Leukoplakia – Causes, Diagnosis and Treatment

Hello and welcome to our podcast series!

My name is MeghannDrella and I am a Senior Solutions Manager here at Outsource Strategies International. Today I will be discussing how to report leukoplakia.

Leukoplakia refers to a condition wherein thick, white or grayish patches or lesions appear inside the mouth. Typically, these white or grayish patches develop on the bottom of the patient’s mouth, inside the cheeks and even on the patient’s lips – which is caused by excess cell growth. These lesions can vary in appearance but are typically white or gray and have thick, raised edges with a hard surface. There is no single or definitive cause for leukoplakia. Tobacco use of any kind is one of the most common influencing factors in the development of the condition. In fact, people who smoke are six times more likely to develop leukoplakia. Mild cases of leukoplakia patches are harmless and often get cured on their own. On the other hand, more severe cases may be linked to oral cancer and must be treated promptly. Regular dental care habits can help prevent its reoccurrence. As medical billing and coding for this condition involves several challenges, physicians need to have adequate knowledge on how to document the procedures correctly in the medical records.

Generally, most cases of leukoplakia lesions are non-cancerous, though some show early signs of cancer. The condition is marked by unusual-looking patches inside the patient’s mouth. These patches can have an irregular shape, are white or gray in color, thick, with a hard or raised surface, hairy/fuzzy with red spots and these patches cannot be rubbed or scraped away. These may take several weeks to develop and are rarely painful. Red spots, in most cases, may be a potential sign of cancer. Hence, it is important to consult a dentist or a primary care professional as soon as unusual, persistent changes arenoticed.

As mentioned, the exact cause of leukoplakia is unknown. Chronic irritation from tobacco and other related products – whether smoked, dipped or chewed can be considered one of the top causes. The lesions or patches commonly appear inside the mouth of chain smokers or users of smokeless tobacco products. Other associated causes include – uneven teeth, injury to the inside of the cheek (such as from biting), dentures, jagged, broken or sharp teeth rubbing on the tongue surface, inflammatory conditions of the body, sun exposure to the lips and long-term alcohol use. Another common type of leukoplakia called hairy leukoplakiaprimarily affects people whose immune systems have been weakened by disease, especially HIV/AIDS.

Leukoplakia is not usually painful and may go unnoticed for a while.Most cases occur in men in the group of 50 -70 years old. Less than 1 percent of cases are seen in patients under the age of 30 years. Common symptoms include –

• Appearance of raised, red lesions
• White or grayish patches
• Irregular or flat-textured
• Thickening or hardening in areas

Diagnosis of symptoms usually starts with an oral exam. As part of the oral exam, the dentist or primary physician may examine the patches in the patient’s mouth and attempt to wipe off the white or gray patches in order to confirm whether the patches are leukoplakia.In some cases, people mistake these patches as the condition for oral thrush – a yeast infection of the mouth. Dentists may also evaluate the patient’s previous medical history and other risk factors for this condition. They may need to do other tests to confirm the cause of the spots as this helps them to recommend a treatment modality that prevents the reoccurrences of patches. If the condition of leukoplakia is confirmed, the dentist will most probably testfor early signs of cancer by performing an oral biopsy and excisional biopsy.

Treatment for this condition becomes most successful when a lesion is found early and treated early, when it is small. Regular checkups are important to inspect the patient’s mouth for areas that look quite abnormal. In most cases, these grey or white patches improve on their own and don’t require any specific treatment. However, if the patient’s condition is related to irritation from a dental problem, the dentist may be able to treat this issue.

If the lesions show early signs of cancer, the treatment may involve removing patches immediately as this helps prevent the cancer cells from spreading. Patches can be removed by using laser therapy, a scalpel, or a freezing procedure.Antiviral medications may be prescribedwhichcan suppress the Epstein-Barr virus, which is the cause of hairy leukoplakia.

Practicing good oral hygiene and stopping activities that damage or stress the mouth lining are the best ways to manage and prevent leukoplakia. Some of the common prevention strategies include – stop smoking and chewing tobacco, stopping the consumption of alcohol, eating antioxidant-rich foods, avoiding abrasive dental hygiene products, such as whiteners and rinses, keeping mouth wounds clean, attending routine dental exams and maintaining dental hygiene.

Medical billing and coding for dental disorders can be complex, as there are different documentation rules and medical codes associated with the conditions.

I hope this helps but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for joining me and please stay tuned for my next podcast!