We hear from Mike Lewis, professor of oral medicine at Cardiff University, who explains how oral lichen planus manifests and what he advises patients to prevent plaque build up.
Lichen planus is a chronic inflammatory condition that affects the skin, hair, nails, and mucous membranes, including the oral cavity. It manifests as purplish, itchy, flat-topped bumps when it appears on the skin, but within the mouth, it often presents as white, lacy patches or red, swollen tissues, sometimes causing painful sores.
What is lichen planus?
Lichen planus is an autoimmune disorder wherein the body’s immune system mistakenly attacks its own tissues. The precise cause remains unknown, though factors such as stress, genetic predisposition, and certain medications may play a role in triggering the condition. While it can affect people of all ages, it is more commonly observed in middle-aged adults.
Oral lichen planus is a chronic inflammatory condition that affects the mucous membranes inside the mouth. It often presents as white, lacy patches or red, swollen tissues, and can sometimes cause painful sores. There are two main types: reticular, which appears as white patches and usually has no related symptoms, and erosive, which appears as red, swollen tissues or open sores and may cause a burning feeling or pain.
The condition occurs when the immune system attacks cells of the oral mucous membranes for reasons that aren’t known. Regular checkups are important because oral lichen planus, especially the erosive type, may raise the risk of getting mouth cancer in the affected areas.
Symptoms
The symptoms of lichen planus can vary depending on the area affected. In the oral cavity, it often leads to:
- White, lacy patches on the gums, tongue, or inner cheeks
- Red, swollen tissues in the mouth
- Burning sensation or pain
- Sores or ulcers
- Difficulty eating or speaking.
If your gums are affected, they could become tender, and tooth-brushing may be uncomfortable. Ulcers or erosions sometimes occur and these are especially painful. Some patients (about 15%) may also have lesions on the skin caused by lichen planus. Mild cases can be symptom-free. Factors such as stress, genetic predisposition and certain medications may play a role in triggering the condition.
In most people, oral lichen planus is not serious. However, an important, although uncommon, feature of oral lichen planus is a tendency to cancerous change, with about a 1% risk over a period of 10 years. In other words, one in a hundred people develop cancer in the mouth. Oral lichen planus is not an infection and is not contagious. (This means that it cannot be passed from person to person.)
Oral lichenoid patches are not oral lichen planus. They may occur in a few people. It can be very difficult to distinguish them from oral lichen planus. These can be caused by medicines, eg some drugs prescribed for high blood pressure and diabetes or dental materials (mercury, nickel, gold, resins, acrylates).
Treatment
Maintaining good oral hygiene is crucial for those suffering from this condition. Proper care can help alleviate symptoms and prevent complications such as secondary infections.
Treatment for oral lichen planus focuses on healing and easing pain or other symptoms:
- Symptomatic treatment: Anaesthetic agents applied to the skin can provide short-term relief for very painful areas. Analgesic mouthwashes such as benzydamine can help
- Corticosteroids: Topical steroids can be applied to the affected area. These medicines can lower inflammation related to oral lichen planus. They can be applied directly to the mucous membrane, via a mouthwash, spray or paste onto the affected area
- Systemic treatment: In severe cases systemic treatment may be required. Oral corticosteroid’s can be prescribed may be used to improve severe symptoms and lessen pain.
If the gums are affected, it is important the teeth are kept as clean as possible by regular and effective tooth brushing. If not, a build-up of plaque can make your gum condition worse. Your dental professional will be able to give oral hygiene advice.
Oral hygiene methods to ease symptoms
Maintaining good oral hygiene is crucial for those suffering from oral lichen planus. Proper care can help alleviate symptoms and prevent complications such as secondary infections. Some effective methods include:
- Using a soft-bristled toothbrush
- Switching to non-foaming toothpaste
- Opting for alcohol-free mouthwashes
- Making dietary adjustments
- Having regular dental check-ups.
Gentle brushing techniques
Using a soft-bristled toothbrush can prevent additional irritation to the already sensitive oral tissues. Brush gently and thoroughly, twice a day, to remove plaque and food particles without causing harm. Using TePe Special Care brush can be used whilst the lichen planus is painful.
The TePe Special Care brush is recommended for brushing after oral surgery and for patients with sore or very delicate oral tissue, very sensitive root surfaces, extremely dry mouth, and after radiotherapy.
Non-foaming toothpaste
Regular toothpaste often contains foaming agents like sodium lauryl sulphate (SLS), which can exacerbate oral sores. Switching to a non-foaming toothpaste can reduce irritation and improve comfort. TePe Pure Toothpaste is a good option as an SLS free toothpaste with a mild peppermint and the unflavoured TePe Pure is a good option for those who are sensitive to mint.
Mouthwashes
Alcohol-based mouthwashes can be harsh on sensitive tissues. Opt for alcohol-free mouthwashes with soothing ingredients such as TePe Hydrating Mouthwash. The viscous consistency moistens and soothes the mouth, leaving a pleasant feeling after use, the mouthwash contains 0.2% fluoride for extra protection against cavities.
Dietary adjustments
Certain foods can trigger pain or exacerbate symptoms. Avoid spicy, acidic, or rough-textured foods that can irritate oral lesions. Instead, opt for soft, bland foods that are easy to chew and swallow.
Regular dental check-ups
Frequent visits to the dentist are essential for monitoring the condition and managing symptoms effectively. Dental professionals can provide professional cleanings and offer advice tailored to individual needs.
Stress management
Since stress is a known trigger, incorporating stress-reduction techniques such as yoga, meditation and deep-breathing exercises can be beneficial.
Conclusion
Lichen planus can be a challenging condition to live with, especially when it affects the oral cavity. However, with proper oral hygiene methods and regular dental care, symptoms can be managed effectively.
Consulting dental professionals and healthcare providers for personalised advice and treatment plans is crucial for optimal management of lichen planus.
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This article is sponsored by TePe.
