A chronic disease – associated with a disorder of epithelial keratinasation. Manifests as bilateral white discolouration of the buccal mucosa, tongue dorsum, gingiva.
Histo: hyperkeratosis, acanthosis ( diffuse epidermal hyperplasia). Civatte bodies. Fibrin deposits in basement memebrane
Poorly understood etiopathogenesis, related to defective cell-mediated immunity.
Suggested but unclear association with dental restorations e.g.amalgam, hep c infections, medications: nsaids, b-blockers, gold, penicillin, allopurinol, anti-malarials.
Has a higher incidence in women.
Types
- Reticular – most common. Forms white lines; net/spiderweb appearance; called Wickham striae, mostly asymptomatic
- Erosive/Ulcerative – irregular red ulcers with yellowish slough, may cause desquamative gingivitis
- Papular – asymptomatic, white raised pinpoint papules approx 1-2mm across
- Atrophic – similar to erosive
- Bullous – small vesicles/blisters within white patches
- Plaque-like – white patches
Usually diagnosed based on appearance and confirmed with biopsy
Treated symptomatically, as there is no cure.
- 0.15% Benzydamine hydrochloride spray/rinse
- 2% lidocaine gel
- topical corticosteroids
- 0.1% triamcinolone acetonide + 1% carboxymethylcellulose paste
- betamethasone rinse
- fluticasone spray/cream
- prednisolone rinse
- beclometasone spray
- clobetasol ointment
- tacrolimus 0.1%
- ciclosporin rinse
Prognosis
Oral lichen planus is generally persistent and rarely fully resolves, therefore treatment is designed to manage symptoms. Limited research into malignant potential and any association with oral squamous cell carcinoma is considered controversial. Nevertheless, monitoring of these lesions is still considered important.
dentalsmackers 