ORAL LICHEN PLANUS (OLP)

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Oral Lichen Planus (OLP) is a chronic inflammatory condition affecting the mucous membranes in the mouth. This is a persistent condition impacting the mouth, characterized by symptoms like white patches, redness, and swelling. While it doesn’t disappear completely, effective management is possible.

Contrary to being contagious, anyone can develop OLP, though it’s more prevalent among women and individuals over 40. Nevertheless, it can also affect children and young adults.

Causes

The precise causes of oral lichen planus remain uncertain, but several factors may contribute:

1. Genetic Predisposition: There’s a possibility that oral lichen planus runs in families.
2. Immune System Involvement: Some experts theorize that the immune system plays a role. Typically, immune cells defend against harmful pathogens, but in oral lichen planus, they may mistakenly target the mouth’s lining.
3. Association with Hepatitis C: Research suggests a connection between oral lichen planus and hepatitis C, with many infected individuals experiencing its symptoms.

Prevalence

OLP affects approximately 1-2% of the population worldwide. It is more common in middle-aged adults and tends to affect women more frequently than men.

Symptoms of Oral Lichen Planus

Symptoms of OLP can manifest gradually or suddenly, presenting with:

• Dryness in the mouth
• A metallic or burning taste sensation Following these initial signs, you may observe:
  • White patches on the tongue, cheeks, and gums, which can form intricate patterns resembling lace, ranging from tiny dots to lines.
  • Redness and swelling in the affected areas
  • Peeling or blistering of the mucous membranes These sores can be painful and may intensify particularly while consuming spicy, salty, acidic (like orange juice or tomatoes), or alcoholic foods. Crispy snacks and caffeinated beverages can also exacerbate discomfort.

Risk Factors for Oral Lichen Planus

Triggers for OLP can either initiate the condition or exacerbate it if you’re already affected. These triggers include:

1. Certain Medications: Some medications like painkillers, treatments for high blood pressure, diabetes drugs, and malaria medications can provoke oral lichen planus.
2. Metallic Reactions: Metal in your mouth, such as dental fillings, might trigger a reaction.
3. Other Oral Issues: Rough dental crowns or habits like cheek or tongue biting can also play a role.
4. Mouth Injuries: Any injury to your mouth can potentially trigger oral lichen planus.
5. Food Allergies: Allergic reactions to certain foods can contribute to the onset or worsening of symptoms.
6. Infections: Infections in the mouth can also be a trigger.

Importantly, oral lichen planus cannot be transmitted to others nor acquired from someone else.

Diagnosis of Oral Lichen Planus

Diagnosing OLP involves a thorough examination of the mouth by a dentist or oral health specialist. Your doctor can diagnose oral lichen planus by conducting a biopsy, where a small piece of tissue inside your mouth is examined. This tissue sample is then analyzed in a laboratory to identify the issue. Additionally, blood tests may be necessary to exclude other possible conditions

Treatment of Oral Lichen Planus

Treatment for OLP varies depending on the severity of symptoms:

1. Minimal Symptoms: If you experience only mild discomfort like slight roughness in your mouth, treatment may not be required.
2. Pain and Sores: For those experiencing pain or the presence of sores, your doctor may recommend the application of a corticosteroid cream. In rare cases where symptoms are severe, steroid pills may be prescribed.
3. Immune System Regulation: If your doctor suspects that your immune system is responsible for your symptoms, they may suggest medications aimed at suppressing its overactive response. These treatments include:
   • Topical Ointments or Gels: Calcineurin inhibitors, similar to those prescribed post-organ transplant to prevent rejection, may be recommended. However, it’s important to note that these medications carry an FDA warning due to their potential association with an increased risk of cancer.
   • Systemic Medications: In cases where oral lichen planus affects other parts of the body such as the scalp, genitals, or esophagus, oral medications may be prescribed to address the condition.

Home Care Tips

1. Maintain good oral hygiene by brushing and flossing regularly.
2. Use mild, alcohol-free mouthwashes or oral rinses.
3. Avoid irritating foods or substances, such as tobacco or alcohol.
4. Stay hydrated by drinking plenty of water throughout the day.
5. Manage stress through relaxation techniques or counseling.

Prevention of Oral Lichen Planus

Preventing OLP involves being mindful of your lifestyle choices and addressing potential triggers. Here are some preventive measures to consider:

1. Dietary Awareness: Be cautious about what you eat and drink, especially spicy or citrus foods and beverages, as they can exacerbate symptoms. Hot or cold items can also increase discomfort.
2. Stress Management: Stress can worsen symptoms, so finding effective stress-reduction techniques is beneficial.
3. Oral Care Habits: Maintain good oral hygiene practices such as brushing your teeth twice a day, flossing daily, and using a mild toothpaste with a soft toothbrush. Regular dental check-ups, at least twice a year, are essential for cleaning and monitoring oral health.
4. Addressing Dental Issues: Ensure any dental problems that could trigger or worsen oral lichen planus are addressed promptly. This may involve having sharp teeth polished, replacing damaged fillings or crowns, and discussing with your dentist about any concerns.
5. Medication Review: Consult your doctor about medications that may contribute to the condition, and explore alternative options if necessary.
6. Health Monitoring: Keep track of changes in your mouth and promptly inform your doctor about any new symptoms or concerns. Regular screenings for oral cancer, ideally every 6 to 12 months, are recommended due to the slight risk of oral lichen planus progressing to oral cancer.
7. Healthy Lifestyle Choices: Maintain a balanced diet rich in fruits and vegetables, quit smoking if you smoke, and limit alcohol consumption. Regular medical check-ups help in monitoring any changes in your oral health status.

When to See a Doctor

If you experience persistent white patches, sores, or discomfort in your mouth, it is important to see a dentist or oral health specialist for evaluation and diagnosis. Early detection and treatment can help alleviate symptoms and prevent complications.

Outlook/Prognosis

The outlook for OLP varies depending on the severity of the condition and individual response to treatment. While it is a chronic condition, many people are able to manage their symptoms effectively with appropriate medical care and lifestyle modifications.

Sources

1. American Academy of Oral Medicine
2. National Institute of Dental and Craniofacial Research
3. Mayo Clinic
4. British Dental Journal
5. Oral Lichen Planus Foundation
6. ClinicalTrials.gov