Information and Care – Oral Lichen Planus

DEFINITION

Oral lichen planus is a persistent inflammatory condition with an unknown cause that affects the lining of the mouth. It typically manifests as distinctive lacy, white patches and is commonly found on the inner cheeks but can also impact the gums, tongue, lips, and other oral areas. In some cases, it may extend to the throat or esophagus.

While oral lichen planus often begins in midlife, it can occur at any age. Initial episodes may last for weeks or months, and the condition is generally chronic, lasting for many years. While there is no cure, management is possible through medications and home remedies.

The condition typically presents as a limited lacy network of pale, shiny, red, or white raised areas on the tongue or inside the cheeks. In rarer instances, it may progress to painful, erosive lesions or ulcers. Sometimes, it may exhibit no signs or symptoms other than the raised areas. Flare-ups may occur intermittently, with symptom-free periods.

Oral lichen planus is often associated with the skin form of the condition, affecting other body parts such as the skin, scalp, nails, and genitals.

SYMPTOMS

The signs and symptoms of oral lichen planus may include one or more of the following:

  • Small, pale, raised areas or bumps forming a lacy network on the tongue, gums, or inside the cheeks.
  • Shiny, red, or white slightly raised patches on the tongue, gums, or cheeks.
  • Red, open sores in the mouth.
  • A burning sensation or pain in the mouth.
  • Dry mouth.
  • A feeling that the mouth is rough.
  • Sore gums.
  • Sensitivity to hot or spicy foods.
  • A metallic taste or blunted taste sensation.
  • Burning, swelling, bleeding, and irritation during tooth brushing.

CAUSES

The precise cause of oral lichen planus remains unknown. However, increasing research suggests it may be an autoimmune condition. In this scenario, the body’s immune system initiates a chronic inflammatory process in the mucous membranes. This process is believed to impact specific skin cells, including those in the mouth.

RISK FACTORS

While the cause of oral lichen planus is uncertain, certain factors may elevate the risk of developing the condition. These include:

  • Gender: Women are more prone to the condition than men.
  • Medications: Some medications used for arthritis, heart disease, high blood pressure, and malaria may act as triggers.
  • Allergies: Oral lichen planus can result from allergic reactions to food, food additives, fragrances, dyes, dental metals, or other substances.
  • Medical Conditions: Certain medical conditions, such as other immune disorders, are linked to oral lichen planus. These may include lichen planus of the skin, liver disease, graft-versus-host disease, primary sclerosing cholangitis, alopecia areata, and myasthenia gravis.
  • Dental Issues: Sharp edges on teeth, dental restorations, poorly fitting dental prostheses, some periodontal surgical procedures, and oral habits like lip and cheek chewing may increase the risk.
  • Betel Quid: Chewing betel quid, a plant and nut combination common in Southeast Asia, may elevate the risk.
  • Emotional Issues: Stress, depression, and anxiety often coexist with oral lichen planus and may exacerbate existing cases.

TREATMENTS AND MEDICATIONS

Oral lichen planus currently has no cure. Medical treatment aims to manage the condition by controlling pain, reducing lesions, and extending periods of symptom-free intervals.

TREATMENT OF MILD SYMPTOMS

The treatment approach for oral lichen planus depends on the severity of symptoms and the underlying cause. In cases of mild symptoms, home remedies may be sufficient, but regular check-ups are advised to monitor any potential worsening of the condition. If an underlying condition is identified as the cause, addressing, and treating that condition may lead to improvement in oral lichen planus symptoms.

TREATMENT OF MORE SEVERE SYMPTOMS

If you find your oral lichen planus symptoms bothersome, especially if erosions or ulcerations are present, treatment options may include:

  • Corticosteroids: High-potency corticosteroid gels, rinses, or ointments applied to oral lesions are effective. Oral corticosteroid pills may also be prescribed, but these may lead to oral thrush, requiring additional medications. In some cases, corticosteroids can be injected into lesions. Long-term use poses risks such as adrenal suppression, so consult your doctor about potential side effects.
  • Medicated Mouth Rinse or Spray: These products can temporarily numb or soothe a painful mouth and may reduce the size of oral lesions.
  • Immunosuppressant Medications: If corticosteroids prove ineffective, medications suppressing the immune system may be considered. Due to potential serious side effects, including a link to cancer, it is crucial to thoroughly understand the risks and benefits.

Bringing oral lichen planus under control can be challenging, and several treatments may need to be explored to find the most effective one for you. Given its chronic nature, treatment may be necessary for months or even years.

LIFESTYLE AND HOME REMEDIES

In addition to regular medical and dental care, adopting self-care measures can help improve oral lichen planus symptoms. These include:

  • Practice Good Oral Hygiene: Keep your mouth clean to reduce symptoms and prevent infection. Gently brush and floss your teeth twice daily.
  • Avoid Alcohol and Tobacco: Both alcohol and tobacco can irritate the mouth and increase the risk of oral cancer. If you consume alcohol, do so in moderation, and refrain from smoking or using any tobacco products.
  • Adjust Your Diet: Consider eliminating spicy or acidic foods if they contribute to or worsen your symptoms.
  • Regular Oral Examinations: Schedule check-ups every six to twelve months, or as recommended, for monitoring your condition and screening for oral cancer.
  • Monitor Symptoms: Take note of any changes in symptoms, such as new or worsening sores, and promptly contact your doctor if you observe such changes.
  • Mental Health Care: Given the link between oral lichen planus and anxiety, stress, and depression, seek appropriate mental health care if needed. Discuss these concerns with your doctor or consult a mental health professional for treatment.

PREVENTION

Preventing oral lichen planus is challenging, and there is no foolproof method. However, managing underlying medical conditions may aid in preventing the worsening of oral lichen planus. Additionally, avoiding alcohol and tobacco can contribute to reducing the risk of oral cancer, a condition linked to oral lichen planus.