In most patients with frictional keratosis, the cause is easily identified.

An oral habit of cheek biting, cheek chewing, tongue thrusting, or mucosal

sucking can often be identified as the cause if the site of the lesion is carefully
examined in relationship to the occlusal plane.
An ill-fitting, rough, or broken removable dental prosthesis or orthodontic
appliance or a fractured or irregular tooth surface frequently affects the
adjacent soft tissues.
Occasionally, a frictional keratosis lesion may develop as a result of the
constant rubbing of an external object, such as a tobacco pipe; a musical
instrument; or, perhaps, a worker's tool, which, for convenience, is held in the
mouth for long periods.
Another cause may be manipulation of the tissues with long fingernails, which
may shred the mucosa.
Improper toothbrushing and other oral hygiene aids affect the attached
gingival tissues.
Irritation from masticatory function may cause frictional keratosis when the
alveolar mucosa and retromolar pad bear the stresses of eating. When
lesions occur at these sites, they are referred to as alveolar ridge calluses.
Pregnancy may significantly increase the risk for cheek biting.
In rare cases, the overuse of topical anesthetics, overuse of antiseptic
mouthrinses, or oromucosal delivery of medications (eg, cannabis) causes
keratosis from chemical irritation.
chronic friction against an oral mucosal surface, resulting in a hyperkeratotic
white lesion, analogous to a callus on the skin. The lesion is a protective
response to low-grade, long-term trauma. When the friction occurs along the
buccal mucosa in the line where maxillary and mandibular teeth contact each
other, it can produce a white line called linea alba.