What is oral lichen planus?
Oral lichen planus is a long-term condition that affects the lining of the mouth. It can cause irritation, discomfort, or pain in your mouth, but sometimes is only noticed by you or your dentist see white patches in your mouth.
Lichen planus can happen when the body’s immune system causes inflammation in the tissues. It is not contagious, so you cannot catch it from someone else or pass it on.
Who gets oral lichen planus?
Oral lichen planus is more common in adults, especially in middle age, and women are affected more often than men.
The cause is not fully understood. It is thought to involve the immune system, and sometimes stress, other illnesses, or certain medicines may play a role.
Lichen Planus symptoms in the mouth
Lichen planus can cause white patches inside the mouth that move around and change appearance over time. The patches can be sore, and sometimes there can also be red patches, ulcers and/or blisters.
The appearance is often categorised into different subtypes of oral lichen planus, each with different characteristics and risk levels, but the appearance can change over time and move between different subtypes.
Common signs of oral lichen planus include:
- White lacy patches – often painless and found on the cheeks.
- Red or swollen areas – which may feel sore.
- Ulcers – cuts or sores in the mouth.
- Blisters – fragile areas that break down usually leaving ulcers.
- Sensitivity – to spicy, hot, or acidic foods.
These features can appear anywhere in the mouth – most often on the inside of the cheeks, and on the sides of the tongue.
Lichen planus in other parts of the body
Lichen planus can affect other parts of the body as well as the mouth. It can also affect:
- Skin – itchy, flat, reddish-purple bumps (often on the wrists, ankles, or lower back).
- Genitals – soreness, redness, or ulcers.
- Nails – ridging, thinning, or loss.
- Scalp – thinning or scarring hair loss.
- Eyes – irritation, dryness, or soreness (rare).
- Oesophagus – difficulty or pain when swallowing (rare).
If you notice any of these symptoms outside your mouth, then you should seek an assessment with your GP.
How is lichen planus diagnosed?
Oral lichen planus is often diagnosed by your general dentist in a routine dental checkup, but for new cases your dentist may refer you to a hospital specialist confirmation of the diagnosis. This is because other conditions can look similar, and sometimes a small biopsy is required to rule out other conditions.
If you first see your GP, they may advise you to visit your dentist or might refer you directly to a specialist.
Oral lichen planus and cancer
There is a small risk of oral lichen planus developing over time in to cancer. The overall risk is small -around 1 in 100 people (Sciencedirect, 2019) – but the risk is higher for specific subtypes or oral lichen planus where the lining of the mouth is fragile and inflamed in the same place for long periods:
- Erosive lichen planus – sore areas or ulcers.
- Bullous lichen planus – blisters in the mouth.
- Atrophic lichen plauns – thinning or red patches.
The subtype of lichen planus you have can change over time, so regular monitoring is important for all subtypes of oral lichen planus. For most people this monitoring will just be regular check-ups with their general dentist – at least every 12 months. In some cases, a hospital specialist may wish to monitor at the hospital separately to your regular dental checkup.
Managing oral lichen planus
Unfortunately there is no cure for oral lichen planus, so treatment is focused on managing the symptoms to help minimise any pain or discomfort.
Preventing flare ups
- Practice good oral hygiene – brush twice a day with a fluoride toothpaste and clean between your teeth with floss and/or interdental brushes – any build up of plaque and tartar can make lichen planus feel more sore.
- Visit your dentist regularly – at least every 12 months (or more often if your dentist advises) – this helps your dentist detect and treat any dental problems that could make your lichen planus feel more sore.
- Report any ulcer lasting more than 3 weeks in the same place, or changes from your usual symptoms, to your dentist.
- When booking, mention that you have oral lichen planus and that persistent ulcers can carry a small cancer risk – this may help you get a timely appointment.
- Avoid spicy, acidic, or very hot foods, and use a SLS (sodium lauryl sulphate) free toothpaste.
Comfort and symptom relief
- Use over-the-counter soothing rinses or anaesthetic gels.
- Rinse with Difflam mouthwash or target at sore areas with Difflam spray – available to buy over the counter but can also be prescribed by your dentist.
- Stronger medicines, such as steroid gels or rinses, are sometimes prescribed under the guidance of a hospital specialist if needed.
Minimising the risk of lichen planus developing into cancer
- Attend your regular dental check-ups to help monitor for any suspicious changes.
- Report persistent ulcers or changes in your usual pattern of symptoms to your dentist or specialist promptly.
- Avoid smoking and keep alcohol intake low.
Minimising the risk of oral cancer in general
- Stop smoking, chewing tobacco (including betel quid or areca nut) or vaping.
- Limit alcohol and avoid heavy drinking.
- Protect your lips from the sun with SPF lip balm.
- Be aware that HPV infection is linked with some oral cancers – HPV vaccination may help protect against this.
Minimising your general risk of cancer
- Eat a healthy diet including lots of fruit and vegetables – at least 5 portions each day.
- Avoid eating processed meat entirely, and avoid or limit eating red meat.
- Maintain a healthy weight.
- Stay physically active with regular exercise.
- Protect your skin from too much sun exposure.
Living with oral lichen planus
Oral lichen planus is a long term condition with symptoms that change over time and come and go in episodes. With the right care, most people manage it well.
Regular dental check-ups are important to monitor changes. It’s important to report any persistent ulcers or changes in symptoms quickly.
Leave feedback about the information on this page