Dear Dr. Mady: I have a bad habit of chewing on the inside of my cheeks inside my mouth. I have been doing this for about 5 years and the other day I looked in my mouth and it looks like a thick white line on each side where I have been chewing. What can it be and is it cancerous or dangerous? Joan in Harrow

Dear Joan, What you are describing is known as Linea Alba. It is a fibrous, white-colored protrusive benign (non-cancerous) thickening of oral mucosa along the chewing line of your mouth. It can not only be caused by chewing of the cheeks but also by habitual sucking of the mucosa against the teeth. It is sometimes created by having a habit of constantly pushing the cheeks between the teeth with a finger while gently biting on the buccal tissues (ones outside of the fronts of the teeth). Sometimes this is happening without the person even realizing, or maybe during your sleep at night.
            These horizontal white streaks are always in line with where the upper and lower teeth come together, level with the biting plane. A similar linear line of excess keratin may be found along the lateral edges of the tongue. Linea Alba are usually noted bilaterally on both sides and are restricted to where the teeth come together. They are generally nothing to worry about but you should still try and “kick the habit”. They can be compared to a callous on your hand or foot (its oral counterpart) from constant repeated rubbing, only softer due to the moist environment that they are present in. They are sometimes technically called frictional keratoses.
            In most cases Linea Alba caused by chewing is initiated by a stressful situation in ones life and after it just continues as a habit. It is much more common in females than males and especially over the age of thirty.  Linea Alba has also been noted more often in individuals that chew tobacco and in those cases it is sometimes mistaken for oral cancer until a biopsy is taken because many clinicians manage this as a premalignancy. This cheek biting habit may produce aching facial or tongue muscles or dysfunction of the temporomandibular joint.
            Although there is generally no treatment unless the white lines get extremely thick, there is one possible solution that I tell my patients about. This involves wearing a sports mouthguard or occlusal night guard that people wear for grinding teeth in their sleep. It can be worn even during the day except while eating to help rid of these annoying white thickenings,. Basically avoiding the area will make it go away. The lines will usually disappear within a few days or weeks after the constant trauma is removed. If they stay longer than two months without trauma, see your dentist for a referral to an oral surgeon for a biopsy.
Normal eating does not create Linea Alba however it can be worsened from eating after the process is initiated from chewing the inside of the mouth. Even though it may be annoying, it is not a real big problem and trying to reduce stress in your life will be the first step in getting rid of it.          

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This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5


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