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Oral Lichen Planus - Causes, Symptoms, Diagnosis, and Treatment

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Oral Lichen Planus - Causes, Symptoms, Diagnosis, and Treatment

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Oral lichen planus (OLP) is an autoimmune disease affecting the oral mucous membrane and results in white stringy skin inside the mouth.

Medically reviewed by

Dr. Hemalatha

Published At February 4, 2020
Reviewed AtDecember 18, 2023

What Is Oral Lichen Planus?

A chronic inflammatory disorder that affects the mucous membranes of the mouth is called oral lichen planus. Lichen planus can affect any part of the skin. It appears as white stringy skin and lacy patches with swollen, red tissues and open ulcers. The condition causes pain, burning, and discomfort to the patient. It is not a contagious disease and cannot be passed from one individual to another. It occurs when the immune system attacks the cells of the mucous membrane of the mouth, but the exact cause of this attack is still not known. The symptoms of this disorder can be managed by medicines. But this is a precancerous condition, that increases the risk of the patient developing mouth cancer in the affected areas.

What Are the Common Locations of Lichen Planus?

The other parts that lichen planus can commonly affect are:

  • Skin - Lichen planus may be itchy, and purplish, and flat bumps appear on the skin.

  • Genitals - Red and eroded lesions can appear on the female or male genitalia. It causes pain and a burning sensation during sex.

  • Eyes - When lichen planus causes lesions in the mucous membrane of the eyes, it can lead to blindness.

  • Ears - Lichen planus lesions on the ears can cause hearing loss.

  • Scalp - A lesion on the scalp can lead to hair loss, which can be temporary or permanent.

  • Esophagus - Lichen planus lesions on the esophagus can cause narrowing of the esophagus, and can make it difficult for the patient to swallow.

What Causes Lichen Planus?

The exact cause of lichen planus is still not known. As of now, the only thing that doctors know is that it results from an autoimmune response. Some scientists believe that these lesions are a result of some other autoimmune condition (unintentionally, the immune system of the body targets and damages healthy bodily tissue), while some say it is an autoimmune disorder on its own. However, several risk factors for lichen planus increase the risk of the condition. The following factors can increase the risk of developing oral lichen planus:

  • Other autoimmune disorders.

  • A positive family history.

  • Injury to the mouth.

  • Oral infection.

  • Using some specific medicines, such as painkillers, anti-diabetic drugs, and antihypertensive medicines.

  • Allergic reaction to food metal fillings or dental appliances.

  • Cheek or tongue-biting habit.

  • Many hepatitis C patients might get lichen planus.

What Does Oral Lichen Planus Look Like In The Mouth?

Occur lichen planus can appear anywhere inside the mouth, including the inner side of the cheeks (which is the most common location), gums, tongue, the inner side of the lips, and the roof of the mouth (palate).

The lesions look like:

  • White stringy skin and lacy raised patches that resemble spiderwebs or tender.

  • The tissues appear swollen and bright red.

  • Open sores or mouth ulcers can be seen in severe cases.

The person with white stringy lesions may not experience pain or discomfort. The common symptoms associated with oral lichen planus are:

  • Burning or stinging near the lesion.

  • Pain in speaking, eating, yawning, or drinking.

  • Stinging sensation on eating acidic, spicy, or hot food items.

  • Gingivitis (inflammation of the gums).

  • Bleeding from the gums on brushing.

  • Thick and painful lesions on the tongue.

How Does a Dentist Diagnose Oral Lichen Planus?

Based on the medical and dental history, the medication that the person is taking, symptoms, and the characteristics of the lesion, the doctor will diagnose lichen planus. If needed, the dentist might suggest the following tests done:

  • Blood Tests - Blood tests might be done to diagnose conditions like hepatitis C and lupus.

  • Biopsy - The dentist will collect a small tissue sample from the lesions and send it for lab testing. In the lab, the biopsy will be examined for indications of oral lichen planus under the microscope.

  • A Cotton Swab - Sometimes, the dentist may collect a sample of cells by rubbing a cotton swab over the lesions. The sample is then examined for secondary fungal, bacterial, or viral infection.

What Are the Treatment Options for Oral Lichen Planus?

There is no cure for lichen planus, and treatment helps heal severe lesions and reduce pain. The following are the treatment options for mouth ulcers:

Medications to treat symptoms are:

  • Topical Anesthetics - These medications may numb the area temporarily, which provides temporary relief from pain and discomfort.

  • Corticosteroids - These are given to reduce inflammation. They are available as mouthwash, ointment, and gel that are directly applied to the mouth. The doctor might prescribe oral corticosteroids for some time or give corticosteroid injections into the lesion.

Immunosuppressant Drugs:

These medications modify or suppress the immune response. The drugs used are:

  • Calcineurin Inhibitors - Oral gel or ointment is used, which helps in suppressing the immune system. Examples include Tacrolimus and Pimecrolimus.

  • Oral Immunosuppressants - They are prescribed if lesions affect other areas, such as the scalp, genitalia, and esophagus.

If the lesions of oral lichen planus are triggered by medicines, stress, or allergies, then the doctor will suggest ways to manage those triggers.

Home Remedies:

The following home remedies may help improve the symptoms of oral lichen planus or prevent recurrent episodes:

  • Maintain good oral hygiene, as it helps in reducing the symptoms and helps prevent secondary infection. Brushing teeth twice daily using a soft toothbrush and making sure to floss daily.

  • Avoid eating spicy, salty, and acidic foods, as they trigger or worsen the symptoms. One should include soft and bland food in the diet to reduce discomfort.

  • Avoid drinking caffeinated beverages.

  • Do not smoke or consume alcohol.

  • Avoid alcohol or tobacco.

  • Avoid habits, such as chewing lips or cheeks.

  • Manage stress with the help of meditation, breathing exercises, etc.

  • Go for regular dental checkups every six months to get teeth cleaned.

What Are the Complications of Lichen Planus?

Oral lichen planus might increase the chances of:

  • Severe pain.

  • Nutritional deficiency due to pain while chewing.

  • Depression.

  • Scarring.

  • Oral fungal infections.

  • Weight loss.

  • Stress.

  • Oral cancer.

Conclusion:

The chronic inflammatory disease known as oral lichen planus (OLP) affects the mouth's mucous membranes, causing pain and other symptoms related to the mouth. OLP is characterized by red, swollen tissues or white, lacy patches. It can produce burning discomfort and make it difficult to eat or speak. Although the precise etiology is uncertain, an immune system reaction is thought to be involved. Clinical examinations and occasionally biopsies are part of the diagnosis process. To manage symptoms, topical or systemic corticosteroids are usually used in conjunction with good oral hygiene. Given that OLP might have episodes of aggravation and remission, ongoing monitoring is essential. Frequent dental examinations are necessary to track and treat the illness.

Frequently Asked Questions

1.

What Does an Oral Lichen Planus-Affected Mouth Look Like?

The lesions of oral lichen planus are commonly found on the inner cheek region and tongue and are characterized by white dots arranged in a lace-like pattern or lacy patches. They also cause redness, sores, gum and tongue ulcers, and pain while having hot and spicy foods in severe conditions.

2.

How Dangerous Is Oral Lichen Planus?

Though oral lichen planus cannot be cured permanently, it can be treated, and it is not a serious or dangerous disease. However, recurrence is possible in some people.

3.

Is Oral Lichen Planus Caused by a Fungus?

No. Oral lichen planus is not caused by fungus or any microorganism, and it is not an infection.

4.

Is Oral Lichen Planus Autoimmune in Origin?

Although the exact cause of oral lichen planus is not clearly identified, it is understood that it possibly occurs due to the body’s altered immune response. Certain precipitating factors are,
- Oral allergens (dental fillings, toothpaste ingredients, etc.).
- Viral infections.
- Drugs like antibiotics, antivirals, painkillers, etc.

5.

What Factors Flare-up Oral Lichen Planus?

- Food allergies.
- Alcoholism.
- Smoking.
- Stress.
- Medications (antihypertensives, antidiabetic, painkillers, etc.).
- Defective dental fillings.
- Infection.

6.

What Are the Foods That Trigger Oral Lichen Planus?

- Alcohol.
- Salty foods.
- Spicy foods.
- Hot foods.
- Orange juice.
- Lemon juice.
- Tomatoes.
- Caffeinated beverages.
- Crisps.

7.

How Fast Does the Spread of Lichen Planus Take Place?

Lichen planus spread takes place over a period of a few weeks to months.

8.

How Much Duration Does Lichen Planus Take To Heal?

Lichen planus usually regresses on its own within a period of six months to one and a half years.

9.

Is Lichen Planus Very Common?

About 1 to 2% of the adult population are affected by lichen planus.

10.

Does Stress Have a Role in Causing Lichen Planus?

Stress indeed plays a role in worsening symptoms of lichen planus or causing lichen planus to flare up.

11.

Does Lupus Exhibit Oral Lichen Planus as Its Symptom?

Though oral lichen planus is not a symptom of lupus, both lupus and lichen planus can coexist. Oral lichen planus is associated with systemic lupus erythematosus in its lesions and microscopic appearance.

12.

Does Oral Lichen Planus Resolve on Its Own?

Oral lichen planus usually resolves on its own and does not require treatment if it is mild. Treatment is aimed to reduce and ease the symptoms.

13.

What Natural Methods Help Treat Oral Lichen Planus?

- Intake of vitamin A-rich foods like sweet potatoes, spinach, etc.
- Turmeric ointments.
- Coconut oil pulling.
- Stress management.

14.

What Does Untreated Lichen Planus Cause?

Mild oral lichen planus does not cause any serious effects. Still, regular monitoring of the lesions and condition is necessary as in rare cases, they tend to become cancerous. If left untreated, it might cause pain while eating and drinking.

15.

What Treatment Methods Help Me Get Rid of Lichen Planus?

Mild oral lichen planus does not need any treatment and needs regular monitoring to note any worsening symptoms.
- Eliminating triggering factors and the following medications help in relieving symptoms.
Corticosteroids.
Cyclosporine.
Dapsone.
Lignocaine.
Tacrolimus.
- Topical anesthetic gel application.
- Tretinoin gel application.
- Steroid injections.
- Steroid ointments.
- Good oral hygiene maintenance.
- Refraining from smoking.
- Using Dexamethasone, Cyclosporine, or Tacrolimus containing mouth rinses.

16.

Which Mouthwash Is Best to Manage Oral Lichen Planus?

- Chlorhexidine mouthwash.
- Hydrogen peroxide mouthwash.
- Benzydamine mouthwash.
- Triamcinolone acetonide mouthwash.
- Clobetasol mouthwash.

17.

Does Saltwater Help to Manage Oral Lichen Planus?

There are no evident studies that support the beneficial effects of saltwater rinses in the management of oral lichen planus.

18.

Does Oral Lichen Planus Have a High Cancer Transformation Rate?

The chances of an oral lichen planus transforming into cancer are rare. There are three types of oral lichen planus, namely, reticular, erosive, and plaque type. Of the three, only the erosive type is prone to become malignant.
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Dr. Sneha Kannan
Dr. Sneha Kannan

Dentistry

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