Opposing Oral Lichen Planus
You have white lace-like threads on the inside of your mouth and it hurts. Your gums are bright red and swollen. They feel tender to the touch. You could have oral lichen planus.
Oral lichen planus is a chronic inflammatory condition that affects the lining of your mouth. In some people, the only symptom is white, lacy lesions on the inner lining of the mouth. Others have erosive lichen planus, where inflammation and ulcerations can cause pain, itching and tenderness. Almost constant discomfort can result. Other symptoms include a sore, dry mouth; metallic taste and sometimes ulceration.
The cause is not known. But the lesions are triggered or at least worsened by stress, certain medications or other chemicals. Other possible triggers include allergies, infections, and other conditions such as diabetes or hypertension. Smoking also makes it worse.
Good oral hygiene and frequent dental visits to make sure there aren’t any dental causes of irritation are essential. Spicy, acidic, hot, salty and rough foods all may exacerbate symptoms and should be minimized. Sometimes bumps in the mucous membranes become filled with fluid and ulcerate.
There is no cure but it can be alleviated. Oral lichen planus is part of lichen planus, which can affect the skin, genitals, nails, esophagus and mouth. Although many experts believe it is an autoimmune disease, possibly after trauma or infection, this is unproven.
Overall, lichen planus affects 2 percent of the population. It mostly occurs between the ages of 30 and 60. It is more common in people with a history of hepatitis C.
Work with your health provider to confirm the diagnosis. Similar conditions that affect the mouth require different treatment. For example, oral thrush (Candida albicans), a fungal infection, causes creamy white, sometimes painful, lesions on the tongue and inner cheeks.
Oral thrush can be aggravated by steroid ointments or gels, a first-line treatment for lichen planus. Another potential complicating factor is that lichen planus and oral thrush sometimes occur simultaneously.
Typically, a biopsy is required to confirm the diagnosis of lichen planus. Your health provider scrapes a small sample of tissue that is then examined under a microscope.
There is some evidence that people who have persistent oral lichen planus are at an increased risk of oral cancer. The reason for this connection is unclear. Just have your health provider monitor your condition on a consistent basis. For severe symptoms, a recheck may be advised every three to four months. Otherwise, every six months may be recommended.
Lichen planus usually shows up in more than one site on the body. However, when dental work is the culprit, it may have to be removed.
A corticosteroid medication is usually used to treat symptoms like pain and discomfort. But there is some trial and error involved in treating the condition. It might take several tries before the right treatment is found because not all patients respond in the same way. Also, medication strength varies, so that can be a factor.
Another thing to keep in mind is that people treated with a corticosteroid may develop a candidiasis infection that needs to be treated along with the lichen planus. So it is a process of keeping things in balance.
Lichen planus can last for several years or it might go away within 18 months. Lesions in the mouth are difficult to treat with ointments, so oral retinoids are an alternative. Oral steroids may be tried, but they should not be used for long periods of time and the lesions typically return after stopping the medication.
Lichen planus is not a life-threatening condition, but it can persist for a long time and come back after apparently successful treatment. In most people, lichen planus mysteriously disappears within a few years of it coming on. Talk with your health care provider if you suspect that you have this disease.
