Oral Lichen Planus

Oral lichen planus is a chronic inflammatory condition which affects mucus membranes of the oral cavity. It appears as lacy, white patches; red swollen tissues or blisters, causing burning sensation, pain and severe discomfort. This condition is caused when the immune system attacks over the cells of mucus membranes. Those affected with oral lichen planus also suffer from lichen planus patches on the genitals, skin and certain other body parts.

Causes of Oral Lichen Planus

The actual cause of this condition is not known. The lesions appear as a result of inflammation which is controlled by T lymphocytes at the site of the disease. Research has not yet found as to why T lymphocytes are activated at this site of oral lichen planus. However, certain medical conditions and factors act as triggers in causing this condition in a few.

The triggers that are responsible for causing oral lichen planus are:

  • Some types of flu vaccines
  • Hepatitis B vaccine
  • Hepatitis C infection and some forms of liver diseases
  • Non steroidal anti inflammatory drugs, like naproxen and ibuprofen
  • Allergens (allergy causing agents), like some foods, dental appliances, etc
  • Some medications for arthritis, high blood pressure and heart disease

Certain factors aggravate the condition and worsen the symptoms. They include:

  • Alcohol
  • Tobacco products
  • Improperly fitting dentures
  • Uneven dental work
  • Poor oral practices like biting cheeks or lips
  • Plaque or tartar formation
  • Stress

Symptoms of Oral Lichen Planus

The initial signs and symptoms are the patches or lesions that affect the mucus membranes of the oral cavity.

Lesion appearance:

  • White, lacy, slightly raised patches
  • Red, tender, swollen patches
  • Open sores

Lesion Location:

  • Tongue
  • Gums
  • Inside of the cheeks
  • Throat
  • Inner tissues of the lips
  • Esophagus

Discomfort or Pain:

The white, lacy lesions do not cause any pain or discomfort. The red, inflamed or open sores cause a severe burning sensation and pain.

Other signs and symptoms:

  • Dry mouth
  • Metallic or blunted tastes on the tongue
  • Sensitivity to spicy or hot foods
  • Difficulty in swallowing
  • Irritation and bleeding while brushing the teeth

Treatment for Oral Lichen Planus

The major goals of treating oral lichen planus are to reduce the pain or discomfort and help relive the severe patches. The physician determines about the dosages of the medications, change in medications and stopping the treatment when necessary.

Treatment is not required in case of white, lacy lesions which cause no pain or discomfort.

Corticosteroids

These are anti-inflammatory drugs that are useful in treating oral lichen planus. However, there are certain side effects that may vary depending on whether it is used as a topical application or a mouthwash or administered as an injection. The promising benefits of corticosteroids are to be balanced with side effects that are as follows:

Topical – Topical medications can cause oral thrush, a fungal infection. For this antifungal medications are required. Prolonged use of corticosteroids can cause cessation in the adrenal gland functioning and therefore the effect of the treatment is lessened.

Oral – Prolonged use can cause side effects like osteoporosis (weakening of the bones), high blood pressure, diabetes, high cholesterol and many other serious effects.

Injections – Repeated administering of injections can cause the similar side effects as oral corticosteroids.

Retinoids

These are artificial versions of vitamin A which can be applied topically or taken orally. Topical retinoids can cause slight irritation on the mucus membranes of the oral cavity. Both topical and oral retinoid medications can result in congenital defects (birth defects). Therefore, these should not be considered during pregnancy or when planning to conceive in the near future.

Non-steroidal topical applications

Calcineurin inhibitors, the topical applications are very effective in treating oral lichen planus. These are identical to oral medications which are used in preventing rejection during organ transplantation.

Addressing triggers and treating them

If the cause of oral lichen planus is due to any trigger like drugs, stress, allergen or hepatitis C, then the physician may recommend certain steps to address the trigger.

Drugs – If any of the drugs you are taking is triggering the condition, then you are asked to stop the drug and use an alternative one.

Stress – If stress is the trigger that is aggravating the condition, then you need to take up certain stress reduction programs to manage and avoid stress. You may be referred to a psychiatrist, psychologist or any mental health advisor.

Allergen – In this case, you are advised to stay away from allergen and recommended to see an allergist or a dermatologist for the further treatment. If any dental appliance is the allergen, you need to see a dentist.

Hepatitis C – In this case, you are referred to a hepatologist (specialist in liver related conditions) for further treatment and management of the disease condition.

Care / Prevention of Oral Lichen Planus

There are no particular preventive measures to avoid or stop the recurrence of oral lichen planus. Avoiding triggers responsible for the condition can alone help to reduce the flare-ups.