Oral Lichenoid Reactions Research Articles

LESI LIKENOID ORAL YANG BERHUBUNGAN DENGAN RESTORASI AMALGAM DAN PERAWATANNYA: ORAL LICHENOID LESION RELATED TO AMALGAM RESTORATION AND ITS TREATMENT

The oral lichenoid reaction is to be regarded as a reaction pattern within the oral mucous directed towards a specific agents in patients predisposed to develop such a reaction. During the last decade, it has been discussed that dental amalgam plays etiological role in the development of lichenoid reaction in oral mucous. Removal of amalgam fillings has led to healing or clinical improvement of a majority of existing lichenoid lesions. We reported a case of oral lichenoid reaction associated to amalgam restoration. A 53 years old woman presented with a sore mouth and ulceration affecting the gingival and buccal mucous in the region of maxillary right first molar filled with amalgam. Patient had no medical history and medication. After replacing amalgam restoration with resin composite and applied of topical corticosteroid, the lesion clinically disappeared. In conclusion, this case suggested that replacement of amalgam restoration with the other material and applied topically steroid be effective in the resolution of the oral lichenoid lesion related to amalgam restoration.

Lichen planus and lichenoid reactions of the oral mucosa

Oral lichenoid reactions represent a common end point in response to extrinsic agents (drugs, allergens), altered self-antigens, or superantigens. Oral lichen planus, a common and under-recognized inflammatory disorder, shares many clinical and histopathological features with oral lichenoid drug reaction and oral lichenoid contact reaction. Clinical presentation can vary from asymptomatic white reticular striae to painful erythema and erosions. Cutaneous and additional mucosal involvement is common. Delay in diagnosis of extraoral mucocutaneous lichen planus (LP) results in conjunctival scarring; vaginal stenosis; vulvar destruction; and stricture of the esophagus, urethra, and external auditory meatus. Although the etiology of LP is idiopathic, oral lichenoid reactions may be caused by medications or exogenous agents such as cinnamates and other flavorings. The clinical features, evaluation, and management of these oral lichenoid reactions are discussed.

Oxidative stress and antioxidant defense in oral lichen planus and oral lichenoid reaction

Background. Oral Lichen Planus (OLP) is an inflammatory disease of unknown etiology while Oral Lichenoid Reaction (OLR) is a condition mimicking OLP. As these conditions are exposed to oxidative stress, they could release reactive oxygen species (ROS) which are implicated in the pathogenesis of a plethora of inflammatory conditions to lethal diseases. We evaluated and compared the levels of a series of oxidative stress markers in patients with OLP and OLR with that of normal controls and tried to identify the role of these oxidative stress markers in these conditions. Methods. Protein thiol oxidation, malondialdehyde (MDA) and total antioxidant activity were estimated in both the groups (OLP and OLR) and compared with that of normal subjects. Results. There were significantly lower levels of serum protein thiols in OLP (p < 0.005) while in patients with OLR the difference was not statistically significant (p < 0.489) when compared with controls. Serum MDA levels were significantly higher in OLP (p < 0.001) and OLR (p < 0.001) than in controls. However, there was no significant difference in serum MDA levels between OLP and OLR patients (p >0.05), but with a significant difference in serum thiol levels between the two (p < 0.047). Total antioxidant levels were lower in OLP (p < 0.016) and OLR (p < 0.017) when compared to normal subjects, while between the study group total antioxidant levels were not significantly different (p < 0.632). Conclusions. The findings from the present study demonstrate involvement of ROS in the pathogenesis of OLP and OLR, though both these disease conditions have a different clinical course.

Oral Lichenoid Reaction Associated With Tin Component of Amalgam Restorations: A Case Report

Amalgam or its components may cause type IV hypersensitivity reactions on the oral mucosa. Majority of the reported cases involved a delayed hypersensitivity to mercury. A case of bilateral oral lichenoid reaction is presented, which was present in relation to amalgam restorations. Histopathological features were compatible with lichenoid mucositis. Patch test was positive with pulverized amalgam and tin. The lesion healed up after replacement of restorations with an intermediate restorative material. The clinician should be aware of all possible pathological etiologies of white lesions. If there is any doubt about the nature or management of an unusual oral lesion, referral to appropriate specialists is mandatory.

Lichenoid Reactions Due to Dental Restorative Materials

ABSTRACTThe pathogenic relationship between the oral lichenoid reaction and dental restorative materials has been confirmed many times. Lichen planus-like lesions (2) (oral lichenoid lesion, oral lichenoid reaction) can be caused by hypersensitivity to materials for dental restorations.The aim of this study is to determine the effect of restorative dental materials removal on the lichenoid reaction development. In this case report we present two male patients who were referred to the Department of Oral Diagnostics and Maxillofacial Radiology, at the Faculty of Dental Medicine, Medical University Sofia. Both patients had lesions located on the tongue and buccal mucosa. The routine examinations together with patch tests for dental allergy were used. The patients showed hypersensitivity to Nickel (Ni), Cobalt (Co), Amalgam and Mercury (Hg). Removal of the positively reacting materials followed by new hypoallergenic restorations led to spontaneous healing.The results have shown that the removal and replacement of these restorative materials do lead to remission of the symptoms and full healing of the oral lichenoid lesions. Close association between the lesion development and the dental materials which gave positive patch tests reaction was confirmed. A replacement of the problem causing restorations with hypoallergenic materials proved to be the reliable method for controlling the clinical symptoms and also led to a state of total healing of these two patients.

Drug-induced oral lichenoid reactions. A literature review

The terms oral lichenoid reactions or oral lichenoid lesions refer to lesions histologically and clinically similar to oral lichen planus, though with the particularity that in these cases the underlying cause is identifiable. In addition, these lesions are described according to the causal factor involved, including alterations resulting from direct contact with dental restoration materials, drug-related lesions, and lesions associated to graft-versus-host disease. Drug-induced oral lichenoid reactions or oral lichenoid lesions were first cited in 1971 by Almeyda and Levantine. Since then, many drug substances have been associated with such lesions. The most common agents are nonsteroidal antiinflammatory drugs and angiotensin converting enzyme inhibitors.

Evaluation of the diagnostic value of a Modified Liquid-Based Cytology using OralCDx Brush in early detection of oral potentially malignant lesions and oral cancer

To determine diagnostic value of modified Liquid Based Brush Biopsy technique. 26 oral premalignant and malignant lesions in 25 patients (12 females; 54.23+/-19.77 years and 13 males; 53.77+/-15.43 years) underwent Modified (Liquid Based) Brush Biopsy and scalpel biopsy simultaneously from the same area. There were 16 positive and 10 negative brush biopsy results, with no inadequate readings. Histological findings were compatible with oral leukoplakia (n=5) with dysplasia, Oral lichen planus and lichenoid reaction (n=7) (with or without dysplasia) oral squamous cell carcinoma (n=11),verrucous carcinoma (n=1) and granular cell tumors (n=2). Sensitivity, specificity, positive predictive value, negative predictive value, positive diagnostic likelihood ratio (LR+) and negative diagnostic likelihood ratio (LR-) were 88.8%, 100%, 100%, 80%, infinity and 0.11 respectively (no false positive results). It is the first attempt to do LBC with a specialized oral brush. Our results show that modified technique is a useful tool for screening of oral premalignant and malignant lesions.

Antiretroviral Drug-Associated Oral Lichenoid Reaction in HIV Patient: A Case Report

Antiretroviral therapy has changed the course of HIV disease and improved quality of life in HIV patients. Incidence of an oral lichenoid drug reaction induced by zidovudine is not common. Once it occurs, it affects a patient's well being, in particular their oral functions. Here we report the first case of a 34-year-old Thai man with painful erosive lesions involving the lip and buccal mucosa. Treatment with topical fluocinolone acetonide 0.1% alleviated the patient's oral pain, but it was not until the subsequent withdrawal of zidovudine that the patient showed improvement and resolution of the lesions. Long-term follow-up was useful in the management of this patient, and no recurrence of the lesion was found during 21-month follow-up in this patient.

Oral lichen planus versus oral lichenoid reaction: Difficulties in the diagnosis

Lichen planus (LP) is a mucocutaneous disease with well-established clinical and microscopic features. The oral mucosa and skin may present clinical and microscopic alterations similar to those observed in LP, called lichenoid reactions (LRs), which are triggered by systemic or topical etiological agents. The difficulties faced to establish the differential diagnosis between the two pathologies were investigated in the literature. It was observed that the etiology of LP is still under discussion, with a tendency to self-immunity, while the etiology of LRs is related to the contact with specific agents, such as metallic restorative materials, resins, and drugs, allowing the establishment of a cause-effect relationship. In this case, the disease is caused by the antigen fixation in the epithelial cells, which are destructed by the immune system. Based on these data, protocols are suggested for this differentiation. The important role played by the integration between the clinician and the oral pathologist in the diagnostic process is highlighted. The treatment of LP comprises mainly the utilization of corticosteroids and the LR is treated by removal of the causal factor. Differentiation between the two diseases allows an effective and correct therapeutic approach.

Oral and cutaneous lichenoid reaction with nail changes secondary to imatinib: Report of a case and literature review

Imatinib mesylate--Gleevec (US), Glivec (worldwide), STI571--is an oral cancer drug that selectively inhibits several protein tyrosine kinases associated with human malignancy. The drug is used for the treatment of chronic myeloid leukemia, malignant gastrointestinal stromal tumors, and some other conditions. Treatment with imatinib is generally well tolerated but not without the risk of adverse effects. The risk of severe adverse events is low. Cutaneous side effects of this drug are common but muco-cutaneous lichenoid eruption with nail changes is very rare. We report a case of lichenoid eruption during imatinib therapy involving the skin, mucous membranes, and nails that cleared in spite of ongoing imatinib therapy.

Association between oral lichenoid reactions and amalgam restorations

The aim of this study was to perform a clinical assessment of the association between oral lichenoid reactions (OLR) and amalgam restorations and to determine the salivary concentrations of interleukin-6 (IL-6) and IL-8 before and after replacement of the amalgam restorations. The study included 20 patients with OLR and 20 healthy volunteers, who were examined between 2001 and 2005 at the Oral Medicine Unit of the Medical Faculty University of Rijeka. All patients were skin patch tested by an experienced physician. Saliva samples were collected, prepared and analysed for IL-6 and IL-8 concentrations using enzyme-linked immunosorbent assay. Sixteen out of 20 patch-tested patients showed a sensitization to inorganic mercury or amalgam. Total replacement of all amalgam fillings was carried out on 20 patients with fillings based on composite resin, gold, porcelain or a combination of these. Sixteen out of 20 patients showed complete healing of OLR; three patients had marked improvement, whereas one patient showed no improvement. Levels of IL-6 detected before replacement were significantly higher than IL-6 levels following the replacement (P = 0.003). The IL-8 levels measured before replacement procedure were significantly higher than the IL-8 levels after replacement of the fillings (P < 0.001). On the basis of clinical observations, restorative therapy resulted in tissue healing. Following the replacement of amalgam fillings with fillings based on other restorative materials, levels of both IL-6 and IL-8 shifted towards normal, as measured in healthy subjects.

Diagnosis and Management of Oral Lichenoid Reactions

Lichen planus is one of the most common mucocutaneous conditions seen in dental practice. A variety of other conditions known as lichenoid reactions can simulate lichen planus either clinically or histologically. This paper will discuss the more common lichenoid reactions seen in clinical practice and review the diagnosis and management of these conditions.

Microbial‐associated oral lichenoid reactions

The objective of the present study was to compare a new type of symptomatic lichenoid reaction, specifically located on the mucosal side of the lips, and associated with microorganisms, with a matched group presenting with reticular oral lichen planus (OLP) of the buccal mucosa. The mean age for both groups was 66 years with a predominance of women (62%). The lichenoid reaction group (n = 25) presented with a reticular reaction pattern embracing various degrees of erythema. Patients presenting with OLP had similar lesions confined to the buccal mucosa but not on the mucosal side of the lips. In both groups, 80% were on any type of medication. However, 56% of the patients with lichenoid reactions medicated with more than three drugs compared with 29% (P < 0.05) in the OLP group. The former group more often used medicaments prescribed for cardiovascular diseases (48%vs 25%). Twenty-two of the patients with lichenoid reactions were treated with chlorhexidine. In 80% of these patients (n = 18), the lesions improved or completely healed, indicating a microbial association. Lichenoid reactions present on the mucosal side of the lips may be initiated by microbial plaque precipitated on the buccal surfaces of the anterior teeth.

Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation

Lichen planus, a chronic autoimmune, mucocutaneous disease affects the oral mucosa (oral lichen planus or OLP) besides the skin, genital mucosa, scalp and nails. An immune mediated pathogenesis is recognized in lichen planus although the exact etiology is unknown. The disease most commonly affects middle-aged females. Oral lichenoid reactions (OLR) which are considered variants of OLP, may be regarded as a disease by itself or as an exacerbation of an existing OLP, by the presence of medication (lichenoid drug reactions) or dental materials (contact hypersensitivity). OLP usually presents as white striations (Wickham's striae), white papules, white plaque, erythema, erosions or blisters. Diagnosis of OLP is established either by clinical examination only or by clinical examination with histopathologic confirmation. Direct immunofluorescence examination is only used as an adjunct to the above method of diagnosis and to rule out specific autoimmune diseases such as pemphigus and pemphigoid. Histopathologic features of OLP and OLR are similar with suggestions of certain discriminatory features by some authors. Topical corticosteroids are the treatment of choice for OLP although several other medications have been studied including retinoids, tacrolimus, cyclosporine and photodynamic therapy. Certain OLP undergo malignant transformation and the exact incidence and mechanisms are still controversial. In this paper, etiopathogenesis, diagnosis, management and malignant transformation of OLP and OLR have been reviewed.

Oral and cutaneous lichenoid reaction secondary to imatinib: report of two cases

Oral and cutaneous lichenoid reaction secondary to imatinib: report of two cases

Positive patch test reactions to allergens of the dental series and the relation to the clinical presentations

The clinical manifestations of contact allergic dermatitis to dental materials are not uniform. This study was performed to detect the frequent allergens in the dental series associated with contact dermatitis and to define the causal relationship between the different allergens and the relevant clinical presentations. Between the years 2000 and 2004, 134 patients, aged 20-80 years, were patch tested. 121 patients were included in the study. The most frequent oral manifestations were cheilitis and perioral dermatitis (25.6%), burning mouth (15.7%), lichenoid reaction (14.0%), and orofacial granulomatosis (10.7%). 18 (14.9%) patients were dental personnel, all of whom suffered from hand dermatitis. The common allergens detected included goldsodiumthiosulphate (14.0%), nickel sulfate (13.2%), mercury (9.9%), palladium chloride (7.4%), cobalt chloride (5.0%), and 2-hydroxyethyl methacrylate (5.8%). Positive reactions to metals were frequent in all the different clinical variants, and no specific association between a specific clinical presentation and a particular allergen was found. Allergy to mercury was not a significant factor contributing to the pathogenesis of oral lichenoid reactions. However, a strong association with contact allergy to mercury in dental fillings was found in 2 patients with orofacial granulomatosis.

Oral lichenoid reactions in HIV–HCV coinfected patients: Report of two cases

Dental materials and drugs may induce epithelial alterations on oral mucosa, which clinically resemble Oral Lichen Planus (OLP), but don’t have all clinical and/or histological characteristics of OLP. Two HIV-HCV coinfected patients, presenting oral lesions clinically compatible with OLP, were referred to the Dental Clinic of our University. These lesions arose after the patients started the anti-HCV therapy with pegylated interferon-alpha and ribavirin. Although these lesions clinically resembled OLP, their histological diagnosis was lichenoid reaction (OLR) with mild and moderate dysplasia. This report highlights some important issues: future studies on the frequency and pathogenesis of oral manifestations of HCV must consider the HCV therapy as a possible confounding factor, thus it is absolutely mandatory to define clearly the clinicopathologic criteria to distinguish OLP from OLR, which may be induced by the HCV therapy itself. The presence in our report of dysplasia highlights the difficulty encountered in classifying, in a clincopathological correct way, the dysplastic lichenoid reactions. Furthermore, HIV-HCV coinfected patients could present an impaired immunological conditions caused by the HIV-infection, altered by the administration of interferon and ribavirin, which could favour the onset of immunologically induced oral lesions.

The role of histopathological characteristics in distinguishing amalgam‐associated oral lichenoid reactions and oral lichen planus

To identify histological features that distinguish amalgam-associated oral lichenoid reactions (AAOLR) from oral lichen planus (OLP). Oral pathologists provided their opinion as to the possibility of distinguishing AAOLR and OLP histologically, the features important in distinguishing AAOLR from OLP and the diagnosis of 12 AAOLR and 12 OLP cases including the features that drew them to their conclusion. There was considerable variation between pathologists in their ability to distinguish the AAOLR and OLP cases. The sensitivity and specificity for histological diagnosis were 40% and 32% respectively. There were four features that were used most commonly to discriminate between AAOLR and OLP: an inflammatory infiltrate located deep to superficial infiltrate in some or all areas; a focal perivascular infiltrate; plasma cells in the connective tissue and neutrophils in the connective tissue. Each was independently predictive of AAOLR or OLP (P < 0.028). This study confirms the uncertainty of the diagnostic histological differences between AAOLR and OLP. Distinguishing these conditions should not rely on histology alone, but should be based on a synthesis of all available information including history, examination, histopathology and skin patch testing.

Amalgam associated oral lichenoid reaction

Amalgam is one of the most widely used restorative material in dentistry. However due to continuous low level release of mercury (Hg) from amalgam Fillings, its safety and wide scale use has been questioned. The main concerns relate to the potential toxic effects of Hg and the possibility that Hg may induce adverse immunological effects. With regard to the latter. there have been a number of reports suggesting that amalgam fillings may induce oral lichen planus (OLP) like or oral Lichenoid lesions(OLL)Here we present a case report of Amalgam Associated Oral Lichenoid Reaction (AAOLR) or Amalgam Contact Hypersensitivity Lesions( ACHL)s with emphasis on current review literature.

The role of histopathologic characteristics in distinguishing oral lichen planus and amalgam-associated oral lichenoid reactions

The role of histopathologic characteristics in distinguishing oral lichen planus and amalgam-associated oral lichenoid reactions