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White spots or patches appearing on the gums can have a range of causes -- and the symptoms and cures will depend on the diagnosis.
Generally speaking, there are four dental conditions that can result in these patches or spots developing. Some are easily treated with medication while others will need the attention of a dentist or oral specialist.

The four main culprits that cause white patches or spots are canker sores, oral lichen planus, oral thrush and leukoplakia.

Canker Sores

Causes - The precise cause of canker sores remains unclear but experts suspect that bacteria, improper diet, oral irritation or injury and even stress may all be contributory factors.

Symptoms - Often referred to as mouth ulcers, canker sores are round or oval shaped with a red edge and have either a white or yellowish centre.

Cure - Most minor cases of canker sores will generally clear up within one to two weeks without treatment. More persistent cases will need to be discussed with a dentist who may recommend a mouthwash or an over-the-counter medication.

Oral Lichen Planus

Causes - As with canker sores, there is no exact cause for oral lichen planus but experts believe it may be an autoimmune reaction to oral infections or injury to the teeth. Other possible causes include an autoimmune disorder or reactions to medications or certain materials.

Symptoms - Oral lichen planus causes inflammation of mucous membranes in the oral cavity which can cause white lace-like patches or red swollen patches to appear. These sores can sometimes peel or blister and be accompanied by burning sensations or pain. In some cases, there can also be discomfort or slight pain when speaking, chewing or swallowing.

Cure - There is no cure for this chronic condition but it can be controlled with proper treatment. This focuses on healing any sores or lesions and relieving any pain or discomfort.

If white spots on the gums are the only issue, then treatment may not be necessary but more severe issues may require the use of topical numbing medications for pain relief or corticosteroids to reduce inflammation.

Oral Thrush

Causes - Also called oral candidiasis, the condition occurs when an imbalance between good and bad bacteria in the mouth allows for the growth of the candida albicans fungus. This imbalance can be be caused by a number of factors including:

  • A weakened immune system
  • Diabetes
  • Diseases such as leukaemia and AIDS
  • Vaginal yeast infection during pregnancy
  • Certain medications may also reduce the amount of good bacteria in the body.

Symptoms - Oral thrush is typified by the presence of raised sores which are cream or white in appearance and have a soft cheese-like texture.

Cure - Treatment is aimed at preventing the fungus from spreading -- but the underlying cause must also be explored to prevent a recurrence.

Many topical medications including tablets, lozenges and mouthwashes are widely available and a dentist or doctor can recommend which may work best on an individual basis.

Leukoplakia

Causes - Another cause of thick, white spots or patches on the gums, the inner cheeks, in the mouth and (occasionally) on the tongue is leukoplakia. Like other dental issues that cause white patches, the exact cause is unknown but the use of tobacco products and the excessive intake of alcohol are the chief suspects.

Symptoms - In many ways leukoplakia is very similar to oral thrush with symptoms including patches or spots that are:

  • White, grey or grey-white in colour
  • Thick to the touch or slightly elevated
  • Coarse or hard in texture

Although leukoplakia patches are generally painless, they may be sensitive to heat, touch, irritation or spiced food.

Cure - Treatment will vary depending on the underlying cause. Smokers will be encouraged to quit or cut down as will heavy drinkers.

If the condition is caused by irritation from rough teeth or ill-fitting dentures, this issue will need to be resolved. If the root problem cannot be rectified, it may be necessary to have the patches surgically removed by a dentist or oral specialist.

A Reason to Smile

In the vast majority of cases white spots and patches are nothing to worry about -- and will either clear up on their own or are easily treatable. It should be noted, however, that some very isolated cases of leukoplakia can be an early indication of cancer.

White or cream spots are most common but occasionally the lesions may be red in colour (called speckled leukoplakia) and these may be cancerous growths.

Pre-cancerous leukoplakia is called dysplasia which can be mild, moderate or severe. Severe cases are most likely to develop into cancer and the diagnosis will determine the best course of treatment.

Whatever the size, shape, colour or location of white patches or spots they should never be simply ignored and always brought to the attention of a dentist or doctor.

As is the case with any physical ailments, it is good practise to keep the teeth, gums, tongue and mouth in the best condition possible by following a good dental health regimen and scheduling regular appointments with a dentist.

Sources:
https://www.medicalnewstoday.com/articles/321454

https://www.colgate.com/en-us/oral-health/mouth-sores-and-infections/white-gums

https://www.webmd.com/oral-health/guide/dental-health-leukoplakia