Leukoplakia usually occurs on your gums, the insides of your cheeks, the bottom of your mouth — beneath the tongue — and, sometimes, your tongue. It isn't usually painful and may go unnoticed for a while.

Leukoplakia may appear:

• White or grayish in patches that can't be wiped away
• Irregular or flat-textured
• Thickened or hardened in areas
• Along with raised, red lesions (speckled leukoplakia or erythroplakia), which are more likely to show precancerous changes

Hairy leukoplakia

Hairy leukoplakia causes fuzzy, white patches that resemble folds or ridges, usually on the sides of your tongue. It's often mistaken for oral thrush, an infection marked by creamy white patches that can be wiped away, which is also common in people with a weakened immune system.

Although the cause of leukoplakia is unknown, chronic irritation, such as from tobacco use, including smoking and chewing, appears to be responsible for most cases. Often, regular users of smokeless tobacco products eventually develop leukoplakia where they hold the tobacco against their cheeks.

Other causes may include chronic irritation from:

• Jagged, broken or sharp teeth rubbing on tongue surfaces
• Broken or ill-fitting dentures
• Long-term alcohol use

Your dentist can talk with you about what may be causing leukoplakia in your case.

Hairy leukoplakia

Hairy leukoplakia results from infection with the Epstein-Barr virus (EBV). Once you've been infected with EBV, the virus remains in your body for life. Normally, the virus is dormant, but if your immune system is weakened, especially from HIV/AIDS, the virus can become reactivated, leading to conditions such as hairy leukoplakia.

Tobacco use, particularly smokeless tobacco, puts you at high risk of leukoplakia and oral cancer. Long-term alcohol use increases your risk, and drinking alcohol combined with smoking increases your risk even more.

Hairy leukoplakia

People with HIV/AIDS are especially likely to develop hairy leukoplakia. Although the use of antiretroviral drugs has reduced the number of cases, hairy leukoplakia still affects a number of HIV-positive people, and it may be one of the first signs of HIV infection.

Leukoplakia usually doesn't cause permanent damage to tissues in your mouth. However, leukoplakia increases your risk of oral cancer. Oral cancers often form near leukoplakia patches, and the patches themselves may show cancerous changes. Even after leukoplakia patches are removed, the risk of oral cancer remains.

Hairy leukoplakia

Hairy leukoplakia isn't likely to lead to cancer. But it may indicate HIV/AIDS.