Management of Linea Alba of the Buccal Mucosa
Linea alba of the buccal mucosa requires identification and elimination of mechanical trauma sources, combined with basic oral hygiene measures—no active treatment is necessary as this benign condition resolves spontaneously once the causative irritation is removed. 1
Identify and Eliminate Mechanical Trauma
The primary management strategy focuses on removing the source of chronic irritation:
Have a dental team evaluate for ill-fitting dental prostheses, fractured teeth, or sharp dental restorations that may be causing mechanical trauma to the buccal mucosa. 1 These are the most common culprits that create the white keratotic line along the occlusal plane.
Counsel patients to stop conscious cheek biting or tongue thrusting against the buccal mucosa. 1 Many patients are unaware of this habitual behavior, which perpetuates the condition. 2, 3
For patients with persistent cheek biting habits despite counseling, consider fabrication of a cheek guard appliance to prevent entrapment of buccal mucosa between teeth during chewing. 4 This is particularly useful in patients with reduced mouth opening or those who cannot control the habit.
Basic Oral Hygiene Protocol
Once mechanical sources are addressed, maintain oral health with these measures:
Brush teeth twice daily with a soft toothbrush using the Bass or modified Bass method. 1 This prevents secondary complications without causing additional mucosal trauma.
Use alcohol-free mouthwash at least four times daily for approximately 1 minute. 1 Alcohol-containing products can cause additional irritation to the already traumatized mucosa.
Maintain adequate hydration to keep oral mucosa moist and promote healing. 1 Dry mucosa is more susceptible to trauma and slower to heal.
Key Clinical Pitfalls to Avoid
Do not confuse linea alba with other white oral lesions such as leukoplakia, lichen planus, or candidiasis. 2, 5, 3 Linea alba has a distinctive shredded or macerated appearance along the occlusal line and corresponds exactly to where teeth contact the cheek.
Do not biopsy or treat aggressively—this is a benign condition that resolves with removal of the irritant. 2, 3 Misdiagnosis has led to inappropriate corticosteroid therapy in some cases. 3
Recognize that most patients are unaware of their cheek biting habit and will not volunteer this information. 3 Direct questioning about parafunctional habits is necessary.
Expected Outcome
The condition typically resolves within days to weeks once the mechanical irritation is eliminated and proper oral hygiene is maintained. 4 No pharmacological intervention is required for uncomplicated linea alba.