Oral Lichen Planus: Causes, Symptoms, Diagnosis, and Treatment

Oral lichen planus (OLP) is a chronic inflammatory condition affecting the mucous membranes inside the mouth. 

It manifests as white, lacy patches, red swollen tissues, or open sores that can cause discomfort and interfere with daily activities such as eating and speaking. 

Although not contagious or life-threatening, OLP requires careful management due to its chronic nature and potential complications. 

This article provides an in-depth look at oral lichen planus, its causes, symptoms, diagnosis, treatment options, and more.

What Is Oral Lichen Planus?

It is a type of lichen planus that exclusively affects the mucous membranes of the mouth. 

It is considered an autoimmune disorder, where the immune system mistakenly attacks the cells of the oral tissues. 

The condition is often chronic, meaning it can persist for months or years with episodes of flare-ups and remissions.

While the exact cause remains unclear, OLP is not contagious or infectious. It primarily affects middle-aged adults and is more common in women than men.

Types of Lichen Planus

It can occur in various parts of the body, each with its unique characteristics:

1. Oral Lichen Planus: Affects the mucous membranes of the mouth, tongue, and inner cheeks.
2. Cutaneous Lichen Planus: Appears as purplish, itchy lesions on the skin.
3. Genital Lichen Planus: Involves the genital mucosa, leading to discomfort or pain.
4. Nail Lichen Planus: Causes thinning, ridging, or splitting of the nails.
5. Scalp Lichen Planus (Lichen Planopilaris): Results in hair loss and scarring.
6. Esophageal Lichen Planus: A rare type affecting the esophagus, leading to difficulty swallowing.

This article will focus exclusively on oral lichen planus.

Symptoms of Oral Lichen Planus

Symptoms of OLP can vary widely in severity. Common manifestations include:

• White, lacy patches (Wickham’s striae) on the inner cheeks, tongue, or gums.
• Red, swollen tissues in the mouth.
• Painful sores or ulcers that can cause burning or discomfort, especially when eating spicy or acidic foods.
• Dryness or sensitivity in the mouth.
• Changes in taste or a metallic taste.

The symptoms may appear symmetrically on both sides of the mouth and can range from mild to severe. 

In some cases, OLP may lead to complications, including increased sensitivity to oral hygiene products and a slightly higher risk of developing oral cancer.

Causes of Oral Lichen Planus

The exact cause is not fully understood, but it is believed to result from an overactive immune response. Possible contributing factors include:

• Genetic predisposition.
• Stress or anxiety, which may trigger or exacerbate symptoms.
• Certain medications, such as NSAIDs, antihypertensives, and antimalarials.
• Allergic reactions to dental materials like amalgam fillings.
• Infections, including hepatitis C.
• Hormonal changes, especially in women.

Environmental factors or systemic diseases may also play a role in triggering OLP.

Diagnosis of Oral Lichen Planus

Diagnosis involves a combination of clinical evaluation and diagnostic tests:

1. Visual Examination: A dentist or oral specialist will inspect the mouth for characteristic lesions.
2. Biopsy: A small tissue sample may be taken for microscopic analysis to confirm the diagnosis and rule out other conditions.
3. Blood Tests: These may be conducted to check for underlying conditions, such as hepatitis C or nutritional deficiencies.

Accurate diagnosis is essential for effective management and monitoring of potential complications.

Treatment Options

Although there is no cure, treatment focuses on symptom management and preventing complications. Common approaches include:

1. Topical Corticosteroids: These are the first-line treatment for reducing inflammation and discomfort.
2. Immune-Modulating Medications: For severe cases, drugs like tacrolimus or cyclosporine may be prescribed.
3. Pain Relievers: Over-the-counter or prescription pain relievers can help manage discomfort.
4. Antifungal Treatment: Secondary fungal infections, such as oral thrush, may require antifungal medication.
5. Good Oral Hygiene Practices: Regular brushing with a non-irritating toothpaste and routine dental checkups can help minimize irritation.
6. Dietary Modifications: Avoiding spicy, acidic, or rough-textured foods can reduce pain and inflammation.

Preventing Flare-Ups

While it’s not always possible to prevent OLP, certain lifestyle changes can minimize flare-ups:

• Manage stress effectively with relaxation techniques.
• Avoid known triggers such as tobacco, alcohol, or specific foods.
• Maintain excellent oral hygiene.
• Regularly visit your dentist for professional monitoring and care.

FAQs

1. Is oral lichen planus contagious?

No, it is not contagious. It cannot be spread through physical contact, sharing utensils, or kissing.

2. Can oral lichen planus lead to oral cancer?

While the risk is slightly higher, most cases do not progress to oral cancer. Regular monitoring and early intervention are essential.

3. What foods should I avoid with oral lichen planus?

Avoid spicy, acidic, or crunchy foods that may irritate the lesions. Opt for soft, bland foods that are less likely to cause discomfort.

4. How is oral lichen planus different from leukoplakia?

While both conditions affect the oral mucosa, leukoplakia often presents as white patches with a higher risk of malignancy, whereas OLP is an autoimmune condition with distinct patterns like Wickham’s striae.

5. Can stress cause oral lichen planus?

Stress does not directly cause it but can trigger or worsen symptoms in individuals with the condition.

6. What toothpaste is best for oral lichen planus?

Use a non-irritating, alcohol-free, and fluoride-based toothpaste to minimize irritation and maintain oral health.

7. Does oral lichen planus ever go away completely?

It is often a chronic condition, but symptoms may improve or resolve with proper treatment and management.