(Leukokeratosis buccalis; Leukoplakia buccalis; Leukoma; Leukoplasia; Ichthyosis linguae; Psoriasis of the tongue; Tylosis linguae; Smokers’ patches; Chronic superficial glossitis).
Definition. A disease of the buccal mucous membrane, especially involving the tongue, characterized by one or more rounded or irregular, often diffused patches with a white color, variable degree of thickening and fissuring.
Symptoms. The earliest stage of leukoplakia, lasting for weeks or months, may be appeared by some sensitiveness to acid and hot foods and may appear as a slightly reddened patch, sometimes with exaggerated papillae. This objective manifestation is so slight that it frequently escapes observation until it develops into a white or opaline spot. When fully developed, the disease presents one or more, variously shaped, glistening, bluish, grayish or ivory white patches, which feel more or less rough to the touch and are sometimes warty or fissured. They may excite salivation, lessen the mobility or give a sense of stiffness to the part. These lesions are seldom painful unless they become dense enough to form deep cracks and excite some degree of inflammation, thus giving rise to soreness, pain, ulceration and sometimes to cancerous degenerations. Usually the course of leucoplakia of the mouth is very slow, often taking years to fully develop and commonly proving rebellious to treatment. Rarely the lesions may undergo resolution without local applications and they may or may not recur after removal or disappearance. The regions, commonly affected, are the dorsal and lateral surfaces of the tongue; the inner surface of the cheeks on a line with the junction of the teeth when pressed together; the gums adjacent to the lateral incisor and canine teeth; the mucous fold alongside the floor and roof of the mouth and gums; and rarely the vulva, vagina, glans penis and urethral orifice.
Etiology and Pathology. This disease occurs almost exclusively in the months of middle-aged men. So many cases have followed syphilis or have developed in the mouths of those who use tobacco that these factors have long been considered etiological. However, non-syphilitics and those not addicted to the tobacco habit suffer as well, so there must be other causal elements. Probably most cases originate from some irritation whether local or constitutional. No matter what opinion is held concerning the essential cause of leukoplakia, all are agreed that sharp, rough or decayed teeth, gastrointestinal disorders, the smoking and chewing of tobacco, alcoholic drinks, highly-seasoned, hot and acid foods and rheumatic and gouty diathesis are contributing factors.
It is not clearly known whether the primary pathological change is a pure hyperkeratinization of the superficial epithelium or an inflammation of the papillary layer of the corium. The horny layer is hyper-trophied, the cells retaining their nuclei. In the derma, inflammatory infiltration and partial obliteration of the papillae are found.
Diagnosis of leukoplakia is usually easy. However, buccal lesions of lichen planus or the mucous patch of early syphilis might prove confusing. Lichen planus of the mouth may closely resemble leukoplakia, but lesions of the former usually occur in linear, festooned or ring shapes of a silver-white color and do not always occupy the points of election of the latter. Characteristic lichen papules or their effects may be usually found on the skin. Syphilitic patches of the mucous membrane may be distinguished from leukoplakia by their softness, quicker development and tendency to ulceration. A history of infection and subsequent cutaneous lesions will aid in diagnosing syphilis.
Prognosis and Treatment. If leukoplakia becomes well developed, it is sure to be persistent and rebellious but a majority of the cases are curable because they seek the physician early and follow his advice. The danger of epitheliomatous degeneration must be borne in mind.
Causal and physiological methods of treatment are essential to a cure. Absolute abstinence from tobacco and irritating articles of food or drink should be required. The teeth should receive careful attention and all existing departures from health should be corrected by physiological living and remedial treatment adapted to the general or special needs of each case. Local treatment includes the regular use of soothing sprays or lotions containing myrrh, potassium chlorate, mucriated iron, boric acid, balsam of Peru, menthol or iodized phenol. For actively destructive purposes, I prefer fulguration, X-raying and thermocauterization (especially the galvanocautery) in the order named. Besides electrical cauterization, chronic acid, lactic acid, silver nitrate, solidified carbon dioxide and innumerable chemical caustics have been employed with varying success. Thorough excision under surgical auspices, erasion with the dermal curette or with the burr of the dental engine, ionisation of various mildly destructive agents and electrothermic coagulation have given good results in several instances. I always endeavor to prescribe internally for these cases and have seen good results follow the administration of Apis, Belladonna, Bryonia, Kali bich., Nitric acid and Rhus tox.