Oral Lichen

1 What is Oral Lichen?

Oral lichen planus is a chronic inflammatory disease that affects the mucous lining of the oral cavity and results into the appearance of white, lacy patches, red, swollen tissues, or open sores.

These may be followed by burning, pain or other discomforts. Oral lichen planus can't be passed from one person to another.

It is an autoimmune disease where the immune system is triggered to attack the cells of the oral mucosal membranes of the host.

This increases the chances for development of mouth cancer.

2 Symptoms

Signs and symptoms of oral lichen planus are as follows:

  • The appearance of which lacy, white, raised patches of tissues, red and swollen lesions on the inner side of the cheek, gums, tongue and inner tissues of the lips.
  • They are often accompanied by burning sensations and pain.
  • Change in taste or a disrupted taste sensation and if the tongue is affected it causes sensitivity towards hot or spicy foods.
  • Accompanied by gingivitis.
  • The appearance of purplish, flat-topped and often itchy lesions on other parts of the body.
  • Formation of lesions on the female genitalia which often causes pain or burning during intercourse.
  • Loss of hearing
  • Under rare conditions, lesions appear on the scalp of the patient which may lead to temporary/permanent hair loss.
  • Thinning or splitting of nails and temporary or permanent nail loss may be caused due to lichen planus of the nails.
  • Sometimes it may affect the eye which causes loss of functioning of the tear duct and scarring of the eyelids.
  • It may also affect the esophagus under rare conditions, but when it occurs, it may result in a narrowing of the esophagus or the formation of tightened, ring-like bands in the esophagus that can make swallowing difficult.

Seek medical help if you notice sores inside your mouth that don't heal at a normal pace and are accompanied by pain and bleeding while brushing or flossing.

If there is any change in the way your mouth looks or feels, or if you have lesions on any other part of your body.

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3 Causes

There is no known cause for lichen planus. The white blood cells get triggered against the cells of the host organism and cause lesions.

However, certain factors may trigger the disease in some cases:

  • Hepatitis C infection and other types of liver disease
  • Hepatitis B vaccine
  • Allergy-causing agents (allergens), such as certain types of foods, dental materials or other substances
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others)
  • Certain medications for heart disease, high blood pressure or arthritis

4 Making a Diagnosis

Depending on the symptoms of oral lichen, you may be referred to a dermatologist, periodontist, gastroenterologist or a gynecologist to receive a diagnosis.

Following steps should be followed before an appointment:

  • Maintain a copy of all previous consultations and tests you've had this problem.
  • Ask if there's anything you need to do before the appointment, such as restrict your diet.
  • Make a list of all the related and even unrelated symptoms.
  • Prepare a list of all the medications.

The doctor or dermatologist may make a diagnosis of oral lichen planus based on your symptoms, after a careful examination of the conditions of your mouth and also may ask you to get a few lab tests done.

Tests like biopsies, culturing of oral microbiota, blood tests, etc. may be conducted.

5 Treatment

The treatments of oral lichen planus aim at the healing of inflammations and pain caused due to the condition.

The doctor might monitor your condition to alter the doses, change medications or stop treatment if necessary. If there are no signs of discomfort and pain, then the treatments are discontinued.

In case the symptoms become severe, the following treatments are undertaken:

Symptomatic treatments

Topical numbing agents can be used to provide temporary relief for areas that are particularly painful.

Corticosteroids

Corticosteroids may reduce inflammation related to oral lichen planus. Depending upon the type of formulation used, the side effects may vary.

Topical formulation is usually preferred for treatment of oral lichen planus.

Retinoids

Retinoids are synthetic versions of vitamin A that can be applied as a topical ointment or can be taken orally.

The topical treatment may irritate the mucous membranes of the mouth, thus is not usually used. Since both topical and oral retinoids can cause birth defects; the drug shouldn't be used by pregnant women or by women who are planning a pregnancy.

Immune response medicines

These are medications that suppress or modify body's immune response. They may be used in the form of ointments, gels or oral medication.

Treatments that suppress immune system abnormalities may improve more severe lesions and lessen the pain.

For example, tacrolimus (Protopic) and pimecrolimus (Elidel) are used to suppress the immune response effectively.

If the doctor suspects that oral lichen planus may be a result of a drug , or to a hepatitis C infection, an allergen or stress, he or she may recommend the following precautions:

  • The doctor may ask you to stop taking a drug that can be a trigger or to try another drug instead.
  • In case an allergen is the potential trigger, it'll be advised to avoid the allergen.
  • If a dental device is suspected as an allergen, you will be advised to see your dentist have dental materials removed and replaced.
  • A gentle oral cleaning and intake of foods that are soft may help in limiting the discomfort associated with oral lichen planus.
  • Since, stress may complicate symptoms or trigger symptom recurrence, you may be advised to develop skills to avoid or manage stress. Your doctor may refer you to a mental health specialist who can help you identify stressors, develop stress management strategies or address other mental health concerns.

6 Lifestyle and Coping

You can take the following lifestyle measures in order to treat and avoid oral lichen planus:

  • Follow regular dental checkups and self-care measures.
  • Keep your mouth clean to reduce the symptoms and help prevent the infection.
  • Gently brush your teeth at least twice a day and floss daily.
  • Adjust your diet and cut out spicy or acidic foods.
  • Reduce or eliminate the use of caffeine, alcohol or tobacco.

7 Risks and Complications

There are several risks and complications associated with oral lichen.

Oral lichen planus most commonly affects middle-aged women.

A disorder that compromises your immune system may increase your risk of developing oral lichen planus. It may be passed on as a genetic trait.

Tobacco products, alcohol, rough dental work, ill-fitted dentures, poor oral habits, such as biting the lip or cheeks, dental plaque or tartar or stress may worsen the condition.

In addition, oral lichen planus may increase the risk of oral cancers, particularly a type of cancer known as squamous cell carcinoma.

To help prevent cancer, take these actions: get oral cancer screenings annually or as directed by your doctor. 

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