What is the condition?

Oral lichen planus is an immunologically mediated condition affecting the mucous membranes of the mouth. It is caused by the patient’s immune system mounting an attack against the cells of the mucous membranes, but the exact cause for this behavior is still unknown. Oral lichen planus predominately affects females between 30 to 70 years of age. Some patients may also have cutaneous lichen planus, which presents on the legs, genitals, scalps, nails etc.

Oral lichen planus has a few presentations, ranging from white, lacy patches, to red, swollen mucosa, with or without open sores, erosions, and ulcerations. The lesions can appear on the inside of the cheeks (most common), along the gum line, on the tongue, and the inner tissues of the lips and the palate. These lesions can cause soreness, burning sensation or pain, particularly with spicy or acidic foods.

Why should I seek treatment?

Oral lichen planus can cause burning sensation, pain and discomfort which may affect chewing and swallowing. If open sores and ulcerations are present, you may also experience bleeding and irritation during toothbrushing. Symptoms can usually be managed and controlled once the condition has been diagnosed. However, patients are advised to modify their diet and avoid spicy or acidic foods to reduce soreness. 

Importantly, patients with oral lichen planus will need long term regular monitoring because the oral lichen planus lesions are considered pre-malignant and carry a small 1% risk of progressing to oral cancer. 

Treatment options

Although oral lichen planus lesions often have a characteristic appearance, the diagnosis should be confirmed with an incisional biopsy. This procedure entails cutting out a small piece of involved oral mucosa and sending the specimen for histopathological examination under a microscope.

Once the diagnosis is confirmed, the treatment is usually symptomatic, as the autoimmune nature of the condition means that lesions are chronic and will persist. Burning sensation, pain and discomfort can usually be managed with topical steroids in the form of mouthwashes or gels. Rarely patients may require systemic steroids for a period for more severe symptoms.

Discuss with your surgeon the appropriate treatment required. 

What to expect

Oral lichen planus requires long-term regular monitoring with a dentist because it is persistent and is considered a pre-malignant lesion. You may require repeat biopsies if the surgeon notices a change in the appearance of your lesions and suspects malignancy. You should also schedule an earlier review appointment if there are ulcers which do not heal within 2 to 3 weeks.

You may be referred to a dermatologist if you have lichen planus lesions that affect other body parts (skin, genitals, ears, scalp, nails, eyes, esophagus).