January 19, 2007

Oral Lichen Planus


Oral lichen planus is an inflammatory condition affecting the lining of the mouth. It occurs most often on the inside of the cheeks, but can affect the gums, tongue, lips and other parts of the mouth. Occasionally oral lichen planus involves the throat or the esophagus.

It usually begins during midlife, between ages 45 and 60. But oral lichen planus can occur at any age, although it rarely affects children. Women are affected twice as often as men are. The condition appears to be related to lichen planus that occurs on the skin. Many people with oral lichen planus also develop lichen planus on the skin or other mucous membranes.

An initial episode of oral lichen planus may last for weeks or months, and recurrences may continue over many years. Oral lichen planus isn't an infectious disease and isn't contagious. But people with persistent mouth sores (lesions) are at increased risk of squamous cell carcinoma — a form of skin cancer. In these cases, a doctor may advise regular examinations to monitor any changes in the mouth. It's also important to stop any tobacco use because tobacco raises the risk of squamous cell carcinoma.

Signs and symptoms
Oral lichen planus may cause one or more of the following signs and symptoms in the mouth and throat:

Small, pale raised areas or bumps that form a lacy network on the tongue or inside the cheeks.
Shiny, red, slightly raised patches on the tongue or cheeks .
Red, open sores in the mouth.
Pain, tenderness, burning or itching in the mouth.
Dry mouth.
A metallic taste or a blunted taste sensation .

Oral lichen planus may be limited to a network of pale, slightly raised areas or shiny, red, raised patches on the sides of the tongue or inside the cheeks, or it may advance into a painful erosive lesion. Your mouth may be sore and dry and have a metallic taste. Some people experience no signs or symptoms other than the raised areas or patches

The exact cause of oral lichen planus isn't known. In some cases, the condition appears to be triggered by an allergic or immune reaction to one or more substances. Certain medical conditions are sometimes associated with oral lichen planus, but often the source can't be determined.

Possible causes of oral lichen planus include:

Medications. Certain medications, such as some of those used to treat arthritis, heart disease, high blood pressure and malaria, may trigger oral lichen planus in some people.

Allergies. Oral lichen planus can result from an allergic reaction to food, food additives, fragrances, dyes, dental metals or other substances.
Infections. Some cases of oral lichen planus have been linked to infections, such as hepatitis C. Oral infections (such as an oral yeast infection called thrush) can lead to or intensify the symptoms.

Medical conditions. Medical conditions associated with oral lichen planus include lichen planus of the skin, hypertension, diabetes and peptic ulcers.
Psychological factors. Stress and anxiety often accompany oral lichen planus. However, it isn't clear whether psychological factors are the cause or the result of oral lichen planus.

There seems to be a relationship between the oral form and the skin form of lichen planus because almost half of those with the oral version also have the skin version.

When to seek medical advice
See your doctor if you:

Notice sores inside your mouth that don't heal
Have lumps or white, red or dark patches in your mouth
Feel persistent pain or have a loss of feeling inside your mouth
Have repeated bleeding in your mouth
Notice any change in the way the soft tissues of your mouth look and feel

Screening and diagnosis
Frequently, a dentist is the first to notice oral lichen planus during a routine examination. A doctor can often diagnose the condition by examining the affected areas of the mouth. Doctors and dentists specializing in dermatology or oral medicine are knowledgeable about conditions such as oral lichen planus.

To make a diagnosis, your doctor may ask about your symptoms and medical history, examine your mouth, and order tests. Blood and allergy tests may determine the cause of your symptoms and rule out other conditions — such as yeast infections and canker sores — that can cause or worsen oral lichen planus. Your doctor may request a biopsy to confirm a diagnosis of oral lichen planus. During a biopsy, your physician removes a small sample of tissue from the affected area for examination under a microscope.

People with persistent oral lesions are at increased risk of squamous cell carcinoma — a form of skin or mucous membrane cancer. If lichen planus lasts several months or longer, regular examinations to monitor any changes in the lesions is advised. It's also important to stop any tobacco use because tobacco raises your risk of squamous cell carcinoma.

There is no cure for oral lichen planus, so medical treatment focuses on managing the symptoms.

Treatment varies depending on the severity of symptoms and the cause of the condition, if known. Mild symptoms may require only self-care measures and periodic observation by your doctor. More bothersome symptoms may be treated with ointments or creams to reduce inflammation and itching of the mouth. Special mouthwashes can temporarily numb or soothe a painful mouth.

Sometimes doctors prescribe pills taken by mouth (oral medications) to treat severe cases of oral lichen planus. The most effective treatment for oral lichen planus is oral corticosteroid medications in addition to high-potency corticosteroids applied to the affected areas.

Additional treatment may be recommended if any of the following appear to trigger your symptoms:

Medications. If a medication seems to be causing the condition, your doctor may switch your medications.

Allergies. If an allergic reaction is involved, elimination of the allergen may bring relief, for example, removal of certain dental materials or a change in diet. Sometimes a series of allergy tests, known as delayed hypersensitivity patch tests, are done to determine if you have a contact allergy to amalgam, gold restorations or other substances.

Infections. Infections sometimes associated with oral lichen planus, such as thrush, should be treated promptly. Screening for hepatitis C is warranted in all cases.

Medical conditions. Treating medical conditions that you have, such as diabetes or hypertension, may improve your symptoms.

Psychological factors. If your symptoms are associated with stress, anxiety or other psychological factors, your doctor may recommend medication, psychiatric therapy or both

The following self-care suggestions may help you avoid irritating the lining of your mouth and make you more comfortable.

Practice good oral hygiene. Keep your mouth clean to reduce your symptoms and help prevent infection. Gently brush and floss your teeth daily. Physical injury to your mouth can lead to sores.

Limit alcohol consumption and don't use tobacco products. People with oral lichen planus have an increased risk of developing oral cancer. Alcohol and tobacco further increase this risk. If you use alcohol, do so in moderation. Don't smoke or use smokeless tobacco or any other tobacco product.

Adjust your diet. Consider eliminating spicy or acidic foods if they seem to cause or worsen your symptoms.

Have regular oral examinations. See your doctor every six to 12 months to have your condition monitored and to be screened for oral cancer.

Adapted from: Mayo Foundation for Medical Education and Research