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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

Oral Lichen Planus

  1. 1. Umm Al-Qura University Faculty of Dentistry Dr. Reham Al-Haratani
  2. 2. Demographic Data <ul><li>AGE : 42 years old </li></ul><ul><li>NATIONALITY : Philipino </li></ul><ul><li>GENDER : Female </li></ul>Chief Complaint: Wants to treat her carious teeth.
  3. 3. <ul><li>MEDICAL HISTORY: </li></ul><ul><li>Rheumatoid Arthritis – Ankle Swelling.. “Voltaren” . </li></ul><ul><li>Hypothyroidism. </li></ul><ul><li>Episodes of headaches and fainting. </li></ul><ul><li>1996, inflammatory lymphadenitis..admitted for surgery. </li></ul>History
  4. 4. Extra-oral Examination:
  5. 5. <ul><li>Dental History: </li></ul><ul><li>Bleeding gum. </li></ul><ul><li>Several extractions. </li></ul><ul><li>some fillings. </li></ul><ul><li>TMJ dislocation. </li></ul><ul><li>Family History: </li></ul><ul><li>Cardiac arrest. </li></ul><ul><li>Hypertension. </li></ul>
  6. 6. Clinical Examination <ul><li>GENERAL : </li></ul><ul><li>Insignificant </li></ul><ul><li>B . Extra-oral : </li></ul><ul><li>Insignificant </li></ul><ul><li>C. Intra-oral Examination : </li></ul><ul><li>Pigmented lesion discovered. </li></ul><ul><li>Otherwise, normal. </li></ul>
  7. 7. INTRA-ORAL EXAMINATION
  8. 8. d. Radiographic Findings
  9. 9. Description of lesion
  10. 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).
  11. 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.
  12. 14. <ul><li>lichen planus. (Reticular form) with areas of pigmentation. </li></ul><ul><li>lichenoid reaction </li></ul><ul><li>Physiologic pigmentation. </li></ul>Differential diagnosis
  13. 15. <ul><li>ORAL LICHEN PLANUS </li></ul><ul><li>Reticular asymptomatic type.. </li></ul>FINAL DIAGNOSIS مرض الحزاز المنبسط الفموي
  14. 16. <ul><li>Thyroid Function Test </li></ul><ul><li>to check the hormonal status : </li></ul><ul><li>Results: </li></ul><ul><li>Within normal range. </li></ul>Investigations done:
  15. 18. Last follow-up was on Sunday 8 - 4 - 2007 Showing stability without any progression Follow Up
  16. 19. Treatment Plan… Further follow up every 6 months - 1 year
  17. 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
  18. 23. OLP associated with patchy brown melanin deposits 28 % have coincident skin lesions..polygonal papules with white lines on surface
  19. 24. HISTOLOGY: 1. Hyperkeratosis. 2. Acanthosis. 3. Saw-tooth Rete Ridges (shortened). 4. Basal cell degeneration (liquefaction). 5. Band-like lymphocitic infiltration.
  20. 25. <ul><li>Management : </li></ul><ul><li>Asymptomatic type No pharmalogical intervention </li></ul><ul><li>Symptomatic Corticosteroids </li></ul><ul><li>Topical orabase </li></ul><ul><li>Retinoids </li></ul><ul><li>+ biopsy and examination every 4-6 months. </li></ul>
  21. 26. Oral Lichen Planus and Hepatitis C and B viruses : is there a real association?
  22. 27. <ul><li>Aim : investigate occurrence of skin and oral LP in patients with CLD.. </li></ul><ul><li>Info. : when 2003 </li></ul><ul><li>where KAUH </li></ul><ul><li>who Dr. Maha Abdel-salam </li></ul><ul><li>Dr. Rabab Feteih </li></ul>
  23. 28. Methods Results <ul><li>94 with CLD </li></ul><ul><li>78 HCV +ve </li></ul><ul><li>HBV +ve </li></ul><ul><li>OLP detected in 5 pts </li></ul><ul><li>HCV +ve </li></ul><ul><li>1 HBV +ve </li></ul>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
  24. 30. Methods Results <ul><li>94 with CLD </li></ul><ul><li>78 HCV +ve </li></ul><ul><li>HBV +ve </li></ul><ul><li>OLP detected in 5 pts </li></ul><ul><li>HCV +ve </li></ul><ul><li>1 HBV +ve </li></ul>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
  25. 32. Methods Results <ul><li>94 with CLD </li></ul><ul><li>78 HCV +ve </li></ul><ul><li>HBV +ve </li></ul><ul><li>OLP detected in 5 pts </li></ul><ul><li>HCV +ve </li></ul><ul><li>1 HBV +ve </li></ul>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
  26. 33. <ul><li>Conclusion: </li></ul><ul><li>OLP … an extrahepatic manifestation of CLD.. </li></ul><ul><li>Comparison : </li></ul><ul><li>when 1997 </li></ul><ul><li>where Dammam </li></ul><ul><li>Differences: </li></ul><ul><li>1. Participants diagnosed 1 st with OLP </li></ul><ul><li>then CLD was studied.. </li></ul><ul><li>2. Claimed </li></ul><ul><li>a correlation between liver enzymes and OLP </li></ul>
  27. 34. Main conclusion: <ul><li>OLP CLD </li></ul><ul><li>Dentist Physician </li></ul><ul><li>HCV and HBV screening results... </li></ul>
  28. 37. References : <ul><li>Abdel-salam M. , Feteih R. “Oral Lichen Planus in Patients With </li></ul><ul><li>Chronic liver disease”. Egyptian Dental Journal, 49, 953 - 958, April, 2003. </li></ul><ul><li>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. </li></ul><ul><li>Sugerman P. et al. “Oral Lichen Planus”.2005. </li></ul><ul><li>www.e-medicine.com </li></ul><ul><li>Neville B.W. et al. “Oral and Maxillofacial Pathology”.(2 nd edition), chp.16, pg 680-685..2003 </li></ul>

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