White lesions are the pathological changes seen in the oral cavity involving the soft tissues like buccal mucosa, palatal mucosa, tongue and floor of mouth. Here we can see a list of white lesions which are divided into 2 categories based on their property of being able to scrape of the lesion – Scrapable White Lesions and Non-Scrapable White Lesions and a list of lesions which cannot be scrapped off. White lesions are usually caused due to thickening of Keratotic layer or accumulation of non-keratotic material on the surface of the mucosa. Most white lesions are not cancerous and are most commonly due to repeated Trauma, the treatment for such lesions usually is removal of the source of trauma or its cause.
White lesions which can be scrapped off:
- Pseudomembranous candidiasis: “Milk curd” or “cottage cheese” appearance may leave a red base when rubbed off
- Morsicatio Buccarum: It is a chronic condition of buccal cheek chewing where the white surface appears to be peeling off
- Thermal burns: Food heated in microwaves cause this type of white lesion which are seen in the oral cavity. Because of the foods being cold on the outside and very hot in the inside.
- Sloughing traumatic lesion: It is also called as Cotton roll stomatitis which is caused due to rapid removal of cotton role from the tissue after it has adhered to it or the prolonged exposure of chemicals absorbed into the cotton role when in contact to the oral mucosa.
- Reaction to toothpaste or mouthwash: Filmy whiteness is seen leaving a normal appearance on mucosa when scrapped or rubbed off.
- Chemical burn: Asprin burn is the most common cause of chemical burn which is put in the oral mucosa to relieve tooth pain. Asprin is available in tablet form and also as a powder.
- Secondary Syphilis: Mucous patches are seen on the oral mucosa which are focal areas of intense exocytosis and spongosis of the oral mucosa leading to zones of sensitive whitish mucosa known as mucous patches.
- Diptheria: Gray white pseudomembranous layer seen on mucosa of oropharynx region.
White lesions which cannot be scrapped off:
- Leukoplakia: Benign Hyperkeratosis, epithelial dysplasia seen as white lesion covering the surface of oral mucosa.
- Leukoedema: Milky white lesions seen on the surface of buccal mucosa bilaterally. The white layer disappears when stretched
- Linea Alba: White layer seen along the occlusal line on the buccal mucosa.
- Tobacco pouch keratosis: Usually seen in mandibular vestibule, it is usually associated with use of snuff or chewing tobacco which is place in the buccal vestibule everyday
- Lichen planus: It is also called as Wickhams striae which is a white lesion seen bilaterally on the buccal mucosa.
- Actinic cheilosis: These are Pale, gray white, scaly alterations seen on the lower lip, usually in older men with history of chronic sun exposure, it is a potentially precancerous condition.
- Morsicatio: Most common location of the white lesion is on the anterior buccal mucosa, labial mucosa and lateral border of tongue which exhibits a ragged surface.
- White coated tongue: Dorsal aspect of the tongue is diffusely involved due to many reasons starting from fever to anu viral disease a white layer is seen covering the oral mucosa.
- Nicotine Stomatitis: White lesions seen on the hard palate which is usually associated with pipe smoking.
- Hairy leukoplakia: Leukoplakia which appears as white hairy overgrowth
- Usually seen on the lateral border of tongue, rough surface with vertical fissures are seen associated with hiv infection.
- Hyperplastic Candidiasis: A clinic feature of candidiasis which usually involves the anterior buccal mucosa.
- Lupus Erythematosus: Resembling lichen planus and leukoplakia seen most commonly on the buccal mucosa with skin lesions associated with it.
- Oral submucous fibrosis: Affected mucosa shows a Blotchy, marble like pallor with a progressive stiffness of subepithelial stiffness giving it the white appearance. Caused due to betel quid chewing.
- White spongy nevus: Generalized lesions most commonly involving buccal mucosa which is hereditary and shows onset of lesions in childhood.
- Hereditary benign intraepithelial dyskeratosis: Hereditary onset in childhood generalized lesions are seen more commonly on buccal mucosa
- Pachyonychia congenita: Hereditary onset in children most commonly seen on the Dorsal surface of tongue and in areas of trauma, nail, palmar and plantar changes are also seen.
Diagnosing of White lesions and Identifying them can be life saving in some cases, as some white lesions are pre-cancerous and early diagnosis can help in prevention of the benign lesion turning cancerous.
Hi, i have oral thrush, should i be wiping the white lesions that are on my inner cheeks and lower lips regularly.
If you are taking medication and you are not feeling any pain or discomfort while scrapping off the white patches, yes you can. Do not forcefully or put excess pressure which might lead to any lesion to form in the location.
Hello sir i have a very small little whitish ulcer like spot under my tongue from last 2 weeks …which is not painful no swelling there its just like spot ….is there a possibility of cancer??..i m really worried
It is better to get a biopsy to rule out any malignancy (cancer). Visit a Dentist and get the biopsy done to make sure that it is not malignant lesion and the treatment can be planned accordingly.
hello sir,
since last two year i am not consuming tobacco . its because during the year 20015 i noticed a white patches on my right cheek . following which i underwent for biopsy at apolo hospital chennai by doctor ramakrishna. the result of biopsy was normal and no caution has prescribed by doctor. now during the month of december 2017 i notices white patches on lateral side of tongue and little bit of on the tongue. i shown to the local doctor as its not posssible for me to reach out chennai .. i have conculted with two doctor. one of them said this is epithelial changes nothing to worry keep under check and given some oxidant.
the second doctor who was private examined and he ruled out the changes of leukoplakia. and given some ointment for oral thrush.. but i am very much worried about it .. continue referring over net to know what it could be .
there is no pain in the patches . and after certain interal of time it become more whitish and while rubbing the patches got removed without. as i am really examining there is no progress . although the size remian constant and i have quit the tobacco . the small patches on the tongue have changes its colour .
kindly suggest me possible what could i do to get rid of the mental trauma that i am facing because of these .
anand prakash
andaman nicobar island
hello sir,
since last two year i am not consuming tobacco . its because during the year 20015 i noticed a white patches on my right cheek . following which i underwent for biopsy at apolo hospital chennai by doctor ramakrishna. the result of biopsy was normal and no caution has prescribed by doctor. now during the month of december 2017 i notices white patches on lateral side of tongue and little bit of on the tongue. i shown to the local doctor as its not posssible for me to reach out chennai .. i have conculted with two doctor. one of them said this is epithelial changes nothing to worry keep under check and given some oxidant.
the second doctor who was private examined and he ruled out the changes of leukoplakia. and given some ointment for oral thrush.. but i am very much worried about it .. continue referring over net to know what it could be .
there is no pain in the patches . and after certain intevral of time it become more whitish and while rubbing the patches got removed without pain. as i am really examining there is no progress . although the size remain constant and i have quit the tobacco . the small patches above the tongue have changes its colour becoming lighter .
kindly suggest me possible what could i do to get rid of the mental trauma that i am facing because of these . i am waiting for your response please
anand prakash
andaman nicobar island
insaneconstable1@gmail.com
As you mentioned that the white patches were removed after rubbing it can be Oral Thrush or Candidiasis which shows this feature. In some cases as you are seeing it on the lateral side of the tongue, trauma from any sharp tooth can also cause traumatic ulcer which is red in the beginning and turns white when it becomes chronic. As Leukoplakia is ruled out and you have quit smoking there are less chances of it being anything malignant. So be positive and make sure you get a proper diagnosis.
thank u very much sir for ur respond .. one more thing i want to ask ..that is it possible that the oral thrush could occur on palate . roof of the mouth and similarly as in the cheek. as i also have projected small size on the roof of the mouth but as i said its also not causes any pain or probelem to me .. but its not like the patches on the tongue which c0mes out after rubbing. when i touch by tongue i felt it .
Hi, i recently got high and smoked an entire pack of cigs and then went to bed with a dry mouth. Woke up with a huge sore under my tongue and lost a lot of taste buds on the tip of my tongue. The sore under my tongue on my frenulum is peeling now and is all white like dead skin. What should i do?
Yes, one of the most common sites of Oral Thrush lesion is on the roof of mouth or Palate
That is something which can only be diagnosed on visual inspection. From what you are saying it appears to be a Burn (Asprin Burn is similar to your description). It is however best to get it checked once to get a clear diagnosis.
Hi Doctor,
I have soft white patches on both sides of my entire cheeks (All places). Both cheeks are completely uneven and white to milky white in some places.
Additionally, On the right side of my cheek, i can see a line from my beginning of lip to the middle.
I had a sore throat for 2 weeks and antibacterial medicine sorted that out.. this happened exactly few weeks before this incident.
Question:
– Is this a symptom of Linea Alba or leukoplakia
– Will leukoplakia come at the same time on both the side of the cheek or entire mouth
It’s kind of very light and thin white patches which gets peeled off after eating food… Its in my both cheeks.
Is it normal or???
I have light white kinda patches in both my cheeks… It’s get peeled off after eating normally.. is it normal or I should be serious about it?
Does it leave any red lesions after getting peeled off ??
I have wrinkled patch inside my lower lip and it keeps peeling… I am three months free from smokeless tobacco?
Cannot comment on the lesion without having a look at the lesion Tom.
Hi Doctor, I’ve noticed that my mouth and the underside of my tongue has been irrated and burning for a few weeks. There are white patches under my tongue that I can scrape off with no bleeding. I also have a white patch that I can’t scrape off on my cheek from biting my cheeks. I am extremely worried that I have cancer. One of my x-boyfriends had his tongue removed from oral cancer. I’m afraid I got a cancerous HPV virus from him. I have an appointment in two weeks to see a general doctor. I’m wondering if I should get in sooner and request a biopsy. Would it hurt to wait another two weeks if it was cancer?
Scrapping of white lesions on tongue suggests Candidiasis infection, whereas the lesion on your cheek can be HPV as you are suggesting your boyfriend has a history of HPV. It is better if you rush the appointment as early as possible and to get it cleared. Two weeks can be a long time aiding in spread of infection.
Sir, I have a white patch on the left side of my tongue.i was chewing panmasala and now I have quitted chewing panmasala. Every day after brushing I am scrapping the white patch and it is removing. I want to know what’s is the white patch?
If the white patch is scrapable and you are able to scrape it off, then it most likely appears to Oral Candidiasis which is a Fungal infection having this trademark symptom. If you are having all the other symptoms like dry corner of the mouth, cracked lips, constant bad taste in mouth then it is best to visit a Dentist or even your General Physician can help in treating the condition.
Hello, Doc Varun, I am a seventy three year old male from Dwarka, Delhi. For many months now, I have an un-scrappable one cm. painless white lesion on my lower front right jaw. I never chewed tobacco and don’t drink either. Cigarettes I had left over 12 years ago. Otherwise my teeth & gums have been quite Ok. No family history of it.
I have started applying Tess ointment.
Request advice from you.
Regards
DV Sharma
Hi,
Over the last 2 weeks I have had a faintly white patch on the inner surface of my lower lip which is very slightly raised and feels different to the rest of my oral mucosa. There is also a very small lump underneath the skin on the side of the patch which is movable. The whiteness can often be rubbed away but the raised patch and lump still remains. I don’t smoke. I feel like this doesn’t match the description of many of these lesions. Any advice?
As you do not have any habit, it might most likely be Traumatic Lesion such as a Traumatic Fibroma which resembles a white lesion and is caused due to prolonged Trauma to the site. If it is a Traumatic fibroma, it is a simple procedure to remove the lesion and as a precautionary measure a Biopsy is preferred to rule out any malignancy.
It can also be a Mucocele as the location (Inside of Lower Lip) is its most common position. It being movable lump is also a trademark sign of Mucocele.
Hello sir….there is a white patch on my lower lips which when i peel off leaves a reddish skin…i chew tobacco and i m concerned that is it leukoplakia or due to the reaction of thoothpaste sfs..please reply
If it is the first time and it is small it can be a burn leading to whitening of the soft tissue, else it can be either Leukoplakia as you have a habit of tobacco chewing. It is best to get it checked by a Dentist to clear any doubts and cure it early.
Sir i got white patch below tongue , and it is scrappable easily without giving any redness,,but it occurs again. Is it leukoplakia?
Is the lesion present only below your tongue or in anyother area of the mouth as well ?
sir h have a small white patch on gums of forward two teeth..the patch is not visible on the back side of that same gum…i tried to rub slightly with toothpick and portion of it has come out..
it is painless and not spreading.
is it an serious issue to look for?
Is the white patch present only in this one place or there are other white patches visible elsewhere?
If only a part of it has scrapped off, it rules out Oral Candidiasis. Do you have any habits like smoking, pan or ghutka chewing ?
It’s only in one place.
I do somoke one cigarette a day but never chewed gutka or pan.
it can be Leukoplakia and if its small it can be easily removed either by Laser or excision of the lesion. Its better to get it checked by a Dentist and clear it out.
We can get a clear Idea if we can see an image of the lesion, but the final diagnosis can be done on Physical examination only.
does it clear out out on it’s own?
i got it checked with dentish, he said its nothing to worry.
but its been more than a month and that whitish layer was skin was still there..so i tried rubbing it and upon removal is a normal skin.
is there a chance if its leukoplakia it will grow again?
does it clear out out on it’s own?
i got it checked with dentist, he said its nothing to worry.
but its been more than a month and that whitish layer was skin was still there..so i tried rubbing it and upon removal is a normal skin.
is there a chance if its leukoplakia it will grow again?
Hey doctor I have a fleshy price of skin attached to the side of my uvula it doesn’t hurt or anything but it’s there I just wanan know what it could be
How many days or months has it been since it is visible ? Is there any difficulty in swallowing ? It is difficult to comment without having a look at it.
Good afternoon, I have a history with genital hpv and am afraid my symptoms orally may be related. Had burning in the mouth, tongue, etc. sensitive to spicy things.
I have bucal mucosa lesions that I can wipe away with my finger nail. Some areas are slightly more stubborn. When I do this, it leaves a raw area.
Have been on candidiasis medication orally, but haven’t noticed a huge difference. Tested negative for all other stds. I have what appear to be swollen glands underneath tongue in the floor of mouth. I sometimes get peelingish skin on gums around teeth. This can often be scraped away.
Doctors don’t really have much of an answer. I’m scared personally.
I thought leukoplakia can’t be scraped off!? I see a few comments here people sha it wipes away but you suggest it could
Be leukoplakia.
Leukoplakia cannot be scrapped off, on the other hand Candida Albicans or Oral Thrush can be scrapped off.
The peeling of Skin and leaving a raw area when done so typically is seen in Cancidiasis. The other symptoms like burning in mouth tongue and sensitivity to spicy things if not related to any particular lesion can be associated with “Burning Mouth Syndrome” which is triggered by Stress or lack of sleep and subsides by itself.
Thanks. I have to scrape hard with my fingernail to get it off and not all of it comes off. Still sound like it’s not leukoplakia!?
Thanks again for what you do on here by answering such questions