What causes a white lacy pattern inside your cheek?

You're running your tongue along the inside of your cheek and there it is: A pattern you're sure wasn't there before, and now you can't stop checking it. In many cases, it's oral lichen planus, a condition that affects the lining of the mouth, but other mouth problems can look similar. A dental provider can examine the area and help you find out what is causing it. 

What you will learn in this article: 

• Fine white lines that look like lace or a web may be a sign of oral lichen planus. 

• The lines may cause little discomfort or appear beside red, sore areas. 

• A white patch that lasts longer than two weeks should be checked. 

• A dental provider may recommend a small tissue test if the cause is unclear. 

If you have noticed a white, lacy pattern inside your cheek, schedule an appointment with an Aspen Dental provider. Your care team can examine the area and explain what to do next. 

What does a white lacy pattern look like? 

The American Academy of Oral Medicine describes oral lichen planus as fine white lines that cross like a net or web. Dental providers call this a reticular pattern. The lines may sit slightly above the nearby tissue and often appear inside the cheeks. They may also affect the tongue or gums and can appear on both sides of the mouth. 

Some people have only white lines. Others also develop red, worn-looking or open areas that may burn or feel sore. Hot, spicy, acidic or rough foods can bother these sensitive spots.¹ 

What causes the white lacy pattern? 

The exact cause of oral lichen planus is not fully known, but the immune system appears to play a role. It is not contagious and does not spread from one person to another.¹ 

A similar-looking change, called a lichenoid reaction, can be linked to a medicine, mouth-care product or metal in a filling. Tell your dental provider about any new medicines, toothpaste, mouthwash or dental work.¹ 

Not every white or raised area is oral lichen planus. Biting the inside of your cheek may leave a rough mark instead of lacy lines. A soft lump inside your cheek or lip is another type of change. A white coating on your tongue may also have different causes. 

If you have a filling that changed color or feels rough against your cheek, point it out during your visit. 

When should a white patch be checked? 

The National Institute of Dental and Craniofacial Research advises seeing a dental provider or doctor if a white or red area, sore, lump or thickened spot remains for more than two weeks. The screening should not hurt and is usually over within a few minutes. Your dental provider may examine your face and neck before looking at your lips, mouth and throat. If anything unusual is found, you may need another test or a visit with a specialist.² 

These signs can have many causes, so needing an exam does not mean you have oral cancer. However, getting a lasting change checked is the safest way to find its cause. 

How is a white lacy pattern diagnosed? 

Your dental provider will look at the pattern, where it appears and whether other areas of your mouth are affected. Be ready to discuss when you first noticed it and whether you recently started a medicine or changed an oral-care product. 

Sometimes an exam is enough to suggest oral lichen planus. If the diagnosis is uncertain, MedlinePlus notes that a dental provider or doctor may remove a very small piece of tissue for a lab to examine. This test is called a biopsy. Symptoms may ease and then return over a long period, so your care team may recommend follow-up visits.³ 

What should you do if you notice a lacy white pattern? 

Do not scrape, peel or pick at the area. Instead, note when you first saw it and whether it changes, spreads, bleeds or becomes painful. A clear photo may help you track changes before your appointment. 

A checkup can help you get a clear answer. If a white pattern inside your cheek concerns you, contact your local dental provider to have it examined. 

What causes a white lacy pattern inside your cheek? FAQs 

Still have questions about a white lacy pattern inside your cheek? These answers cover a few common concerns. 

Is oral lichen planus contagious? 

No. Oral lichen planus does not spread through kissing, sharing food or other contact. 

Can stress make the pattern worse? 

Stress alone cannot tell you what caused the pattern. If you notice changes during stressful times, write them down and discuss them with your dental provider. 

Does the pattern hurt? 

It depends on which type you have. The lacy white lines by themselves often go unnoticed, but if red or open areas develop alongside them, pain can range from mild burning to soreness that makes eating uncomfortable. 

Can the pattern go away? 

It may fade and return over time. Even if it improves, follow the care plan and checkup schedule your dental provider recommends. 

Can food or oral care habits bother the area? 

Yes, especially anything with sharp edges, strong spices or high acidity. Track which foods trigger discomfort so you can avoid them, and mention the pattern to your dental provider before starting a new toothpaste or mouthwash in case it's a lichenoid reaction rather than lichen planus. 

Sources 

¹ American Academy of Oral Medicine, Patients, Patient Condition Information: “Oral Lichen Planus.” https://www.aaom.com/index.php?Itemid=171&id=123%3Aoral-lichen-planus&option=com_content 

² National Institute of Dental and Craniofacial Research, Health Info: “Oral Cancer.” https://www.nidcr.nih.gov/health-info/oral-cancer 

³ National Library of Medicine, MedlinePlus, Medical Encyclopedia: “Lichen planus.” https://medlineplus.gov/ency/article/000867.htm