Leukoplakia: what is it and how is it treated in dentistry?

There are three types of leukoplakia, which are sequential forms of development of the same disease:

• flat leukoplakia - looks like a whitish film that cannot be removed mechanically. Depending on the location and duration of the disease, the color can vary from white to dirty gray. The surface of the lesion is dry and rough; slight redness of the integument may develop along the perimeter;
• verrucous leukoplakia - develops at the next stage and looks like whitish plaques or warty growths. This stage of the disease is precancerous - without proper treatment, the tumor may degenerate into malignant;
• erosive leukoplakia is characterized by ulcers and cracks that appear against the background of one of the two previous stages of the disease. Of the three stages, only at this stage does the patient experience pain.

Leukoplakia of the oral cavity: causes of the disease

The reasons causing the development of the disease include:

• Smoking. When using tobacco, the oral cavity is exposed to various irritants, including thermal (incoming smoke has a temperature of about 60 degrees Celsius) and chemical (nicotine, tar and combustion products). No less dangerous is chewing tobacco, which is also a provoking factor.
• Eating either very hot or very cold food on a regular basis for a long time.
• Mechanical trauma (bad bite, sharp edges of teeth, orthopedic structures installed with violations).
• Metal seals that cause galvanic currents.
• Inhalation of vapors of gasoline, benzene, varnishes and paints, as well as other resins.
• Hormonal imbalance, constant stress and lack of retinol.

What is HIV? What is HIV infection

The human immunodeficiency virus, or HIV, was identified and described relatively recently. Invading the human body, it primarily affects macrophage cells and T-lymphocytes, which are responsible for recognizing and destroying hostile bacteria. Thus, the body's immune barrier loses its ability to resist both external bacterial attacks and internal opportunistic flora.

The immunodeficiency virus is transmitted exclusively through sexual contact or through direct contact of a healthy body with infected blood. Transmission of the virus through household or food contact is impossible.

HIV infection is a slow-onset disease caused by a virus and occurs against a background of suppressed immunity. It can take years from the introduction of the virus to the clinical manifestations of the disease. During this entire period, the virus does not manifest itself in any way, and its presence can only be diagnosed using a laboratory method.

Symptoms

The first signs of the disease often go unnoticed because they do not cause any pain or discomfort in the patient. Nevertheless, a specialist will be able to determine the onset of leukoplakia by the appearance of the mucous membrane, lips and the area where the teeth meet.

The first sign of the disease is the appearance of a keratinized gray area, which can appear on the palate (in smokers), in the corners of the mouth, on the inside of the cheek, etc. An easily removable white plaque forms in this area, but after a few days the formation makes itself felt again . The patient may feel tightness in the mouth, but, as practice shows, most people simply do not pay attention to this.

Plaques with a diameter of no more than 4 centimeters are formed. They may appear:

• on the inner surface of the cheeks;
• on the tongue (on the back or sides);
• in the sky;
• on the gums;
• in the corners of the mouth.

The process of plaque formation takes up to one month. At the first stage, the area of ​​the future formation seems slightly swollen; when you feel it with your fingers, the compaction is not felt. However, over time, another symptom of oral leukoplakia appears - the mucous membrane at the site of the swelling loses its original shine and becomes rough, which is noticeable when touched.

There is no pain in this case: only sometimes a feeling of dryness at the site of the outbreak is possible.

Gradually, the color of the spots changes from gray to bright white. The spots in most cases have clear boundaries. Their increase is possible when the disease enters its second stage, called verrucous.

The disease often causes candidiasis and malignant cancers. In an advanced state, leukoplakia is very difficult to treat: the affected areas become even more keratinized, ulcers can form, and the infection gradually spreads to other areas of the mouth.

How to treat hairy leukoplakia

Before starting treatment, you need to conduct a number of studies. The patient is referred to a therapist at the clinic. There, the doctor can prescribe laboratory tests: biochemical blood test, testing for sexually transmitted diseases, etc.

If a person is diagnosed with HIV infection, antiretroviral therapy is administered. With long-term use of drugs, the patient’s well-being improves, and the disease in the mouth goes away.

The dental clinic provides oral examinations, dental diagnostics, and professional hygiene. If sharp edges of fillings or failed prostheses are detected, they are replaced. Treatment of caries and its complications is carried out. Recommendations are given for home dental care: personal hygiene products (brushes, pastes, dental floss, rinses) are selected.

Keratolytic drugs are suitable for local treatment. In advanced cases, they resort to surgical manipulations: excision of the affected areas with a laser.

Kinds

• The most common is simple or, as it is also called, flat leukoplakia . It is usually discovered by chance during an examination by a dentist, since the patient does not experience any subjective sensations. A burning sensation occurs extremely rarely, and the appearance of the mucous membrane may change. If the disease affects the tongue, loss of taste may occur.

• Hairy leukoplakia of the tongue resembles stomatitis. The shape of the spot that appears, as well as its size, can be different, the color - from pale gray to white. The surface of the mucous membrane at the site of the lesion becomes slightly rough, which can be felt to the touch. On the cheeks it appears as solid or broken lines. It can also be found on the lips, where it looks like thin paper pasted on.

• Verrucous leukoplakia is the second stage of the development of the disease. The keratinization thickens, the affected area seems to rise above the nearby tissues. When you touch it with your fingers, you feel a compaction.

• Erosive form . Untimely diagnosis of the two previous stages of the disease leads to a worsening of the situation - the person feels pain when exposed to any irritants, erosions or ulcers are visible in the mouth.

• Soft leukoplakia is a type of cancer. Its distinctive feature is peeling of tissue in the area of ​​the lesion. To clarify the diagnosis, a histological method of studying cells is required.
• Tappeiner's leukoplakia . This form of the disease affects people who abuse smoking. According to studies, daily smoking 10 cigarettes a day increases the chance of developing the disease by 50 times (as the number of cigarettes increases, the risk also increases)

The disease begins with the formation of lesions on the roof of the mouth (sometimes they appear on the gums). The mucous membrane changes its color to a pronounced gray or bluish, which is noticeable to the naked eye, folds appear on it. Reddish nodules may begin to appear, which is accompanied by infectious inflammation of the oral cavity (caused by the accumulation of salivary gland secretions in the tissues).

Diagnosis of the disease

Diagnosis of leukoplakia is carried out by a dentist. To make an accurate diagnosis, it is necessary to use laboratory and instrumental studies. The most important stage of diagnosis is a biopsy of the lesion and subsequent histological analysis.

It is very important to conduct a laboratory diagnosis of HIV, and also to exclude diseases such as oral candidiasis, condyloma, hypertrophy of the oral papillae, genital warts and mucosal keratosis before making a diagnosis of hairy leukoplakia.

Diagnosis of oral leukoplakia

Treatment of any disease begins with diagnosis: leukoplakia is no exception in this regard.

During the examination, the doctor interviews the patient to determine the factors contributing to the development of the disease. These include regular exposure to tobacco smoke, working in hazardous conditions, recent dental surgery, etc.

Next, laboratory tests are prescribed. The following procedures can be carried out:

• tissue sampling (biopsy). Accompanied by anesthesia;
• examination of the collected material under a microscope. The method allows you to determine the presence or absence of cancer cells in the formation;
• a smear of the mucous membrane is taken;
• A Schiller test is done (the mucous membrane is stained with a solution consisting of water and iodine - foci of leukoplakia are not stained);
• blood is taken for analysis (an increase in ESR may indicate the presence of malignant neoplasms).

In addition, the doctor may additionally prescribe a urine test, conduct a biochemical blood test and request the result of fluorography. You may need to consult an oncologist (if cancer is suspected), a therapist (to rule out infectious diseases) and a dermatologist (to look for other foci of disease).

Epidemiology

The only source of infection is a person infected with this virus. The most dangerous are those who do not have any clinical manifestations: virus carriers are the main source of the spread of HIV infection among the population.

During a dental appointment, infection can occur in the following cases:

• when using medical instruments contaminated with blood or other biological fluid that have not been disinfected (various devices, discs, burs, probes, needles, syringes, cutting and piercing instruments, etc.);
• in the presence of wound surfaces and ulcerations in the oral cavity;
• in case of extensive contamination of the skin of healthcare workers with blood, blood getting into the eyes;

There are known examples of infection during acupuncture treatment.

(There is no airborne transmission of infection.)

The immunodeficiency virus is found in the highest concentration in the blood. Next in descending gradation are sperm, vaginal and cervical secretions of the glands, breast milk, and saliva. Blood and other specified biological fluids are factors in the transmission of HIV from an infected person to other persons.

The virus is moderately resistant outside the human body. In the external environment (biosubstrates), its infectious effect lasts up to 2 weeks, in a dried state (discharge on linen, objects, etc.) - up to 1 week. Radiation exposure and ultraviolet rays do not affect it. When boiled, the virus dies within 5 minutes; when heated to 56°C, inactivation occurs after 30 minutes. Disinfectants used in the practice of medical institutions (chloramine, calcium hypochloride, hydrogen peroxide, alcohol, etc.) in concentrations provided for the disinfection of hepatitis viruses are guaranteed to destroy HIV upon direct contact of the disinfectant with contaminated blood or other human biological fluid on the surface of an object, including a hollow one ( internal surfaces of the syringe, needles, capillaries, probes, etc.).

Leukoplakia of the oral cavity: treatment with medications

Treatment involves the complete elimination of irritating factors that led to the development of the disease:

• to give up smoking;
• grinding down sharp edges of teeth;
• sanitation of the oral cavity;
• replacement of fillings;
• use of products to protect the surface of the lips.

Additionally, a course of vitamin A is prescribed, lasting at least a month, which inhibits the process of tissue keratinization.

If the measures taken do not cause complete disappearance of the manifestations of the disease, surgical intervention is allowed: the lesion is excised, depending on the degree of development of the disease, cryodestruction or electrocoagulation is used.

Ulcers deserve special attention, as they can develop into cancerous tumors. For their treatment, drugs are prescribed that enhance the process of tissue regeneration and epithelization. If there is no positive dynamics, surgical intervention cannot be avoided.

A person with leukoplakia must constantly visit the dentist for examination to prevent malignant degeneration of the cells.

In addition to quitting smoking, the patient’s diet is adjusted: during treatment, spicy and too salty foods are excluded from the diet, and it is recommended to eat more vegetables and fruits.

Drugs prescribed:

• products that restore the epithelium (the most effective was 30 percent tocopherol acetate, which is applied to damaged areas three times a day for 15 minutes, after which it is washed off with water);
• antiseptics (after each meal it is recommended to rinse your mouth with a solution of chlorhexidine at a concentration of 0.05%);
• analgesics (their use is justified in the presence of pain. Lidocaine, applied to the mucous membrane before meals, has worked well).

Under no circumstances should you use drugs that have an irritating effect, as otherwise this can lead to the formation of cancer cells.

If there is no improvement within a couple of weeks, surgery is prescribed: this can be either excision with a scalpel or the application of cold in the form of a liquid stream of nitrogen.

Prevention

To date, there are no specific preventive measures for hairy leukoplakia, which is caused by the Epstein-Barr virus. However, measures to prevent infection with any viral infection include the use of barrier methods of contraception, avoidance of promiscuous sexual intercourse and regular blood tests.

Other forms of leukoplakia can be prevented by following these rules:

• regularly visit the dentist, identify and treat inflammatory diseases of the oral cavity;
• install high-quality dental fillings, dentures and braces;
• Take care of your oral cavity regularly, in addition to brushing your teeth, get rid of bacterial plaque using mouth rinses, use dental floss after meals;
• prevent injury to the oral mucosa;
• promptly identify and treat chronic and autoimmune diseases;
• stop smoking and drinking alcohol;
• Do not abuse spicy and salty foods, introduce foods rich in protein and fiber into your diet.

Natural prevention should include measures to strengthen the immune system, such as hardening, playing sports, and walking in the fresh air. It is necessary to follow a daily routine, eat well, avoid stress and nervous overload.

As it became clear, the appearance of atypical formations on the tongue is an alarming sign. It should alert a person and force him to immediately consult a dentist in order to avoid complications and the disease progressing to an advanced form, fraught with the development of oncology. Patients over 50 years of age, suffering from chronic diseases and having a weakened immune system should be especially attentive to their health.

Oral leukoplakia: how to treat it at home

In addition to drug treatment, oral leukoplakia can be treated with traditional medicine.

There are many recipes, here are just the main ones:

• rinsing with herbs (infusions of oregano, chamomile, ginseng and other adaptogens that reduce the inflammatory process and increase the body’s resistance to harmful factors are suitable);
• regular consumption of nuts and tinctures based on them;
• rinsing with decoctions of calendula, St. John's wort, eucalyptus. Alternation works well - once the oral cavity is rinsed with a soda solution, after a couple of hours - with an infusion of herbs. This procedure should be repeated at least 5 times a day;
• lubricating the lesions with sea buckthorn and olives (the fruits must first be mashed in your hands so that the juice appears).

Timely detection of the disease and compliance with all doctor’s recommendations is the key to recovery in the shortest possible time and reducing the risk of complications. If you start treatment at the initial stage, you can reduce the likelihood of complications to almost zero.

Diagnosis for suspected HIV infection

For differentiated diagnosis of HIV infection from similar dental diseases, the following tests are used:

1. Blood test for PCR reaction (aimed at detecting HIV).
2. Immunoblotting technique.
3. Linked immunosorbent assay.
4. Checking immune status.

If the results are unclear, additional blood tests, as well as bacteriological studies, may be prescribed. Early diagnosis of the root cause of diseases can significantly alleviate the course of the disease.