Abstract
The spectacle of Koebner’s phenomenon (KP) is interesting in that trauma precipitates a subset of pathologically distinct conditions, indicating the subtle interplay between sensitization and dermato-mucosal integrity. KP is interesting because, if factors initiating it are controlled, then it may be possible to prevent these debilitating conditions through induction of reverse Koebnerization. Herein, we present a report of a patient with an erosive lesion, localized to the occlusal plane on buccal and lingual mucosa, that interestingly subsided following 1 week after a dental scaling procedure. This report analytically describes the role of dental calculus and cuspal trauma as important triggers surrounding the genesis of oral lichenoid lesion and oral lichen planus. An engaging discussion on these closely related enigmatic entities forms the central theme of this report.
Highlights
Koebner’s phenomenon (KP) was first identified by Heinrich Koebner in 1877
KP is often associated with lichen planus, psoriasis, and vitiligo,[1] and can be triggered through simple irritation from ECG electrode placement,[2] trauma caused from tattoos and acupuncture procedures,[3] and surgical procedures like biopsy
Subtle sources of irritation in oral lichen planus (OLP) and oral lichenoid lesion (OLL) include: dental plaque and calculus,[4,5,6,7,8,9,10,11] and low-grade trauma caused by dental cusps.[12,13]
Summary
Koebner’s phenomenon (KP) was first identified by Heinrich Koebner in 1877 It can be defined as mechanical irritation precipitating a skin or mucosal eruption in a patient without pre-existing dermatosis.[1] KP is often associated with lichen planus, psoriasis, and vitiligo,[1] and can be triggered through simple irritation from ECG electrode placement,[2] trauma caused from tattoos and acupuncture procedures,[3] and surgical procedures like biopsy. Patient was not under any systemic medication or oral ointment, is not a tobacco/betel-quid chewer, did not change toothpaste recently, and had no dental restorations or prosthesis in the oral cavity She was in good general health, and displayed no signs-of-anxiety during examination. The close proximity between dental calculus and oral lesion distribution compelled us to advise dental scaling, and no topical corticosteroids were recommended during that visit She was recalled a week later for review and a significant regression of lesions was noticed (Figures 4 and 5). She is under follow-up, and has not developed any symptoms during the last 6 months
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