Linea Alba of the Buccal Mucosa: Initial Management
Linea alba of the buccal mucosa is a benign frictional keratosis that requires no active treatment in most cases—the primary approach is reassurance and elimination of mechanical trauma sources.
Understanding the Condition
Linea alba is a white horizontal line along the buccal mucosa at the occlusal plane, caused by chronic friction or pressure from teeth, cheek biting, or nocturnal bruxism. This is a benign hyperkeratotic response to mechanical trauma, not a pathological lesion requiring intervention 1.
Initial Management Approach
Identify and Eliminate Trauma Sources
- Have a dental team evaluate for sources of mechanical trauma, including ill-fitting dental prostheses, fractured teeth, or sharp dental restorations 2
- Assess for parafunctional habits such as cheek biting (morsicatio buccarum) or nocturnal teeth grinding that create the frictional stimulus 1
- Consider a bite guard if bruxism or nocturnal grinding is suspected as the causative factor 1
Patient Reassurance and Education
- Explain the benign nature of linea alba—it is not premalignant and does not require aggressive treatment 1
- Counsel patients to avoid conscious cheek biting or tongue thrusting against the buccal mucosa
- Advise that the lesion will resolve once the mechanical irritation is eliminated 1
Basic Oral Hygiene Measures
While linea alba itself doesn't require treatment, maintaining good oral hygiene prevents secondary complications:
- Brush teeth twice daily with a soft toothbrush using the Bass or modified Bass method 2
- Use alcohol-free mouthwash at least four times daily for approximately 1 minute 2
- Maintain adequate hydration to keep oral mucosa moist 2
When Treatment May Be Considered
If the patient experiences discomfort or the lesion becomes symptomatic (rare):
- Hydrogen peroxide rinses may help reduce hyperkeratotic buildup in symptomatic cases 1
- Topical corticosteroids (triamcinolone 0.1% in Orabase) are generally ineffective for frictional keratosis but may be tried if inflammation is present 1
Critical Pitfall to Avoid
Do not confuse linea alba with leukoplakia or other potentially malignant white lesions. Key distinguishing features of benign linea alba include:
- Location strictly along the occlusal line corresponding to tooth contact 1
- Bilateral and symmetric presentation 1
- Ability to scrape away superficial layers without bleeding or pain, revealing normal underlying mucosa 1
- No induration, ulceration, or erythema 3, 4
If the white lesion deviates from these characteristics, has irregular borders, shows erythema, or appears unilateral, biopsy is mandatory to rule out dysplasia or malignancy 3, 4.