Oral Lichen Planus

Oral lichen planus (OLP) is a condition that causes inflammation inside your mouth. Normally, inflammation helps your body heal. But with OLP, it happens for unknown reasons and ends up damaging the thin tissue (mucosa) lining your cheeks, gums and tongue.

Oral lichen planus isn’t dangerous. It’s not contagious, so you can’t spread it to others. But it can cause abnormal tissue (lesions) to form in your mouth. It can make your mouth hurt.

This is why you should see a dental care provider if you notice signs of this disease. There’s no cure for oral lichen planus, but treatments can provide relief.

Types

There are two main types of OLP:

• Reticular oral lichen planus. This mild form of OLP causes white spots, patches or thread-like lesions inside your mouth. It usually isn’t painful.
• Erosive oral lichen planus. This severe form causes bright red, irritated gums. It can hurt to eat, drink or brush your teeth. Ulcers can develop in one or more places inside your mouth.

Symptoms of oral lichen planus

Signs and symptoms depend on which type of OLP you have. Often, they occur as occasional flare-ups that go away on their own or with treatment. You may have:

• White, web-like lesions inside your cheeks or on your tongue
• White spots or patches on your tongue or gums
• Ulcers on your gums, tongue or the roof of your mouth
• Bright red gums
• Mild to severe pain, especially when you brush your teeth or eat certain foods (especially acidic, crunchy, salty or spicy foods)

People with oral lichen planus often have skin lichen planus. This form of the condition can cause an itchy rash on your genitals or scalp.

Oral lichen planus causes

Doctors don’t know exactly why oral lichen planus occurs. But they do know that it’s related to your immune system. Typically, your immune system releases immune cells that attack harmful substances, like germs. In this way, your immune system keeps you from getting sick. But with OLP, the immune cells attack the tissue lining inside your mouth.

OLP shows up more often in people who take certain medicines, like:

• Antifungals
• Antiparasitics
• Antiseizure medications
• Beta-blockers
• Diuretics
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

It also sometimes occurs with diseases, like

• Hepatitis B
• Hepatitis C
• Human papillomavirus (HPV)
• Primary biliary cirrhosis

But more research is needed to understand the connection between these conditions and OLP.

What triggers oral lichen planus?

Many people with OLP learn to recognize triggers that spark symptom flare-ups. Common ones include:

• Allergic reactions (to foods, toothpaste or floss, materials from dental procedures)
• Dental issues (like a misaligned bite or having jagged teeth)
• Medications
• Mouth injuries
• Mouth infections
• Stress or anxiety

Risk factors

Females are 3 to 4 times more likely than males to develop oral lichen planus. You can develop it at any age. But most people diagnosed are between 30 and 70 years old.

Complications of oral lichen planus

Oral lichen planus can lead to weight loss if eating hurts so much that you skip meals. Damage to the mucosa inside your mouth can also increase your risk of yeast and bacterial infections.

Research shows that about 1% to 4% of people develop oral cancer. The chance is greater if you have erosive oral lichen planus (the more severe form). But more studies are needed to understand why some people with OLP get cancer and others don’t.

Just to be safe, your healthcare provider will check your mouth for precancerous changes during check-ups. This is important because providers can often cure early-stage oral cancers.

How doctors diagnose this condition

A healthcare provider can diagnose oral lichen planus by examining your mouth. In many cases, providers take a tissue biopsy to confirm the diagnosis and rule out other diseases.

How is oral lichen planus treated?

Treatment for OLP focuses on reducing symptoms and preventing flare-ups. This means you may not need treatment if you don’t have symptoms that are bothering you.

Treatment usually involves a mix of medications and lifestyle changes to avoid triggers.

Medications

If you have symptoms, your healthcare provider will likely recommend medications. Some may calm your immune system so there’s less inflammation. Others relieve pain. Common oral lichen planus treatments include:

• Corticosteroids. You may get a gel or ointment to rub on the lesions. If that doesn’t work, your provider may prescribe this medicine as a shot or a pill that you take by mouth.
• Calcineurin inhibitors. Providers may prescribe this type of medicine if corticosteroids aren’t helping. The most common type is an ointment you rub on the lesions.
• Pain relievers. Often, over-the-counter medicines reduce pain from OLP. Options include acetaminophen and NSAIDs. You may need medicines like lidocaine to numb the pain.

Lifestyle changes

Making small changes to your routine can help prevent flare-ups. Not everyone has the same triggers. But for many people, it helps to:

• Avoid acidic, crunchy, salty or spicy foods
• Avoid drinking alcohol or using tobacco products
• Use a soft-bristled toothbrush or an electric toothbrush on the lowest setting
• Use mild, unflavored toothpaste and dental floss (no mint, cinnamon or sodium lauryl sulfate)
• Practice stress management techniques daily
• Stop taking medications that cause flare-ups

You should always talk to your healthcare provider before stopping medications. They can help you stop taking a medicine safely.

Recovery time

Most people notice major symptom relief within a month of using topical corticosteroids (the type you rub on the lesions). With a shot, it may take two to three treatments to feel better. With pills, it may take a few weeks.

Depending on the medication, your healthcare provider may gradually reduce your dosage so you take less of it over time. This reduces the chance of developing side effects from the medicine.

When should I see my healthcare provider?

Once you’re diagnosed with oral lichen planus, you’ll need regular check-ups to keep tabs on your condition. This is the case even if you’re going through a period with no symptoms. For example, it’s important that your healthcare provider checks for precancerous changes. You may need more frequent dental cleanings to keep your mouth healthy.

If you’re experiencing a symptom flare-up, let your provider know. They can start you on treatments that can help you feel better.

What can I expect if I have oral lichen planus?

Oral lichen planus never fully goes away. But this doesn’t mean you have to live with uncomfortable symptoms. Most people have periods of both symptom flares and remission. Remission means there aren’t any signs or symptoms of OLP.

And the experience of symptoms differs. Some people with OLP have painless lesions that don’t require treatment. Others need strong prescription medicines to feel relief.

Your healthcare provider can explain what you should expect based on your symptoms.

Is there anything I can do to feel better?

Speak to a therapist if the stress of managing your condition is taking a toll on your emotional health. Many people with long-term conditions benefit from therapy to help keep stressors at bay. This is especially important with OLP, as stress is a common trigger for symptom flare-ups. Don’t hesitate to ask for the care you need.

What can be mistaken for oral lichen planus?

Oral lichen planus can be mistaken for a yeast infection in your mouth (thrush) and leukoplakia. Like OLP, both involve white patches or spots in your mouth. But their causes are different, and so are their treatments. A healthcare provider will do tests to find out which condition you have.