The link between oxidative stress and oral lichen planus and its future implication on treatment.pdf

Highlight attention to the relation of oxidative stress, oral lichen planus, and treatment implications.

1. The link between oxidative
stress and oral lichen planus
and its future implication on
treatment
Dr. Shimaakotb
Ass. Lecturer of Oral Medicine, periodontology, at Sphinx University, Egypt.

2. outlines
Definition
Risk factors
Pathogenesis
classification &
clinical feature
of Lichen planus
Aim of study
Management of
OLP
Antioxidant
Selenium
Conclusion
References

4. Lichen planus
It is derived from the Greek
word
leichen” means moss that
is seen on rocks
Latin word “ planus”means
flat.

5. Oral Lichen planus
(OLP) is a chronic mucocutaneous inflammatory disease
affects about 4% of the global population.
prevalence increases significantly and progressively from
the age of 40 years
It is more common in women
Most frequently occurein the non-keratinize mucosa.

6. Etiology of
OLP
(unknown exactly)
mediated by T-lymphocyte
aggression directed towards the
basal layer of the oral
epithelium.
The disease is neither infectious
nor contagious.
autoimmune in nature.

7. Cutaneous lichen planus is distinguished by:
5 p:
Purple
Polygonal
pruritic
plaque
papules
on the flexor surface of the wrist, chins,
trunk, and medial thighs, mostly hidden by
Wickham striae.

8. Clinical
Classification
of OLP
Reticular ( Mild form ) appears as white
hyperkeratotic striae )wickhamstria)
Erosive-ulcerative “severe” form and can be a life
threatening affection, preventing the patients from
eating and drinking due to painful symptoms.
Papular
Atrophic
Plaque
Bullous

9. Reticular –papular–Atrophic –Erosive

10. Clinical Classification of OLP
Asymptomatic
-Reticular
-plaque
-Papular
-Bullous
Symptomatic
Erosive
Atrophic

11. Clinical
Feature
Asyptomatic: white hyperkeratosis
stria or plaque
Symptomatic: discomfort , pain,
burning sensation and intolerance
to spicy and hot food.

12. Characteristic clinical feature of OLP
The bilateral and
symmetric
distribution is typical
of OLP(mirror
image).
The most involved
sites are the buccal
mucosa, borders,
and dorsum of the
tongue and gingiva.

13. Diagnosis of OLP :
Clinical manifestations of
OLP are sufficient to make a
correct diagnosis.
Oral biopsy with histopathological analysis
recommended to confirm the clinical
diagnosis to exclude malignancy.

14. Histopathology of OLP

15. Risk Factors
Medications (hypertensive drugs,
hypoglycemic drugs, NSAIDs).
Dental materials(Amalgam, composite).
Genetics
Viral infection (Hepatitis-c).
Endocrinal disturbance.
Micro-circulation disturbance .
Stress

16. Pathogenesis
T-cell mediated immune response from :
. Exogenous agents . Endogenous agents
➢Presented by APC (keratinocytes)by toll-like receptors that
stimulate secretion of abundant TNF, INF, IL
➢These proinflammatory mediators migrate to regional L.N
,where it stimulate differentiation of lymphocyte to T helper
CD4 and T cytotoxic CD8 .
➢CD8 (stimulate apoptosis of keratinocyte)activation in skin.
➢CD4

17. Pathogenesis
The key factor is the ROS generation stimulated by pro-
inflammatory mediatorsinfiltration composed by T cells
and cytokines.
ROS further induce cellular and DNA damages, thus
induce keratinocyte apoptosis which is a hallmark
biomarker of OLP
the levels of ROS-biomarkers in saliva and serum/ plasma
significantly increased in OLP patients, while the levels of
antioxidant-related biomarkers reduced significantly .

18. Response of Immune system
Response of body to defense damage happen ,
The body possess several antioxidant systems to
maintain redox homeostasis:
Saliva (first line defense against ROS)
There are Enzymztic/non enzymatic molecules
Glutathione peroxidase (GPx): Consider as first
line defense against ROS, converting superoxide
anion into H2O2.

19. Glutathione peroxidase
They are a group of detoxification enzymes that are
piovital components of cellular defense against
oxidative stress .
Low level of functional GST enzymes could
increase ROS-mediated oxidative stress and
thus contribute ininflammatory diseases
propagation .

20. Role of Glutathione peroxidase enzyme
Main abundant
intracellular
anti-oxidant.
Most important
radical
scavenger.
thus has a role
in sustain redox
balance

21. Aim Of study

22. Aim of study
Evaluate Clinically (pain score and severity of symptoms)
Evaluate biochemicallyTo assess:
Glutathione biomarker level as an antioxidant enzyme in
saliva by ELISA analysis

23. Management OF ORAL
LICHEN PLANUS

24. Management of Oral Lichen
planus
OLP appears to be an incurable ,disappointing
disease.
the primary target:
Controlling inflammation relies on relieving symptoms.

25. Management of OLP
pharmacological treatments
ozone therapy
cryotherapy (with nitrous oxide gas (NOG)
photodynamic therapy (PDT), and low-level laser therapy (LLLT), also called
photobiomodulation

26. Management of Oral Lichen
planus
Corticosteriodids: is the first line of treatment
Topical corticosteroids are generally preferred resulting from the significant anti-
inflammatory effect.
Several corticosteroids used in the topical treatment of OLP, including:
Triamcinolone acetonide (ta)
Betamethasone sodium phosphate
Dexamethasone
Clobetasol

27. Managments
Immunosuppressant
Tacrolimus (Inhibit proliferation
of T-lymphocytes)
•Side effect:
•Bad sense ,burning sensation
•Nephrotoxicity hypertension
•High price .

28. Antioxidant
substances present at low
concentrations.
It significantly inhibit oxidation
of substrate,
By counteract elevated level of
ROS .
Protection of the cells and
organ against reactive oxygen
species

29. Selenium
Essential trace natural elements essential for mammalian
cellular function:
Potent antioxidant enzymes (glutathione peroxidase)in
human body .
Prevent diseases from free radical damage
Sofunction against oxidative stress :
Slow down aging process
Immune system modulation

30. Role of selenium
Selenium
Role
Antiinflama
tory
Antioxidant
Antiaging
anticancer
Immunmod
ulator
Enhance
antibacteri
al ,antiviral,
antifungal
resistance

31. Conclusion
OLP is a persistant , dynamic disease with different clinical forms
evolving from mild-to-severe forms, With predicted flare-up times
and symptom-free periods
OLP has a negative impact on the quality of life. This is mainly
because of burning sensation and pain.
A continuous periodic follow-up is necessary.
Glutathione peroxide enzyme can be used as biochemical marker
for diagnosis and treatment of OLP
Selenium may act as a promising immunmodulatorantiinflamatory
efficacy

32. References
DePorras-Carrique,T.;Ramos-García,P.;Aguilar-Diosdado,M.;Warnakulasuriya,S.;
González-Moles,M.Á.Autoimmunedisordersinorallichenplanus:Asystematic
reviewandmeta-analysis.OralDis.2022.
González-Moles,M.;Warnakulasuriya,S.;González-Ruiz,I.;González-Ruiz,L.;Ayén,
Á.;etal.Worldwideprevalenceoforallichenplanus:Asystematicreviewandmeta-
analysis.OralDis.2021,27,813–28.
SerafiniG,DeBiaseA,LamazzaL,MazzucchiG,LollobrigidaM.EfficacyofTopical
TreatmentsfortheManagement ofSymptomaticOralLichenPlanus:ASystematic
Review.IntJEnvironResPublicHealth.2023;10;20:1202.
Łukaszewska-Kuska,M.;Slebioda,Z.;Dorocka-Bobkowska,B.Theeffectivenessof
topicalformsofdexamethasoneinthe´treatmentoforallichenplanus-Asystematic
review.OralDis.2021.
JiaWang,JingjingYang,ChenWang,ZhibaiZhao,YuanFan,"SystematicReviewand
Meta-AnalysisofOxidativeStressandAntioxidantMarkersinOralLichen
Planus",OxidativeMedicineandCellularLongevity.2021,ArticleID9914652,16.

33. Thank
you