Lichen planus is a chronic disorder which can affect the skin, genitalia and/or the oral tissues. It affects about 2% of the population, occuring more often in women than in men.
Lichen planus mostly occurs in adults above 50 years old. In about 50% of the cases, only the mouth is involved. This condition is called oral lichen planus.
Oral lichen planus is an allergy type disease that relates to our immune system. Although the exact caus or trigger is still not known, the disease has sometimes been associated with the use of certain medications, reactions to some types of dental filling materials, food substances or having certain medical conditions such as diabetes, hypertension, liver disease and auto-immune disorders. Stress is also known to be linked to this condition.
How does oral lichen planus appear?
In the mouth, it can appear in five different forms:
It can occur as a single form or in combination, usually a mixture of lacy-white lines, red patches and ulcerations. It can appear as isolated lesions affecting only one area or as a widespread disease, involving many areas of the mouth such as the gums, tongue, cheeks and even the throat.
Is oral lichen planus contagious?
No. Oral lichen planus is not an infection and therefore cannot be transmitted from one person to another.
Is oral lichen planus inherited?
There is little evidence to indicate that the disease runs in families.
Does oral lichen planus cause cancer?
Oral lichen planus itself is not a cancerous condition. However, it is important to have a biopsy done to confirm its diagnosis and to be periodically examined by the dental surgeon or physician. Additional biopsies may be necessary from time to time to check for any tissue changes as there is a 1% risk of cancer change.
How long will I have oral lichen planus?
The duration and severity of the disease is not predictable. Some patients have it for many years, while for others, the disease may disappear after several months and it may or may not recur.
In some cases, the disease may be completely symptom-free and is only discovered by the dental surgeon during a routine dental check-up. In other cases, symptoms may range from a burning or stinging sensation to bothersome pain. Symptoms are often aggravated when taking spicy food. The red and ulcerated forms of oral lichen planus are more likely to cause symptoms.
Symptom-free cases will not require any treatment but should be reviewed by the dental surgeon or physician every six months to one year.
For symptomatic cases, much of the discomfort can often be reduced simply by avoiding triggering factors such as spicy food or certain toothpastes or mouthwashes, and maintaining good oral hygiene. Medications or dental fillings may need to be changed if these are suspected to be associated with the appearance of the disease. Change of medications would require approval from your physician.
Various medications have been used to treat oral lichen planus, the most common being a steroid paste/ointment applied directly onto the affected area(s) inside the mouth. Depending on the severity of the disease and its symptoms, steroid injections directly into the affected areas or oral steroid tablets may be necessary. Sometimes, an anti-fungal medication or mouthwash may also be prescribed.
Other less common medications used include vitamin A analogues, anti-malarials, immuno-suppressants like cyclosporine and aziathioprine.
Laser treatment to remove the affected area(s) can also be performed but the condition tends to recur. The treated area can sometimes become pigmented or darkened.
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