December 2018

Rees’s Pieces

This article begins a series of articles by OLP Support Group founder Dr. Terry Rees. It will appear in the December 2018 issue of the OLP Newsletter.

The phases of therapy for oral lichen planus

Terry Rees, DDS, MSD

Oral lichen planus is one of a group of diseases that may affect the skin, mouth and other mucous membranes of the body.  Since many of these diseases may cause similar oral lesions, a correct diagnosis and proper management approach must be carefully determined.  This multi-part discussion will attempt to clarify the philosophy of practice that we adhere to in our Stomatology Center at Texas A&M College of Dentistry in Dallas, Texas. This may be of some importance since in our chat sessions we often allude to the way we manage oral lichen planus and it won’t necessarily coincide with the management concepts of your own health care provider.

Several previous authors have described various phases of therapy in treatment of mucocutaneous diseases and, in our practice, we have adopted their concepts with a little modification.  We believe that diagnosis and management can be divided into 4 phases as follows:

1. Diagnostic phase (Essential to successful management.)
2. Control Phase (Therapy to reduce or eliminate the signs and symptoms of the disease)
3. Consolidation Phase (A period in which we gradually reduce or eliminate therapy to determine what level if any of ongoing treatment may be required as the lesions improve)
4. Maintenance Phase (Long term control of the disease, if necessary to maintain an acceptable state of health and comfort). As always, our goal is to eliminate the disease if possible but we believe that since we don’t know what causes most oral lichen planus, even former sufferers with complete elimination of their signs and symptoms should be followed periodically for many years.

Diagnostic Phase-

1. Past history
2. Clinical appearance
3. Biopsy, when needed (microscopic evaluation often and direct immunofluorescence occasionally) _
4. Yeast culture or exfoliative cytology (Similar to Pap smear.)
5. Occasional use of some ancillary tools

 We believe the biopsy examination of diseased tissue is the gold standard for accurate diagnosis of oral soft tissue lesions. Usually this requires microscopic examination and occasionally something called direct immunofluorescence is also used to look for diagnostic features of some of the mucocutaneous diseases. Direct immunofluorescent requires some special transport media for the biopsied tissue which will be provided free to the doctor upon request. We also want to know if the patient has lesions elsewhere on the body and whether or not these have been previously diagnosed.  A classic example is lichen planus of the genitalia which often occurs in concert with oral lichen.  This is more common in women although it also may occur in men.  We believe that any woman diagnosed with oral lichen planus should have an OBGYN exam as well to identify or rule this out.

Yeast (Candida) cultures are important to us because a sore mouth is often more susceptible to oral yeast than a healthy mouth.  This can also cause lesions similar to those of lichen planus and if one is not as responsive to therapy as expected it may be due to a secondary yeast infection.

To be continued: Keep watching this site for upcoming installments.