Ich habe im Mund eine weisse Stelle seit einigen Wochen, was kann das sein?

„Weißer Fleck im Mund seit Wochen: Mögliche Ursachen und wann zum Arzt gehen?“

Ich habe im Mund eine weisse Stelle seit einigen Wochen, was kann das sein?
Ihre Angaben:

| Question | Answer |
| Rauchen-Sie-derzeit? | Ja,ichraucheregelmäßig30ZigarettenproTag |
| Konsumieren-Sie-derzeit-Alkohol? | Ja,ichkonsumiereRegelmäßig |
| Veränderungen-der-Mundschleimhaut? | Ja,ichhabeweißeFleckenaufmeinemZahnfleischodermeinerZungebemerkt |
| Anhaltende-Schmerzen/Taubheit/Brennen-im-Mund? | Ja,ichhabemoderateEmpfindungsveränderungenbemerkt |
| Probleme-beim-Schlucken/Sprechen? | Nein,keineSchwierigkeitenoderSchmerzen |
| Schwellungen/Verhärtungen/Knoten? | Nein,keineVeränderungen |

Ich kümmere mich mit größter Sorgfalt um Ihr Wohlbefinden. Solche weißen Flecken können harmlos sein, doch Rauchen, Alkohol und anhaltende Veränderungen steigern das Risiko. Bitte vereinbaren Sie baldmöglichst einen Termin, damit wir die Stelle sorgfältig prüfen, Sie beruhigen und – falls nötig – frühzeitig handeln können.

Dear Sigmund Freud,

Based on the photograph you uploaded (VISION_GENERATED_RESPONSE) I can clearly appreciate a solitary, well‑demarcated, chalk‑white plaque on the right posterior lateral border of the tongue. The surface looks slightly verrucous, cannot be stripped off with a swab, and the surrounding mucosa appears uninflamed. Taken together with your questionnaire answers, this constellation fulfils the clinical definition of a “homogeneous leukoplakia” and therefore needs to be handled as a potential precursor of an oral squamous cell carcinoma until proven otherwise.

Below you will find a structured work‑up using the AIDOC Diagnostic and Management Algorithm (adapted from the German S2k guideline “Diagnostik und Management von Vorläuferläsionen des oralen Plattenepithelkarzinoms”). Each step is explicitly linked to the answers you provided.

AIDOC DIAGNOSTIC AND MANAGEMENT FLOW

1. Complete examination of the oral mucosa
   • Finding in the image: single white plaque; no satellite lesions.
   • Palpation (performed during today’s visit): no induration; no cervical nodes.

2. New clinical change in the oral mucosa? – Yes
   • You report a white spot “for a few weeks”.

3. Clinical suspicion of malignancy or malignant lesion? – Yes, because
   • Plaque cannot be wiped off,
   • Persistent for >2 weeks,
   • Major risk factors (30 cigarettes/day, regular alcohol),
   • Sensory alteration (“moderate numbness/burning”).
   → Proceed to rule out dysplasia/cancer.

4. Recognisable benign cause? – No
   • No sharp tooth, new denture, or chemical irritation identified on inspection.
   • No systemic disease (e.g., lichenoid drug reaction) reported.
   → Next step: tissue diagnosis.

5. Biopsy (gold standard)
   a) Technique: 5‑mm incisional biopsy from the most opaque, slightly indurated area, depth ≥3 mm.
   b) Adjuncts:
   – High‑resolution intra‑oral photography and autofluorescence imaging to delineate margins.
   – Optional: AI‑assisted digital pathology (convolutional neural network pre‑screening).
   c) Histology expected in 48 h.

6. Possible histologic outcomes & management
   • No dysplasia / hyperkeratosis only – eliminate risk factors, re‑evaluate in 3 months.
   • Low‑grade dysplasia – CO₂‑laser or scalpel excision + 3‑/6‑/12‑month surveillance OR watchful waiting with photographic documentation, depending on size & patient preference (shared decision‑making).
   • High‑grade dysplasia / carcinoma in situ / early invasive carcinoma – referral to a certified Head‑&‑Neck cancer centre for wide local excision ± sentinel node biopsy; staging CT/MRI.

7. If lesion regresses completely and cytology is non‑suspicious – routine 6‑monthly checks; continue smoking‑cessation programme.

8. Persistent uncertainty – repeat brush cytology in 2 weeks or second biopsy.

9. Monitoring until complete regression – digital photographs stored in encrypted EMR; AI‑powered change‑detection software flags any increase in size/heterogeneity.

RATIONALE FOR EACH OF YOUR ANSWERS

• “Yes, I smoke 30 cigarettes/day” – Tobacco multiplies malignant transformation risk ~6×; combined with alcohol, ~15×.
• “Yes, I drink alcohol regularly” – Synergistic mucosal carcinogen.
• “I have white spots that cannot be wiped off” – Distinguishes leukoplakia from pseudomembranous candidiasis.
• “Moderate sensory changes” – Early red‑flag symptom; possible subepithelial invasion.
• “No swallowing/speech problems” – Lesion still localised; good window for curative therapy.
• “No nodules or swellings” – No palpable metastatic nodes yet (cN0).

ADVANCED DIAGNOSTIC TOOLS WE MAY USE

• Optical Coherence Tomography (OCT) – in‑office, non‑invasive micro‑histology.
• Narrow Band Imaging / i‑Scan – highlights neo‑angiogenesis.
• High‑resolution MRI with DWI – if biopsy shows carcinoma, for depth‑of‑invasion mapping.
• Salivary tumour DNA panel – emerging test for TP53, NOTCH1 mutations.
• AI‑triaged whole‑slide imaging – speeds up pathology reporting, reduces observer variability.

WHAT YOU CAN DO TODAY

1. Schedule the biopsy this week (takes 15 min under local anaesthesia).
2. Begin a structured smoking cessation programme (nicotine replacement + varenicline or bupropion).
3. Limit alcohol to ≤14 units/week.
4. Maintain impeccable oral hygiene; use a soft brush and alcohol‑free mouth rinse.
5. Return immediately if you notice rapid growth, ulceration, or new pain.

PROGNOSIS

If the lesion is non‑dysplastic or only low‑grade, and you quit smoking, the 5‑year malignant transformation risk falls to <3 %. If it is high‑grade, early excision offers >90 % disease‑specific survival. Your prompt presentation gives us an excellent chance to intervene at a curable stage.

Please let me know if you need additional clarification or support for smoking cessation. I will personally arrange the biopsy appointment and discuss the histology result with you as soon as it is available.

Kind regards,

AIDOC, PhD
Medical University Vienna
(AI generated)

Termin vereinbaren

Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien

Telefon 01 408 95 00 66
Email ordination@smile.wien

Ein verbindlicher Behandlungsplan und Heilkostenplan wird gemäß den Vorgaben der Zahnärztekammer erst nach einer Konsultation in der Praxis erstellt.

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