Does Lichen Planus Cause Dry Mouth? How does it affect the oral cavity?

 

In today's episode, I’m going over.....

The Effects of Lichen Planus on the Oral Cavity and Dry Mouth 

I'm Dr. Anna

and In the next few minutes you are going to learn…

How Lichen Planus affects the oral cavity including the sensation of pain and altered taste. Whether Lichen Planus actually causes Dry Mouth? And whether Dental Materials can Cause a Reaction in the Oral Cavity?

Head over to www.mysmilegenius.com to get the Free Dry Mouth eBook and work sheets which are designed to help you find answers and possible solutions to dry mouth.

With that being said

👉👉 Do you have Lichen Planus and Dry Mouth?  Let me know in the comments, about your experience.

First I am going to discuss what is Lichen Planus?

It is an autoimmune disorder which occurs when the body’s immune system attacks healthy tissues. This immune attack creates a reaction in the skin, nails and mucous membranes (including the oral cavity aka Oral Lichen Planus).   

There are 2 Types

  • Cutaneous which affects skin, scalp and nails
  • Mucosal which affects GI tract such as the mouth, esophagus, and other areas such as eyes ears, nose, bladder.

Causes of lichen planus are not known in general: It is suspected that genetics and environment may contribute.

However, there is a variation of this condition called a Lichenoid Reaction - refers to lesions that clinically and under the microscope look like Lichen Planus but that have likely known causes, and typically but not always resolve if those causing factors are removed.

However, it is often difficult to distinguish the difference between Lichen Planus and Lichenoid Reaction.  

 Some suspected triggers of Lichenoid Reactions include:

  • A hypersensitivity to medications: HPP medications, antidepressants, diuretics, antidiabetics, NSAIDs. Some rarer medications include Levamisole (Levantine) (for parasitic worm infections) and quinidine drugs (used to treat certain heart conditions and is a malaria medication.)
  • A hypersensitivity reaction to dental materials such as amalgam, composite, nickel, palladium, cobalt, gold etc. (and typically lichenoid reaction symptoms go away once the materials are removed and or replaced.)
  • Hypersensitivity to foods and oral hygiene flavor additives.
  • Emotional stress etc.

 Who is mostly affected?

Lichen Planus generally occurs more commonly in females, in a ratio of 3:2, and most cases are diagnosed between the ages of 30 and 60, but it can occur at any age.

Oral lichen planus is relatively common. It is one of the most common mucosal diseases. About 2% of the general population have it.

How is it diagnosed?

The medical doctor or dentist typically goes over the patient’s medical and symptom history, performs a clinical exam and possibly does a skin biopsy.

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Even though Lichen Planus can affect various areas of the body, I will focus on the oral cavity which is called

Oral Lichen Planus (OLP)

Mostly occurs as white lesions on the side of the cheeks (on both sides). Other areas of the mouth include tongue, lips, gums, floor of the mouth and palate. These lesions are chronic and can also affect the skin.

SYMPTOMS:

 Depending on the type of OLP but in general:

  • White, red, yellow patches inside the mouth including cheeks, tongue, gums.
  • Burning sensation or pain
  • Sensitivity to spicy and or acidic foods and or drinks.
  • Inflamed and or bleeding gums
  • Altered and or metallic taste
  • Bleeding when brushing and or eating
  • Discomfort when speaking and or swallowing
  • Feeling of dry mouth
  • Also, some patients experience a secondary fungal infection (cansisiasis)

TYPES:

There are many ways in which oral lichen planus can show up in the oral cavity. It is important to understand them and I will briefly discuss them.

 

Reticular:

Net-like/spider web like white lines. Usually there are no symptoms. It can progress to more severe subtype such as erosive form.

Erosive/ulcerative/ erythematous:

Characterized by ulcers and areas of redness, ulcerations, and or erosions covered by a yellow slough. Occurs in multiple areas of the mouth and in 25% of patients the condition can affect the gums (desquamative gingivitis). If top of tongue is involved (dorsum of the tongue) there can be a change in sensation and taste which can also relate to sensation of dry mouth – but more on that later.

Atrophic:

Similar to erosive form, mix or red and white patches, can show up on the gums as desquamative gingivitis.

Papular:

Small white papules that not cause symptoms.

Plaque-like:

Large, uniform white patches. This is common in smokers.

Bullous:

Rare, fluid filled white or gray-purple vescicles that can range in size 1-2 mm. They can rupture easily and cause ulcerations.

These different types can coexist. The atrophic and ulcerative sybtypes usually cause burning sensation and or severe pain. Lesions can persist for many years, with relapses (return of lesions) being common. 

Does Lichen Planus cause DRY MOUTH?

Before I go into discussing why patients with Lichen Planus report suffering from dry mouth, it is important to note that there is a difference between the sensation of dry mouth (xerostomia) and actual decrease in saliva production (aka hyposalivation).  Sometimes they are not the same and there are things that may make us feel like we have a dry mouth but we are actually not producing less of it.

This actually occurs in Lichen Planus.

One study found that 45% of patients with erythematous and ulcerative OLP also report suffering from xerostomia (the subjective feeling of dry mouth) and a sensation of very viscous saliva. (1)

However, the study found that there is no difference actual change in saliva flow rate in patients with OLP and healthy patients.  (2)

In another study, only 15% of the 45% OLP patients who complained about xerostomia, actually had hyposalivation.  However, these 15% were also taking medications which cause dry mouth, so the effects of the medication could had influenced these Dry Mouth numbers. (3)

Therefore in summary, these studies suggest that OLP on its own and in most cases does not actually cause our bodies to secrete less saliva. We only feel like we have less of it.

 So why do we continue to have the sensation of dry mouth with OLP?

 1) Changes in saliva composition

Studies show that sometimes the quality and composition of saliva plays a role in the feeling of dry mouth (Role of salivary mucins in the protection of the oral cavity. (4)

It recently been reported that in patients with OLP the total protein concentration was higher than in healthy patients (5)

It has been also found that patients with OLP and OLL have higher levels of immune system molecules in saliva (immunoglobulins IgA and IgG) (6)

Why do patients with OLP have higher concentrations of these proteins and immune molecules?

One study found that these molecules are present in higher concentration in patients that have higher levels of of anxiety, depression and sleep disturbances.  Patients OLP showed a pattern of more sleep disturbances, and also higher values for immune molecules (sIgA), stress hormone (cortisol), and total proteins (7)

 2) Second reason for sensation of dry mouth in OLP patients is inflammation and the harmful role it plays on the oral tissues:

 One study shows that it is likely that the inflammatory changes in the oral mucosa due to OLP, lead to sensory disturbances, including sensation of oral dryness as well as thermal (hot, cold) sensation and pain. (8)

3) Third possible reason for sensation of dry mouth in OLP patients are medications: There are many medications that cause dry mouth. And studies have shown that patients OLP who have actual lowered salivary flow also take dry-mouth causing medications.

 4) Finally the fourth possible reason for sensation of dry mouth in OLP patients is the co-presence of other Dry Mouth causing conditions such Sjogren’s Syndrome, Hepatitis C infection, type 1 Diabetes and graft-vs-host disease. (9)

 

There are also many other factors that could contribute to dry mouth including other health conditions, diet, habits dehydration etc. . I encourage you to explore the www.mysmilegenius.com blog on the topic.

 

👉👉 Do you have Lichen Planus and Dry Mouth?  Let me know it the comments, about your experience.

 

 

Interesting fact.

Just like we can experience dry mouth without actually having lower salivary flow, the opposite can happen as well. One study has shown that salivary secretion can be reduced as much as 50% of a person’s normal whole saliva flow rate, before person actually detects oral dryness (Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man. (10)

To sum up:

Even though patients that suffer from OLP can experience dry mouth, the sensation usually does not come from an actual decreased salivary flow but from

  • Changes in the saliva composition due to OLP as well as stress, depression, sleep disturbances which occur at higher rates in OLP patients.
  • Alternations in sensation due to changes in oral tissues caused by the condition
  • Effects of dry-mouth causing medications.
  • Possible co-existence of other hyposalivation – causing conditions.

Treatment Oral Lichen Planus:

  • No cure for LP/OLP
  • Mostly treatment is to provide comfort;
  • Identification and possible removal / substitution of triggers such as
    • Dental materials,
    • Oral hygiene products,
    • Medications (consult your physician)
  • Topical corticosteroids (ex: dexamethasone),
  • Immunosuppressant medications
  • Pain medications (NSAIDs),
  • Calcineurin inhibitors.

Prescription of some of these medications should be coordinated with the medical doctor and perhaps the patient should be referred to an oral medicine specialist.

 Fungal infections should be treated with antifungal medications.

OLP Lesions can persist for many years, are difficult to treat and relapse is common. There is also a chance of malignancy so it is important to have any lesions checked out and followed by a medical professional.

 

To learn more about Dry Mouth and its management go to www.mysmilegenius.com. Where you can obtain the Free Dry Mouth eBook and work sheets which are designed to help you find answers and possible solutions to dry mouth,

I’m Dr. Anna. Thank you for watching. 

For more information on Dry Mouth and its management follow the links below: 

Start with the Free Dry Mouth eBook and Dry Mouth Worksheets: 👉👉👉https://aniaglin.clickfunnels.com/lead-magnet4e6r82bjl4d3bmbklwgdltjqymqusdfs

Join the Dry Mouth Community on Facebook: 👉👉👉https://www.facebook.com/groups/1096621073841219/

Video on the “7 Best Dry Mouth Remedies”👉👉👉: https://www.youtube.com/watch?reload=9&v=F3zxlnzrKIM&t=109s

Best Wishes,

Dr. Anna Glinianska

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

 

References:

  1. Oral findings in patients with primary Sjögren's syndrome and oral lichen planus--a preliminary study on the effects of bovine colostrum-containing oral hygiene products. Pedersen AM, Andersen TL, Reibel J, Holmstrup P, Nauntofte B Clin Oral Investig. 2002 Mar; 6(1):11-20.
  1. Sialochemistry of whole, parotid, and labial minor gland saliva in patients with oral lichen planus. Gandara BK, Izutsu KT, Truelove EL, Mandel ID, Sommers EE, Ensign WY J Dent Res. 1987 Nov; 66(11):1619-22.
  2. Villa A, Wolff A, Narayana N, Dawes C, Aframian DJ, Lynge Pedersen AM, Vissink A, Aliko A, Sia YW, Joshi RK, McGowan R, Jensen SB, Kerr AR, Ekström J, Proctor G Oral Dis. 2016 Jul; 22(5):365-82.
  3. Tabak LA, Levine MJ, Mandel ID, Ellison SA J Oral Pathol. 1982 Feb; 11(1):1-17.)
  4. (Oral lichen planus: salival biomarkers cortisol, immunoglobulin A, adiponectin. Lopez-Jornet P, Cayuela CA, Tvarijonaviciute A, Parra-Perez F, Escribano D, Ceron J J Oral Pathol Med. 2016 Mar; 45(3):211-7.)
  5. Oral lichen planus: salival biomarkers cortisol, immunoglobulin A, adiponectin.Lopez-Jornet P, Cayuela CA, Tvarijonaviciute A, Parra-Perez F, Escribano D, Ceron J J Oral Pathol Med. 2016 Mar; 45(3):211-7.
  6. Oral lichen planus: salival biomarkers cortisol, immunoglobulin A, adiponectin.Lopez-Jornet P, Cayuela CA, Tvarijonaviciute A, Parra-Perez F, Escribano D, Ceron J J Oral Pathol Med. 2016 Mar; 45(3):211-7.
  7. Niissalo S, Hampf G, Hietanen J, Malmström M, Solovieva S, Pertovaara A, Konttinen YT J Oral Pathol Med. 2003 Jan; 32(1):41-5.)
  8. Petrou-Amerikanou C, Markopoulos AK, Belazi M, Karamitsos D, Papanayotou P. Prevalence of oral lichen planus in diabetes mellitus according to the type of diabetes. Oral Dis. 1998;4:37–40.
  9. Dawes C J Dent Res. 1987 Feb; 66 Spec No():648-53). This shows that we are not necessarily the best judges of our actual saliva flow and presence in the oral cavity.

 

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