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Oral Lichen Planus: Symptoms, Causes, and Treatment

Oral lichen planus is an autoimmune disorder affecting a notable population segment.

The cause of lichen planus is unknown, but it can lead to discomfort, pain, and scarring in oral mucosa.

This informative article provides a detailed analysis of oral lichen planus, covering its signs, causes, diagnostic processes, treatment alternatives, and potential complications.

In addition, we will delve into how the immune system activates lichen planus and its connection with Hepatitis C infection.

If you or someone close has oral lichen planus, this informative article aims to offer helpful guidance. Keep reading to learn more about Oral Lichen Planus.
picture of oral lichen planus on a male tongue
Table of Contents

What is Oral Lichen Planus?

Oral lichen planus is a chronic inflammatory condition that affects the mucous membranes in the mouth. This condition appears as white lacy patches or sores that can cause pain along with discomfort. It’s not contagious. Medical experts don’t know the exact cause. Most believe it comes from an autoimmune response.

Identifying the Symptoms of Oral Lichen Planus

Flat-elevated papules of varying sizes often begin as LP, which can subsequently merge into larger plaques.
Papules are distinguishable because of their miniature central hollow and striking light-grey lines, known as Wickham’s striae.
By detecting these visual signs, oral pathologists can identify oral lichen planus more precisely.

Typical Visual Indications

The typical appearance of oral lichen planus features a tiny elevated white spot at the intersection of white lines.
In the oral cavity, many unseen lesions are scattered irregularly, with the highest frequency on buccal mucosa, which is the inner portion of cheeks, the tongue, lips, gums, floor and roof of the mouth.
Taking steps for these lesions is crucial because they frequently escape detection and display symmetry.
Severe cases of oral lichen planus exhibit redness in texture.

Discussing the Causes of Oral Lichen Planus

Many factors lead to OLP, although its origins remain a mystery.
Oral restorative materials such as silver amalgam, gold, cobalt, palladium, and non-metals like composites can trigger oral lichen planus.
Systemic drugs can sometimes trigger oral lichenoid reactions as well.

Association of Oral Lichen Planus With Chronic Illnesses

OLP behave in an erratic manner, in those individuals who have diabetes mellitus, high blood pressure, anxiety, and stress.

The Role of Immune System

Oral lichen planus is a T cell-induced inflammatory disease of the oral mucosa.

Data suggests a sustained, erratic immune response to specific antigens.

Pathogenesis involves antigen-specific and non-antigen processes.

Antigen-specific keratinocyte killing is one mechanism involving CD8(+) T cells.

The non-specific mechanisms include mast cell degranulation and matrix metalloproteinase activation.

The Connection between Hepatitis C Virus Infection and Oral Lichen Planus

Research has found a notable connection between HCV and oral lichen planus.

The risk of oral lichen planus increases among those infected with hepatitis C virus infection.

HCV can substantially affect the occurrence and gravity of oral lichen planus.

Anti-HCV testing is advisable for those with presence of oral lichen planus.

Addressing the HCV infection, during the presence of oral lichen planus, is vital to successful treatment.

The Diagnostic Process of Oral Lichen Planus

A thorough oral cavity investigation by a dentist, help in diagnosing any soft tissue abnormalities in oral cavity.

By conducting a tissue biopsy, it becomes possible to analyze with magnification whether oral lichen planus is present. 

Proper diagnosis requires teamwork between dental and medical professionals to rule out other oral conditions.

Differentiating from Other Conditions

Reports show that the rate of OLP malignant transformation varied between 0% and 10%.

1.1% of OLP lesions progress to OSCC (Oral Squamous Cell Carcinoma), with smokers, alcohol users, and people with hepatitis C virus being more susceptible, according to a recent meta-analysis.

Erosive OLP appears to have the highest probability of progressing into OSCC.

Lesions found on the tongue have a high tendency to undergo malignant transformation.

Oral biopsies can definitively diagnose conditions, while the immune system’s involvement plays a pivotal role in the initiation of lichen planus.

Lichen planus affecting the skin manifests as rash-like lesions, but it can also affect other parts of the body such as the scalp, esophagus and genitals.

Treatment Modalities

Pharmacological Treatments

Managing oral lichen planus entails the use of both topical and internal methods.
Applying clobetasol propionate-based products directly to affected areas provides effective relief.
In cases of persistent or unresponsive skin issues, systemic corticosteroids are crucial.
Cyclosporine, tacrolimus and retinoids like acitretin are alternative choices in managing oral lichen planus.

Non-Pharmacological Treatments

Managing oral lichen planus necessitates the adoption of gentle brushing and soft toothbrush techniques.
Quitting smoking and limiting alcohol consumption play a significant role in better oral health.
Acidic and spicy foods can lead to unpleasantness; therefore, it is wise to shun them.
Relief and protection are possible by applying petroleum jelly or other protective agents.

Complications of Oral Lichen Planus

Complications may occur when medication or dental materials trigger lichenoid reactions.
If untreated, it may lead to permanent scarring.
Increase risk of malignant transformation in erosive lichen planus.  

Tips for Coping with the Condition

Gain insight into the complexities of oral lichen planus by educating yourself.
Reducing stress through relaxation techniques or exercise is an option.
Turn to trustworthy individuals or groups for aid and counsel.
Eat a balanced diet, avoid consuming large amounts of alcohol, and quit smoking.
Ensure clear and direct communication with your healthcare provider about any issues.
Keep a journal or a diary to monitor symptoms and treatment success.

Frequently Asked Questions

How does Hepatitis C Influence the Occurrence of Oral Lichen Planus?

The oral mucosa is susceptible to the immune response caused by HCV. The risk of oral lichen planus increases due to the presence of Hepatitis-C virus infection. Enhanced oral lichen planus management follows HCV treatment with direct-acting antivirals. Close expert monitoring is essential for managing problems efficiently.

How to treat Oral Lichen Planus?

Avoiding spicy foods and practicing good oral hygiene can provide some comfort.
Systemic corticosteroids or immunosuppressive drugs provide effective results in severe cases of oral lichen planus, where topical treatment shows no improvement in symptoms.
Regular dental check-up protects against future complications and ensure optimal oral wellness.
Phototherapy and laser therapy are the recommended options in the most challenging situations.

How to Manage or Live with Oral Lichen Planus?

One can effectively oversee and address oral lichen planus concerns by prioritizing regular dental visits. Key to optimal wellness, stress management and a balanced lifestyle are crucial.

Conclusion

To conclude, oral lichen planus poses a long-term inflammation within the oral cavity.

Though its etiology is uncertain, managing this condition entails an extensive approach featuring many treatment options.

Knowledge of its potential causes helps in proper intervention.

An effective healthcare strategy helps to minimize the symptoms of oral lichen planus. This enhances the quality of life and prevents long-lasting complications.
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