Oral Lichen Planus
Exodontia.Info
What is Lichen Planus?

Lichen Planus is a long-term disease, which can affect the
skin and mouth and, in some cases, the genital area.

It affects 1 - 2% of men and women in the UK and is more
common in people over 40-years old.

It is not a cancer or an infectious disease that can be
passed on and it does not run in families.

What is the Cause of Lichen Planus?

The cause of Lichen Planus is not known but it is probably
related to the immune system where cells that normally
fight off germs attack normal parts of the body.

Certain drugs used in the treatment of high blood pressure,
arthritis and diabetes may cause
Lichen Planus-like
lesions.

Also, where the cheeks or tongue have been lying against
teeth have amalgam restorations,
Lichen Planus-like
lesions may occur.  Emotional stress and spicy foods or
citrus fruits can often cause symptoms to worsen.

It is not thought to be infectious.

What are the signs and symptoms?

Lichen Planus appears in a wide variety of ways and can
cause pain, burning and/or soreness in the mouth.

It can often go unnoticed and may only be recognised by a
dentist or hygienist during a routine examination.  White,
net-like lines or white patches are usually seen on the
inside of both cheeks and can also appear on the tongue
and gums.  These do not usually cause any discomfort.

In some cases, red patches, ulcers or blisters appear
which can be painful.  The gums can also become thin, red
and shiny in appearance and it may hurt to brush your
teeth.  About one third of people also get a purple, itchy
rash with raised dots on the skin, especially on the wrists
and shins.  Very rarely, changes can be seen in the genital
area, hair and nails.
Photos of Oral Lichen Planus affecting the tongue & buccal mucosæ
How Is It Diagnosed?

Blood tests and a biopsy of an affected area may be required.

How is it treated?

As long as there is no pain, treatment is not usually necessary.  In all cases, it is
important to keep your mouth clean, as it stops the
Lichen Planus from getting
infected.

There are many different treatments available for treating the condition if it is
causing a problem.

The usual treatment is
steroid medication and / or antiseptic / pain-relieving
mouthwashes
.  These are not absorbed into the body as they only work on the
area they are applied to and therefore cause no side effects.

It may be an idea to try to identify factors that make the problem worse, e.g.
stress, spicy food such as chillies, citrus fruit and strongly-flavoured toothpastes
(containing
cinnamonaldehyde).

In severe cases, the hospital doctor will prescribe some stronger medication.

Prognosis.

Most
lichen planus is benign.  There are some forms of lichen planus that may
rarely, after years, lead to a tumour; in this case, have yourself checked regularly
if the specialist advises.
Last Updated 6th September 2015
Treatment Algorithm for Oral Lichen Planus
Useful Websites:

International Lichen Planus Support Group Web

American Academy of Dermatology


Useful Articles:

NEJM 1990.  Effect of Topical Cyclosporine Rinse on Oral Lichen Planus

Eastman Dental Institute Oral Medicine Clinic.  Oral Lichen Planus Patient
Information Sheet.  1999.

Dental Update 2002.  Oral Lichenoid Drug Eruptions: Their Recognition and
Management.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004.  Healing of oral lichenoid
lesions after replacing amalgam restorations: A systematic review.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontology
2005.  Current controversies in oral lichen planus: Report of an international
consensus meeting. Part 1. Viral infections and etiopathogenesis.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontology
2005.  Current controversies in oral lichen planus: Report of an international
consensus meeting. Part 2. Clinical management and Malignant Transformation.

2005.  Oral Lichenoid Lesions - More than Mercury

Evidence-Based Dentistry 2008.  How Common is Oral Lichen Planus

British Society for Oral Medicine 2010.  Guidelines for the Management of Oral
Lichen Planus In Secondary Care

Cochrane Database Syst Rev 2011.  Insufficient evidence for effectiveness of any
treatment for oral lichen planus