Oral mucosal white lesions

White lesions are not necessarily sinister or dangerous, particularly if they have remained in the same spot, unchanged, and without notice for many years.

New white lesions are interesting to the doctor, and maybe be hallmarkers for changes that may not all together be good for you. Your doctor will usually go to some length to determine what a white lesion means in you, and importantly to make a distinction between whether it is good... or bad.

Mucosa is normally pink in colour, with variations in shade, quality and transparency. The colour and type of mucosa changes subtly from point to point in the mouth.

If you look into a normal mouth, you will notice many different shades of "pink" ranging from near white over the palate and gum margins, to blue beneath the tongue, and a deep red in the very bases of the sulci (recesses between the lips and teeth) and at the back of the throat.

Off-white represents an abnormal change in light refraction of the mucosa, and usually occurs as the mucosa becomes thickened with a moist overlying keratinised layer, and which obscures the underlying pink-red capillary bed. You can see these changes easily when you keep your finger tips immersed in water for a long time. The surface keratin of your skin becomes saturated with water, thickens, and the light diffusion characteristics change making your finger tips appear abnormally white.

There are many reasons for hyper-keratinisation of oral mucosa. They include scars, candidiasis, lichen planus, leukoplakia, and unfortunately also cancer.

All white lesions should be specialist assessed for possible causes.  Most causes will be minor and of no concern.  However early detection of a potentially debilitating lesion can improve treatment success rates and allow for less invasive treatment regimes.