TREATMENT OF LEUKOPLAKIA
is a condition commonly considered potentially pre- Cancerous. People with leukoplakia are typically middle-aged and older adults; men are more likely than women to develop the disease. Causes
of leukoplakia are considered to be smoking, tobacco betel chewing, and alcohol, chronic irritants like sharp edges of teeth, irregular denture surface, or fillings. Reports have found that low dietary levels of vitamin C and fiber and vitamiA or, according to one study, many different nutrients including vitamin Bcomplex, are associated with an increased risk of leukoplakia.
The goal treatment of leukoplakia mainly involves avoidance and 1.Removal
of Predisposing factors
like Smoking, Tobacco Betel chewing, Alcohol The usual treatment for leukoplakia is to remove the predisposing factors. For most people, stopping smoking or alcohol consumption clears the condition. When this isn''t effective or if the lesions show early signs of cancer, remove leukoplakic patches by other means. 2 . Removal of chronic irritants
like sharp edges of teeth, irregular denture surface, or fillings with sharp margins. Removal of the source of irritation is important and may lead to disappearance of the lesion. 3. Maintain the dietary level of nutrients
Elimination of the causative factor and periodic clinical inspection are most acceptable regimen for most patients with simple leukoplakia. Definive Treatment of leukoplakia includes 1. Removal of causative factors and maintaining the dietary levels of nutrients
2. Medical Management.
3 Surgical Management
4 Fulguration with electrocautery
6 Carbon dioxide Laser Therapy
1. Removal of causative factors
and maintaining the dietary levels of nutrients
1. Removal of causative factors like stopping, alcohol consumption, Betel chewing, smoking, and use of tobacco and removal of the source of Irritation like sharp edges of teeth, irregular denture surface, or fillings.
2. Maintaining the dietary levels of nutrients that is used, to prevent Leukoplakia to occur and to promote treatment to complete include, Vitamin A,Vitamin C ,Vitamin E, Betacarotene,Lysene ,vitamine Bcomplex 2 Medical Treatment
includes 1. Topical medications.
2. Systemic medications 1 Topical medication.
1. Green tea, mixture of whole green tea, green tea polyphenols, and green Tea pigments painted on the lesions three times per day for six months.
2. Retinoids — derivatives of vitamin A: Retinoic acid, a vitamin A Derivative, seems to inhibit the replication of the Epstein-Barr virus (for the Treatment of hairy leukoplakia
3. Podophyllum resin solution: Podophyllum solution is a mixture obtained from the dried rhizomes and roots of two common plants. When applied topically, It can heal leukoplakic patches, but it may cause some discomrt and affect your Sense of taste. In addition, the patches often return several weeks after being treated.
5.Fluconazole for the treatment of candidal type 2 systemic Treatment
1.Beta-carotene 150,000 IU of beta-carotene twice per week for six months significantly increased the remission rate
2.vitamin A derivative, isotretinoin, and 13-cis retinoic acid: 28500IU per day
3. Combination of beta-carotene (150000 IU per week and vitamin A(100000 IU per week)
4 Combination of betacarotene(50000IU) , VitaminC(1gram) and VitaminE (800IU) Per day for nine months
5. Lysine A lysine is an organic compound which is one of the 20 amino acids commonly found in animal proteins. . It is one of several essential amino acids needed in the diet; the human body cannot synthesize it from simpler metabolites. Young adults need about 23 mg of this amino acid per day per kilogram (10 mg per lb) of body weight. Lysine is found in particularly low Concentrations in the proteins of cereals; wheat gluten
6. Antiviral medication for the treatment of hairy leukoplakia, like, Oral Acyclovir (Zovirax), famciclovir (Famvir), and zidovudine (Retrovir). 3.Surgical Management
1. Surgical striping (leukoplakia of lip which causes esthetic problems)
2. Excision and primary closure, in case of small lesions.
4. Fulguration with electrocautery
Fulguration with electrocautery appliance is another treatment of leukoplakia.This procedure requires local or general anaesthesia.The healing process is slow and painfull. 5.Cryosurgery
Cryosurgery has several advantages over fulguration: application can take Place without an anesthetic, desquamation is completely no painful Process; during he healing phase there is absence of infection and pain; and the Wound is cleaner without foul odor The technique of cryosurgery consists of applying a disc type cryophobe to the moistened surface lesion that produces a very low freezing temperature in the tissue. The first freeze is for one minute followed by a five minutes thaw. A second one minute freeze is then administered. Freezing of the tissue produces a white area of necrotic tissue. 6 Carbon dioxide Laser Therapy
A carbon dioxide (CO2) laser uses CO2 gas. Watery tissue absorbs this type of laser energy, which doesn''t penetrate very deeply, but vaporizes surface cells. A CO2 laser leaves a residue of carbon, called char. If a dentist leaves char in place, it serves as a biological dressing, maintaining sterility.
Advantages of laser therapy include durable timely hemostasis, less stress for soft tissue, applications minimal anesthetic, immediate aesthetic, result fiber access to confined areas ,precise incision/excision, minimal requirement for anesthetic ,minimized requirement for sutures ,selective removal of diseased tissue ,enhanced healing less postoperative inflammation
Disadvantages of laser therapy include High cost, Needs protection of eyes, Delayed wound healing References
1.Text book of OMFS by Laskin
2.Surgery of mouth and jaws by:J R Moore
3Johnson J, Ringsdorf W, Cheraskin E. Relationship of vitamin A and oral leukoplakia. Arch Derm 1963;88:607–12.
5. Textbook of OMFS by Kruger