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Oral Lichen Planus
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Case presentation about oral lichen planus step by step from history to the final dignosis

Case presentation about oral lichen planus step by step from history to the final dignosis

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  • 1. Umm Al-Qura University Faculty of Dentistry Dr. Reham Al-Haratani
  • 2. Demographic Data
    • AGE : 42 years old
    • NATIONALITY : Philipino
    • GENDER : Female
    Chief Complaint: Wants to treat her carious teeth.
  • 3.
    • MEDICAL HISTORY:
    • Rheumatoid Arthritis – Ankle Swelling.. “Voltaren” .
    • Hypothyroidism.
    • Episodes of headaches and fainting.
    • 1996, inflammatory lymphadenitis..admitted for surgery.
    History
  • 4. Extra-oral Examination:
  • 5.
    • Dental History:
    • Bleeding gum.
    • Several extractions.
    • some fillings.
    • TMJ dislocation.
    • Family History:
    • Cardiac arrest.
    • Hypertension.
  • 6. Clinical Examination
    • GENERAL :
    • Insignificant
    • B . Extra-oral :
    • Insignificant
    • C. Intra-oral Examination :
    • Pigmented lesion discovered.
    • Otherwise, normal.
  • 7. INTRA-ORAL EXAMINATION
  • 8. d. Radiographic Findings
  • 9. Description of lesion
  • 10.  
  • 11.  
  • 12. So…regarding the buccal mucosa (lesion): -Location: Irregularly distributed, bilaterally. -Texture: Smooth.. Does not disappear upon rubbing nor stretching. -Color & Shape: Brown pigmentations + white striations (characteristic Wickham’s striae).
  • 13. -Size: Brown pigm. All over. White striations extend from retromolar area up to the commissures. - Lingual gingiva of lower anterior teeth. -Painless - No discomfort upon eating nor swallowing.
  • 14.
    • lichen planus. (Reticular form) with areas of pigmentation.
    • lichenoid reaction
    • Physiologic pigmentation.
    Differential diagnosis
  • 15.
    • ORAL LICHEN PLANUS
    • Reticular asymptomatic type..
    FINAL DIAGNOSIS مرض الحزاز المنبسط الفموي
  • 16.
    • Thyroid Function Test
    • to check the hormonal status :
    • Results:
    • Within normal range.
    Investigations done:
  • 17.  
  • 18. Last follow-up was on Sunday 8 - 4 - 2007 Showing stability without any progression Follow Up
  • 19. Treatment Plan… Further follow up every 6 months - 1 year
  • 20. Background: Autoimmune chronic mucocutaneuos condition. Age: middle-aged persons Gender: female predilection Etiology: T-cell-mediated autoimmune disease. Clinically: Types Reticular ASYMPTOMATIC Erosive (ulcerations) Atrophic (erythema) Bullous (blisters) SYMPTOMATIC – Pre-malignant About Lichen Planus
  • 21.  
  • 22.  
  • 23. OLP associated with patchy brown melanin deposits 28 % have coincident skin lesions..polygonal papules with white lines on surface
  • 24. HISTOLOGY: 1. Hyperkeratosis. 2. Acanthosis. 3. Saw-tooth Rete Ridges (shortened). 4. Basal cell degeneration (liquefaction). 5. Band-like lymphocitic infiltration.
  • 25.
    • Management :
    • Asymptomatic type No pharmalogical intervention
    • Symptomatic Corticosteroids
    • Topical orabase
    • Retinoids
    • + biopsy and examination every 4-6 months.
  • 26. Oral Lichen Planus and Hepatitis C and B viruses : is there a real association?
  • 27.
    • Aim : investigate occurrence of skin and oral LP in patients with CLD..
    • Info. : when 2003
    • where KAUH
    • who Dr. Maha Abdel-salam
    • Dr. Rabab Feteih
  • 28. Methods Results
    • 94 with CLD
    • 78 HCV +ve
    • HBV +ve
    • OLP detected in 5 pts
    • HCV +ve
    • 1 HBV +ve
    2. Biopsies obtained Confirmed the clinical diagnosis 3. Liver function tests Insignificantly associated 4. Statistical analysis, assess reliability of liver enz. to predict OLP Not predictive
  • 29.  
  • 30. Methods Results
    • 94 with CLD
    • 78 HCV +ve
    • HBV +ve
    • OLP detected in 5 pts
    • HCV +ve
    • 1 HBV +ve
    2. Biopsies obtained Confirmed the clinical diagnosis 3. Liver function tests Insignificantly associated 4. Statistical analysis, assess reliability of liver enz. to predict OLP Not predictive
  • 31.  
  • 32. Methods Results
    • 94 with CLD
    • 78 HCV +ve
    • HBV +ve
    • OLP detected in 5 pts
    • HCV +ve
    • 1 HBV +ve
    2. Biopsies obtained Confirmed the clinical diagnosis 3. Liver function tests Insignificantly associated 4. Statistical analysis, assess reliability of liver enz. to predict OLP Not predictive
  • 33.
    • Conclusion:
    • OLP … an extrahepatic manifestation of CLD..
    • Comparison :
    • when 1997
    • where Dammam
    • Differences:
    • 1. Participants diagnosed 1 st with OLP
    • then CLD was studied..
    • 2. Claimed
    • a correlation between liver enzymes and OLP
  • 34. Main conclusion:
    • OLP CLD
    • Dentist Physician
    • HCV and HBV screening results...
  • 35.  
  • 36.  
  • 37. References :
    • Abdel-salam M. , Feteih R. “Oral Lichen Planus in Patients With
    • Chronic liver disease”. Egyptian Dental Journal, 49, 953 - 958, April, 2003.
    • El-rifaei A., Fathalla S. “The Prevalence of Indices of HC and HB infection in Patients With OLP in Eastern Saudi Arabia”. Saudi Society of Family and Community Medicine,1997.
    • Sugerman P. et al. “Oral Lichen Planus”.2005.
    • www.e-medicine.com
    • Neville B.W. et al. “Oral and Maxillofacial Pathology”.(2 nd edition), chp.16, pg 680-685..2003