Knowing what to look for can help you identify oral lichen planus early and seek appropriate medical care. This article will guide you through the common symptoms, warning signs, and the diagnostic process.
Common Symptoms of Oral Lichen Planus
The symptoms of oral lichen planus vary significantly depending on the type and severity of the condition. Some people experience no discomfort at all, while others deal with daily pain and sensitivity.
Visual Symptoms
White Patches or Streaks
- Lacy, web-like white lines (Wickham’s striae)
- Most commonly on the inside of the cheeks
- May form intricate patterns resembling lace or spider webs
- Usually bilateral (appearing on both sides of the mouth)
Red, Inflamed Areas
- Bright red patches of tissue
- May appear shiny or atrophic (thinned)
- Often surrounded by white borders
- More common in erosive OLP
Open Sores or Ulcers
- Painful lesions that may bleed
- Slow to heal
- Can make eating and drinking difficult
- Characteristic of erosive OLP
Gum Changes
- Red, inflamed gums that bleed easily
- Gums pulling away from teeth (desquamative gingivitis)
- Sensitivity when brushing
Physical Symptoms
Many people with oral lichen planus experience physical discomfort:
Pain and Burning
- Burning sensation in the mouth
- Pain that worsens with eating or drinking
- Particularly severe with erosive OLP
- May be constant or intermittent
Sensitivity
- Increased sensitivity to hot, cold, spicy, or acidic foods
- Difficulty tolerating citrus fruits, tomatoes, or spicy dishes
- Sensitivity to certain toothpastes or mouthwashes
- Discomfort with crunchy or rough-textured foods
Taste Changes
- Altered sense of taste (dysgeusia)
- Metallic taste in the mouth
- Reduced ability to taste foods
- Can affect appetite and enjoyment of meals
Difficulty Eating and Drinking
- Pain while chewing
- Discomfort swallowing
- Avoidance of certain foods
- Potential nutritional impact in severe cases
Dry Mouth
- Feeling of mouth dryness (xerostomia)
- Reduced saliva production
- May be a side effect of medications used to treat OLP
- Can worsen oral discomfort
Symptom Patterns and Triggers
Understanding your symptom patterns can help with management:
Flare-Ups and Remissions
Oral lichen planus typically follows a pattern of:
- Active periods with more severe symptoms
- Quiet periods with minimal or no symptoms
- Unpredictable cycles that vary from person to person
Common Triggers
Many people notice their symptoms worsen with:
- Stress and anxiety – emotional stress is a significant trigger
- Certain foods – spicy, acidic, hot, or crunchy foods
- Dental work – trauma from dental procedures
- Infections – viral infections or oral candidiasis
- Medications – some drugs can exacerbate symptoms
- Hormonal changes – menstruation or menopause in women
When to See a Healthcare Provider
You should seek medical evaluation if you notice:
- Persistent white patches or red areas in your mouth
- Painful sores that don’t heal within two weeks
- Burning sensation in your mouth lasting more than a few days
- Difficulty eating or drinking due to mouth pain
- Bleeding gums not explained by gum disease
- Any unusual changes in the appearance of your oral tissues
- New lumps or thickened areas (to rule out cancer)
Urgent Warning Signs:
- A sore that persists for more than three weeks
- A lump or thickened area that continues to grow
- Numbness in the mouth or tongue
- Difficulty swallowing or persistent hoarseness
- Unexplained weight loss
The Diagnostic Process
If you suspect oral lichen planus, here’s what to expect during diagnosis:
Medical History
Your healthcare provider will ask about:
- When you first noticed symptoms
- Whether symptoms come and go or are constant
- What makes symptoms better or worse
- Current medications and supplements
- Other medical conditions
- Family history of autoimmune diseases
- Recent dental work or changes in dental products
- Stress levels and lifestyle factors
Physical Examination
A thorough oral examination includes:
- Visual inspection of all oral surfaces
- Palpation (feeling) of affected areas
- Photography to document lesion appearance and location
- Assessment of overall oral health
- Evaluation of teeth and gums
Tissue Biopsy
A definitive diagnosis usually requires a biopsy:
Why It’s Needed:
- Confirms the diagnosis of lichen planus
- Rules out other conditions (especially oral cancer)
- Identifies the specific type of OLP
- Guides treatment decisions
What to Expect:
- Local anesthetic to numb the area
- Small tissue sample removed (usually 4-6mm)
- Procedure takes only a few minutes
- Minimal discomfort during and after
- Stitches may or may not be needed
- Results typically available in 1-2 weeks
Pathology Findings:
The biopsy will be examined under a microscope for:
- Band-like infiltration of T-cells
- Damage to the basal cell layer
- Characteristic “saw-tooth” appearance
- Absence of dysplasia (abnormal cells)
Additional Tests
Depending on your case, your provider may order:
Blood Tests:
- Complete blood count (CBC)
- Liver function tests (hepatitis C screening)
- Blood glucose (diabetes screening)
- Autoimmune markers
Allergy Testing:
- Patch testing for dental material allergies
- Screening for contact allergens
- Evaluation of reactions to specific metals or resins
Fungal Culture:
- To rule out oral candidiasis (thrush)
- May occur concurrently with OLP
- Requires different treatment
Differential Diagnosis
Your healthcare provider will work to distinguish OLP from similar conditions:
- Oral candidiasis (thrush) – fungal infection
- Leukoplakia – white patches with different causes
- Oral cancer – must be ruled out, especially with erosive lesions
- Pemphigus – another autoimmune blistering condition
- Lichenoid drug reaction – medication-induced similar lesions
- Contact stomatitis – allergic reaction to dental materials
- Geographic tongue – benign inflammatory condition
Keeping Track of Your Symptoms
Consider maintaining a symptom diary:
What to Record:
- Date and time of flare-ups
- Severity of pain or discomfort (scale of 1-10)
- Foods or activities that preceded symptoms
- Stress levels
- Medications taken
- Photos of lesions (if comfortable)
- Impact on daily activities
This information helps your healthcare provider:
- Identify patterns and triggers
- Assess treatment effectiveness
- Make informed decisions about care adjustments
Self-Examination
While professional evaluation is essential, regular self-checks can help you:
Monthly Self-Exam:
- Use good lighting and a mirror
- Look at all surfaces inside your mouth
- Note any changes in lesions
- Check for new areas of concern
- Assess pain or sensitivity levels
What to Look For:
- Changes in size or color of existing lesions
- New white patches or red areas
- Sores that don’t heal
- Areas of thickening or lumps
- Increased bleeding or pain
Moving Forward After Diagnosis
Receiving a diagnosis of oral lichen planus can bring mixed emotions. You might feel:
- Relief at finally having an explanation
- Concern about the chronic nature of the condition
- Anxiety about potential complications
- Uncertainty about treatment
Remember that early diagnosis and proper management significantly improve quality of life. In the next articles, we’ll explore treatment options, specialist care, and practical strategies for living well with oral lichen planus.
This article is for informational purposes only. Always consult with qualified healthcare professionals for proper diagnosis and personalized medical advice.
Oral LP 
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