Oral lichen planus

Oral lichen planus

1. Oral Lichen Planus

2. Presenter Dr. Nusrat Fahmida Trisha Honourable chairperson Dr. Jalal Uddin Mahmud Sir Head of the department Periodontology And Oral pathology Dhaka Dental College

3. Lichen Planus is common chronic inflammatory disease of skin and mucous membrane presence of cutaneous violaceous papules that may coalesce to form plaques What is Lichen Planus ?

4. Types of Oral Lichen Planus

5. Striae Most common Sharply defined snowy white, lacy, starry or annular patterns Not palpable or firmer than the surrounding mucosa

6. Erosive shallow irregular area of epithelial destruction very persistent and may be covered by smooth, slightly raised yellowish layer of fibrin margins may be slightly depressed due to fibrosis and gradual healing at the periphery striae may radiate from the margins of these erosions

7. Atrophic red areas of mucosal thinning often combined with striae

8. Plaques occasionally seen in early stages particularly on the dorsum of the tongue

9. Bullous form Raised fluid filled lesions Short lived on gingiva resulting in an ulceration

10. Ulcerative form fibrin coated ulcers surrounded by an erythematous zone frequently displaying white striae

11. Pathogenesis of Oral Lichen Planus

12. CD8 T cell trigger the apoptosis of oral epethelium cell These cells become cytotoxic for basal keratinocytes Liquefaction degeneration of basal keratinocytes

13. Contributing Factor of Oral Lichen Planus

14. Immune system has a primary role in the development of this disease Predisposing factor Genetic background Dental material Drugs Infectious agent Habits Trauma Diabetes and hypertension Stress Miscellaneous associations

15. Diagnosis Clinical features Investigation Treatment

16. CLINICAL FEATURES: Patients usually over 40 years ,Children are rarely affected Females account for at least 65% of patients Untreated disease can persist for 10 or more years Common sites are: Buccal mucosae Dorsum of tongue Gingivae (infrequently) Lip(mucosal side Posterior buccal mucosa ( most common site )

17. Lesions usually bilateral and often symmetrical Cutaneous lesions only occasionally associated Striae alone may be asymptomatic, but atrophic lesions are sore and erosions cause more severe symptoms Eating becomes difficult

18. Gingival lichen planus CLINICAL FEATURES Lesions are usually atrophic, so gingivae appear shiny, inflamed and smooth Only limited segments of the gingivae may be affected.

19. Soreness caused by atrophic lesions makes tooth brushing difficult Plaque accumulation and associated inflammatory changes appear to aggravate lichen planus

20. Investigation Incisional biopsy ANA test Immunofluorescent studies- Fluorecent dyes like FITC Immunoglobulin assay PAS staining

21. Histological features Hyperkeratosis or parakeratosis Saw-tooth profile of the rete ridges Saw-tooth rete ridges

22. Liquefaction degeneration of the basal cell layer Compact, band-like lymphoplasmacytic (predominantly T-cell) infiltrate cells hugging the epithelio -mesenchymal junction CD8 lymphocytes predominate in relation to the epithelium Basal cell degeneraton Infiltration of lymphocytes

23. Treatment

24. No treatment for oral lichen planus is curative Goal: Reduce painful symptoms Resolution of oral mucosal lesion Reduce risk of Oral SCC Improve oral hygiene Eliminate exacerbating factor Diet Reduce stress

25. Medication: Topical corticosteroid Systemic corticosteroid cyclosporin Griseofulvin Retinoids Prophylactic use of 0.12% Chlorhexidine mouthwash Surgery laser photochemotheraphy

26. Complication 1.OLP and its treatment may predispose people to oral candida albicans super infection. 2. Malignant Transformation : Reported transformation rates vary from 0.5 to 2% over a period of 5 years. - Erosive and atrophic forms commonly undergo transformation. 3. Oral SCC in patients with OLP is a controversial issue.

27. Case presentation

28. Particulars of patient Name- Mrs. Salina Age-45 y Sex -female Reg no-3492/130 Address-Mirpur 10, Dhaka Chief complaint Burning sensation in the mouth for 6 months H/o present illness According to the statement of the patient she was reasonably well 6 months back. Then she developed burning sensation in the mouth for last 6 months while consuming spicy food and bilateral pigmentation on the inner part of cheek. She is diabetic. Now she admitted to DDCH for better management.

29. Intraoral examination On intraoral examination, a greyish brown patch with white striae were observed in the posterior buccal mucosa extending into retromolar fossa . Lesions are non tender on palpation. No other mucosa or skin surface showed lesional change Diagnosis - Oral lichen planus Treatment scaling oral hygiene maintain Trialon ointment Listacare mouthwash           Diagnosis - Oral lichen planus Treatment scaling oral hygiene maintain Trialon ointment Listacare mouthwash           Diagnosis Oral lichen planus Treatment Scaling Oral hygiene maintain Trialon ointment Mouthwash

30. Oral lichen planus is a complex and poorly understood clinical condition which can not be cured . A definitive diagnosis and careful, conscientious follow-up are imperative..Symptoms and complications are common and challenging but may be managed with a variety of therapies including orally administered and systemic medications as well as lifestyle alterations and reduction of precipitating factors . Conclusion

31. REFERENCE CAWSON’S ESSENTIALS OF ORAL PATHOLOGY AND ORAL MEDICINE By R.A. Cawson and E.W. Odell

32. THANK YOU!