Oral lichen planus

Oral lichen planus is a chronic autoimmune inflammatory condition affecting the lining of your mouth, usually resulting in characteristic lacy white patches. Oral lichen planus occurs most often on the inside of your cheeks but also can affect your gums, tongue, lips and other parts of your mouth. Oral lichen planus sometimes involves your throat or esophagus.

While oral lichen planus usually begins during midlife, it can occur at any age. An initial episode of oral lichen planus may last for weeks or months. But unfortunately, oral lichen planus is usually a chronic condition and can last for many years. Although there's no cure, oral lichen planus can be managed with medications and home remedies.

Symptoms

Oral lichen planus signs and symptoms may include one or more of the following:

• Small, pale raised areas or bumps that form a lacy network on your tongue or inside your cheeks
• Shiny, red, slightly raised patches on your tongue or cheeks
• Red, open sores in your mouth
• Mouth pain
• Burning in your mouth
• Dry mouth
• A sense that your mouth feels rough
• Sore gums
• Sensitivity to hot or spicy foods
• A metallic taste or a blunted taste sensation
• Burning, swelling, bleeding and irritation with tooth brushing

Oral lichen planus usually causes only a limited lacy network of pale, slightly raised areas or shiny, red, raised patches on the sides of your tongue or inside your cheeks. Less commonly, it may turn in to a painful erosive lesion, or ulcer. Sometimes oral lichen planus causes no signs or symptoms other than the raised areas or patches. You may have periods when your oral lichen planus flares up, alternating with periods when you're symptom-free.

When you have oral lichen planus, you may also have the skin form, called lichen planus. You may notice lesions on other parts of your body, including your skin, scalp, nails and genitals.

When to see a doctor
See your doctor or dentist if you:

• Notice sores inside your mouth that don't heal
• Have lumps or white, red or dark patches in your mouth
• Have mouth pain
• Have a loss of feeling inside your mouth
• Have repeated bleeding in your mouth
• Notice any change in the way your mouth looks and feels
• Have lesions or sores on your skin, scalp, nails or genitals

Risk factors

While it's not known what causes oral lichen planus, factors that may increase your risk of the condition include:

• Sex. Women are more likely than are men to have oral lichen planus.
• Medications. Certain medications, such as some of those used to treat arthritis, heart disease, high blood pressure and malaria, may trigger oral lichen planus.
• Allergies. Oral lichen planus can result from an allergic reaction to food, food additives, fragrances, dyes, dental metals or other substances.
• Medical conditions. Certain medical conditions, including other immune disorders, are associated with oral lichen planus. These may include lichen planus of the skin, liver disease, graft-versus-host disease, primary sclerosing cholangitis, lupus erythematosus, primary biliary cirrhosis, Sjogren's syndrome, ulcerative colitis, alopecia areata, and myasthenia gravis.
• Dental issues. Sharp edges on your teeth, dental restorations, ill-fitting dental prostheses, some periodontal surgical procedures, and oral habits such as lip and cheek chewing may raise the risk of oral lichen planus.
• Betel quid. Chewing betel quid — a plant and nut combination common in Southeast Asia — may increase your risk.
• Psychological issues. Stress, depression and anxiety often accompany oral lichen planus and may worsen existing cases.

Complications

Besides pain and taste changes that may accompany oral lichen planus, the condition also may cause or be associated with such complications as:

• Squamous cell carcinoma. This is a form of skin or mucous membrane cancer. There's considerable controversy about whether oral lichen planus can increase the risk of this cancer since evidence has been mixed. The risk appears to be heightened with ulcerative forms of oral lichen planus and with tobacco use.
• Oral thrush (Candida albicans). Oral lichen planus and its treatment may increase the risk of this fungus infection. In some cases, it can become resistant to antifungal medications, resulting in a so-called superinfection that's difficult to control.

Tests and diagnosis

Frequently, your dentist is the first to notice oral lichen planus symptoms during a routine examination. The condition often can be diagnosed just by examining the affected areas of your mouth. In some cases, though, you may need to see a doctor or dentist who specializes in dermatology or oral medicine for a definitive diagnosis and treatment.

To make a diagnosis, your doctor may:

• Ask about your symptoms
• Discuss your medical history
• Examine your mouth and other areas of your body
• Order tests, such as blood and allergy tests, to rule out other conditions, such as yeast infections and canker sores
• Take a biopsy of your lesions, especially if they're erosive or ulcerated

Prevention

There's no sure way to prevent oral lichen planus. Getting underlying medical conditions under control may help oral lichen planus from worsening, though. Also, avoiding alcohol and tobacco can help reduce your risk of oral cancer, which has been linked to oral lichen planus.