, but particularly on the gum or cheek. It should disappear if the source of irritation is removed.

Smokers keratosis

This is a white patch that may or may not be in an area subject to friction, in a person who is a smoker. Commonly, it occurs on the roof of the mouth as a white 'tile-like' pattern with little red spots. It is believed that the chemicals in the cigarette smoke induce inflammatory reactive changes in the skin lining the mouth. We will usually recommend that you cease or at least greatly reduce your smoking.

Fungal infection (oral thrush)

This fungal infection (called oral candidiasis) can appear throughout the mouth as attached thick white patches. The organisms involved are normally present in the mouth but can occasionally cause an infection. It is more common in people with diabetes, depressed immune system, asthmatics on steroid inhalers and the elderly. Treatment is with the use of antibiotic tables and topical mouthwashes or creams.

Management of white patches

Diagnosis and biopsy

Occasionally, we may choose to take a biopsy. This is done under local anaesthetic by taking a small piece from the patch and then placing a few dissolvable stitches. The area may be a little sore for a couple of days and you should rinse your mouth with warm salt water for a week to keep the area clean.

Removing possible causes

• Smooth sharp teeth
• Remake or reline dentures
• Eradicate infection
• Cease tobacco smoking

Providing symptomatic relief

Occasionally, white patches may become sore. If this is the case, it is important to avoid anything which makes it worse, such as spicy or abrasive foods and alcohol. We can arrange special mouthwashes or ointments for you to make things more comfortable if it becomes a problem.

Leukoplakia

Leukoplakia

This is a term given to those white patches that do not fit into any of the above categories. Depending on the biopsy result, we may choose to completely remove the patch or keep a watch over it if it is a cause for concern. We will discuss this with you in more detail.

Should I be worried?

White patches are most commonly due to come type of irritation and so are not a cause for concern. Occasionally, they can be a sign of early sinister changes. This is why it is important to remove possible causative factors.

Review appointments

It is important that you attend these appointments which are usually spaced about three to twelve months apart. This is to check that the white patch has not changed. If you think that it has changed, or if it becomes painful of forms an ulcer, simply ring and make an appointment with your local Maxillofacial Surgeon sooner.

© OMFSAboutFace 2009