Oral leukoplakia: an update for dental practitioners

Abstract

Statement of the problem Oral leukoplakia (OLK) is a common mucosal pathology frequently encountered in general dental practice which belongs to a group of conditions known as oral potentially malignant disorders (OPMDs). This inferred risk of progression to oral squamous cell carcinoma warrants an understanding of the etiology of this condition, its clinical presentation, and how patients diagnosed with OLK are managed in both general and specialist care practices. Purpose of the review To update the dental practitioner on the current understanding concerning the diagnosis and management of OLK. Methods A search strategy was conducted in the MEDLINE Ovid and Embasse databases and the Cochrane Library. No time limit was applied. The search results were limited to those in the English language. Discussion The etiology for oral white patches can range considerably from innocuous frictional keratosis to oral squamous cell carcinoma. A thorough history and clinical examination should precede referrals to secondary care, with the elimination of risk factors a priority. In cases where white patches are suspicious or remain despite managing known risk factors, prompt referral to a specialist centre is warranted. Despite the extent of research in this field, controversy remains in OLK management and there is currently no agreed international consensus on the management of OLK from governing bodies. Therefore, management is primarily governed by local contemporaneous guidelines, and management is based on the most reliable predictor of malignant transformation: the grade of dysplasia. Despite various treatments, OLK may still undergo transformation to malignancy. Conclusions General dental practitioners (GDPs) are the health care practitioners best placed to detect OLK on a daily basis, given the volume of patients encountered from various backgrounds. An understanding of the causes and presentation of OLK will allow GDPs to recognise this entity in practice, and facilitate further management and treatment in a bid to prevent transformation.