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Understanding Oral Lichen Planus: Causes, Symptoms, and Treatment Options

Oghenefejiro Okifo | MD

Medically reviewed by Oghenefejiro Okifo | MD, Harvard Medical School | Henry Ford Hospital - Detroit, MI on April 14th, 2024.

Key Takeaways

  • This autoimmune condition creates distinctive white lacy patterns or painful erosions on the tongue, gums, and inner cheeks, affecting women 3 times more often than men, typically after age 40.
  • The reticular form appears as painless white streaks, while the erosive form causes burning pain that intensifies with citrus, tomatoes, or spicy foods—some patients experience both types simultaneously.
  • Hepatitis C patients have 5 times higher risk of developing this condition, and certain blood pressure medications (ACE inhibitors) and dental amalgam fillings can trigger flare-ups in susceptible individuals.
  • Topical corticosteroids like clobetasol 0.05% gel provide first-line treatment for painful lesions, while severe cases may require systemic immunosuppressants like cyclosporine or tacrolimus.
  • Regular oral cancer screenings every 6-12 months are essential since erosive forms carry a 1-2% annual malignant transformation risk, particularly for lesions on the tongue.

Oral lichen planus is a chronic condition that affects the mouth, causing symptoms such as white patches, redness, and swelling. While it is not contagious, anyone can develop oral lichen planus, with women and people over 40 being more commonly affected. In this article, we'll explore the causes, symptoms, and treatment options for managing oral lichen planus.

What Causes Oral Lichen Planus?

The exact cause of oral lichen planus is not known, but several factors may contribute to its development:

  • Genetic predisposition

  • Immune system dysfunction

  • Hepatitis C infection

Additionally, certain triggers can cause oral lichen planus to develop or worsen, including:

  • Certain medications

  • Reactions to dental materials

  • Mouth injuries or irritation

  • Food allergies

  • Infections

Symptoms of Oral Lichen Planus

Oral lichen planus symptoms may develop gradually or appear suddenly. Early signs may include:

  • Mouth dryness

  • Metallic or burning taste in the mouth

As the condition progresses, you may notice:

  • White patches on the tongue, cheeks, and gums

  • Redness and swelling

  • Peeling or blistering of the affected areas

These sores can be painful, especially when consuming spicy, salty, acidic, or alcoholic foods and beverages. Crispy foods and caffeinated drinks may also cause discomfort.

Understanding Oral Lichen Planus: Causes, Symptoms, and Treatment Options

Diagnosing Oral Lichen Planus

To diagnose oral lichen planus, your doctor may perform a biopsy by removing a small piece of affected skin from your mouth for laboratory analysis. Blood tests may also be ordered to rule out other conditions with similar symptoms. Learn more about the diagnosis of oral lichen planus.

Treatment Options for Oral Lichen Planus

Treatment for oral lichen planus depends on the severity of your symptoms. Mild cases may not require treatment, while more severe cases may benefit from:

  • Corticosteroid creams or pills

  • Immunosuppressive medications, such as calcineurin inhibitors (topical) or systemic medications (oral)

It's important to note that calcineurin inhibitors carry an FDA warning due to a potential increased risk of cancer. Discuss the benefits and risks of these medications with your doctor. For more information on treatment options, visit the National Institute of Dental and Craniofacial Research.

Managing Oral Lichen Planus

In addition to medical treatment, there are several steps you can take to manage oral lichen planus and prevent flare-ups:

  • Avoid trigger foods and drinks, such as spicy, citrus, hot, or cold items

  • Manage stress levels

  • Address dental issues, such as sharp teeth or damaged fillings

  • Maintain good oral hygiene

  • Use a mild toothpaste and soft toothbrush

  • Attend regular dental check-ups

  • Monitor your symptoms and report any changes to your doctor

Due to a slight increased risk of oral cancer associated with oral lichen planus, it's crucial to undergo oral cancer screenings every 6 to 12 months. Maintaining a healthy diet rich in fruits and vegetables, quitting smoking, and limiting alcohol consumption can also help promote overall oral health. For more tips on managing oral lichen planus, consult the American Academy of Dermatology Association.

By understanding the causes, symptoms, and treatment options for oral lichen planus, you can work with your healthcare provider to effectively manage this chronic condition and maintain good oral health.

The Bottom Line

While this chronic inflammatory condition has no cure, proper treatment can effectively manage symptoms and prevent complications. Avoiding trigger foods, maintaining excellent oral hygiene, and using prescribed topical medications can significantly improve quality of life. If you're experiencing persistent white patches or burning mouth pain, Doctronic can help you get a proper evaluation and treatment plan.

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