Let's Yap: Oral Lichen Planus

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Have you ever noticed white, lacy patches in your mouth or felt a burning sensation when you eat spicy foods? Do you suffer from autoimmune disorders or notice flare-ups when stressed? There's a chance you may have stumbled upon Oral Lichen Planus- a chronic inflammatory condition with an interesting name and an even more interesting clinical presentation.

What is Oral Lichen Planus?

Oral Lichen Planus (OLP) is an ongoing inflammatory condition that affects mucous membranes within the mouth. Several other Lichen Planus adjuncts can be found throughout the body- on skin, nails, scalp, genitals, ears, nose.. anywhere there's skin, really.

There are six classical clinical presentations of OLP.

• Reticular- the most common and usually asymptomatic form that showcases fine, white, lacy-looking striations on soft tissue of the mouth

  

• Bullous- fluid-filled blisters on top of existing OLP lesions, usually present on the inner cheek, near the molars.

  

• Atrophic/ Erosive: typically found on the tongue, a shiny, thin, smooth patchiness. This type of OLP can appear similar to gingivitis.

  

• Plaque: dense, thickened, white patches. This type can be asymptomatic, but may be a precursor to oral cancer.

  

• Papular: small, raised white bumps on the inside of the cheek or borders of the tongue.

  

Why Does it Happen?

In order to understand an autoimmune disease, let's talk about how the body's immune system functions normally. The immune system is the body's first line of defense from germs and illnesses. It's built from organs, white blood cells, proteins and chemicals that work together to detect and destroy foreign materials before serious disease occurs. One of the coolest parts about the immune system is that it can detect the difference between cells of your body and cells that don't belong in your body.

Autoimmune diseases occur when your immune system mistakes your own cells for diseased cells and attacks itself. Now we can dive into OLP! OLP has been studied as a T-cell mediated autoimmune disease and occurs more often in middle-aged females. T-cells are ones that typically help our bodies fight off infections, however, OLP causes CD8 (the co-receptor that helps T cells find infections in the body) to mistakenly mark the patient's mucosa as an infection.

CD8 and T cells are found in high numbers on biopsies of OLP. This increase in inflammatory cells leads to hyperkeratosis- a thickening of the skin, and gives the mouth's lining the characteristic white color. Since these cells are known to cause cell death, OLP is often treated as an autoimmune disorder. Hence, this cannot be passed from person to person. It can be aggravated by medications such as non-steroid anti-inflammatory drugs (NSAIDs such as ibuprofen), beta-blockers, and ACE inhibitors. Certain toothpastes, dental materials, and dental appliances can also impact OLP severity.

How is OLP Diagnosed?

Suppose your provider suspects OLP and you've not had a previous diagnosis. In that case, lesions are typically biopsied, cultured, or assessed via blood work to confirm it is OLP and not conditions that appear similar such as thrush.

There are 5 crucial P's of diagnosis:

• Purple

• Polygonal

• Pruritic (itchy)

• Papules

• Plaque

These are usually used to diagnose non-oral lichen planus in flexor regions of the body, such as behind the knees and the inner thighs. In the oral cavity, it's characterized by lesions with white/grey, velvety papules in linear, annular, and retiform arrangements that give a lacy, reticular characteristic.

How Can it be Treated?

OLP is a lifelong condition that does not have a direct cure, but rather, there are options to alleviate symptoms. Sample treatment options include numbing agents, ointments, and systemic medications. However, systemic medications are reserved for those with severe cases affecting the oral mucosa and other areas of the body, such as the scalp, esophagus, or genitalia.

Management of OLP such as the delivery of local drugs is novel to the dental field and are not common practice, thus this realm requires more research to improve treatment outcomes. Patients have also tried cryotherapy, laser and phototherapy (using UV light between 320-400nm, which can penetrate deep levels of skin), and surgical excision in extreme cases.

Patients that prefer natural methods may use turmeric and its ingredient curcumin which are believed to have anti inflammatory, antioxidant and anticancer properties. Since the use of steroids comes with hazardous side effects, and NSAADS are less effective, turmeric is being studied as a potential treatment.

Image on the left shows OLP before Turmeric treatment. Right image shows 3 months of treatment.

Let's Summarize:

Oral Lichen Planus is a lifelong, autoimmune disease that is specific to the mouth, while its sibling- lichen planus, can be found in other areas of the body. Though there is no cure, there are remedies that can help manage these moderately painless lesions. OLP is not contagious person to person, but rather a mutation within your own immune system that convinces your body to attack itself. It's important to monitor OLP symptoms with your dentist because other diseases, including oral cancer, may manifest from or with these lesions.

I hope you learned something fun and new and are ready to take your oral health to the next level!

xx

Beka

Works Cited:

“Oral Lichen Planus.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 24 Dec. 2024, www.mayoclinic.org/diseases-conditions/oral-lichen-planus/symptoms-causes/syc-20350869. Accessed 15 Nov. 2025. 

Gupta, Sonia, and Manveen Kaur Jawanda. “Oral Lichen Planus: An Update on Etiology, Pathogenesis, Clinical Presentation, Diagnosis and Management.” Indian journal of dermatology vol. 60,3 (2015): 222-9. doi:10.4103/0019-5154.156315. Accessed 16 Nov. 2025

Metz, Brian, et al. “Oral Lichen Planus.” Midwest Ear, Nose & Throat, LLC, www.mwent.com/71-enthealth/776-oral-lichen-planus#:~:text=What%20Causes%20Oral%20Lichen%20Planus,contribute%20to%20the%20disease%20process. Accessed 18 Nov. 2025.

Singh, Vibha et al. “Turmeric - A new treatment option for lichen planus: A pilot study.” National journal of maxillofacial surgery vol. 4,2 (2013): 198-201. doi:10.4103/0975-5950.127651