What is it?
Oral lichen planus is a condition that causes a long-standing inflammatory change in the lining of the mouth. Cells of the immune system are thought to be targeting the top layer of the lining. The most typical appearance is white lines in a net or lace pattern inside the cheek, usually on both sides at once; these lines do not come away when wiped.
The condition is not limited to the cheek. The top of the tongue, the inside of the lip and the gums can also be involved. When the gums are involved, they look red and shiny and bleed easily on brushing; this picture is often mistaken for ordinary gum inflammation. In the forms with red areas and sores, burning and pain become marked.
Oral lichen planus is not contagious. Its course fluctuates: long quiet spells can be followed by flare-ups. In most people it is not expected to clear up completely on its own; the aim is therefore to keep the symptoms under control and to monitor the lining at regular intervals.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
An immune response that targets the lining
The condition is accepted to rest on a continuous reaction by immune cells directed at the surface of the lining. No single external cause has been shown; that is why it is not a contagious disease and not one that comes from diet.
- 02
Similar pictures caused by medicines and filling materials
A very similar appearance can develop with some blood pressure, rheumatism and diabetes medicines, or on surfaces in contact with certain filling materials. This is called a lichenoid reaction; telling the two apart matters because it changes the direction of treatment.
- 03
Factors that set off flare-ups
Times of heavy stress, rubbing from a sharp edge on a tooth, a poorly fitting denture, smoking and alcohol can make flare-ups more frequent. Spicy, acidic and very hot food makes existing symptoms worse.
- 04
Findings that can occur outside the mouth
Similar lesions can be seen on the skin, the nails, the scalp and in the genital area. Where the doctor thinks it necessary, they may want these areas and some blood tests to be assessed as well.
How does it progress?
- Reticular
Lacy white lines
This is the most common form. White lines that do not wipe away are found inside the cheek, usually on both sides. It may produce no symptoms and can be picked up by chance at a routine examination.
- Erythematous
Red, tender areas
Bright red areas form between the white lines or on the gums. Bleeding on brushing, burning and sensitivity to hot and spicy food are seen.
- Erosive
The form with open sores
There are open sores on the surface of the lining. The pain is marked; it can make eating and toothbrushing difficult. This form is monitored at closer intervals.
How is it treated?
The diagnosis is not always made from the appearance alone. A white patch that does not wipe off, that is on both sides and in a net pattern, points the way; but a biopsy is usually asked for in order to tell it apart from leukoplakia and other conditions of the lining. A biopsy and examination of the tissue are the work of oral and maxillofacial surgery and of oral medicine; the result sets the direction of treatment.
The part the dentist takes on is limited to the inside of the mouth. In the lacy form that produces no symptoms, medicines are usually not used; sharp edges on teeth are smoothed, the fit of a denture is sorted out, tartar is removed and monitoring is planned. If there is burning or a sore, a topical treatment the dentist considers appropriate can be arranged; if thrush has developed as well, that is dealt with separately.
When the skin, the nails, the scalp or the genital area are involved, and in widespread cases that cannot be controlled with treatment inside the mouth, the assessment passes to dermatology; the decision about treatment for the whole body is that doctor's. If a lichenoid reaction to a medicine is suspected, only the doctor who prescribed it can decide to change it, so do not stop it on your own. Monitoring continues on both sides; you are advised to attend your check-ups at the intervals your clinician sets.
- An area is becoming hard, raised or thickened at its edges
- A new sore has appeared that has not healed in two to three weeks
- You are eating and drinking less because of the pain and you are losing weight
- A rash has appeared on your skin, on your nails or in the genital area
How is it prevented?
- Do not miss your check-up appointments; in this condition monitoring is part of the treatment.
- Stop smoking and drinking alcohol; both increase flare-ups and the strain on the lining of the mouth.
- Cut down on acidic, spicy and very hot food during flare-ups.
- Clean regularly with a soft brush; when the gums are involved, plaque build-up makes the picture worse.
Frequently asked questions
- Does oral lichen planus turn into cancer?
- No firm statement can be made about this. In the great majority of cases no such change is seen; on the other hand, because change over time has been reported in a small proportion of cases, regular monitoring is advised. The point of monitoring is not to frighten you but to pick up early any area that becomes hard, raised or fails to heal.
- Is it contagious, can I pass it to my partner?
- It is not contagious. It is not passed on by kissing or by sharing a glass or cutlery. It is a condition linked to the immune system's response to the body's own tissue, not an infection. People living in the same house do not need to take any extra precautions.
- Do my fillings need to be replaced?
- Not in every case. If the white or red area sits only where it touches a particular filling surface, a lichenoid contact reaction can be considered and replacing that restoration may come into it. In widespread cases on both sides, no benefit is expected from changing fillings; the decision is made after an examination and, if needed, a biopsy.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.