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Daume L, Kreis C, Bohner L, Jung S, Kleinheinz J. Clinical characteristics of oral lichen planus and its causal context with dental restorative materials and oral health-related quality of life. BMC Oral Health 2021; 21:262. [PMID: 33992107 PMCID: PMC8126149 DOI: 10.1186/s12903-021-01622-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/06/2021] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this study was to investigate the influence of clinical characteristics and dental restorative materials on oral health-related quality of life in patients with oral lichen planus. In particular, the influences of amalgam and metals were investigated. Methods A total of 112 patients with clinical and histological features of oral lichen planus from the Department of Cranio-Maxillofacial Surgery at the University Hospital of Münster participated in this prospective study. Clinical parameters of oral lichen planus and the dental restorative materials used were evaluated. Oral health-related quality of life was investigated by using the short form of the German version of the Oral Health Impact Profile (OHIP-14). In addition, physical pain was rated on a visual analogue scale. Results The average OHIP-14 score was 13.54. A high correlation was seen between OHIP and pain. Likewise, higher OHIP-values were seen for male patients, and such as for those patients with non-reticular forms of oral lichen planus (OLP). A local form of OLP is more often seen on female patients, such as with the presence of reticular lichen. In regard to the restorations, the presence of composite restorations is correlated with a local lichen, whereas the presence of gold restorations is often seen with a generalized lichen. Furthermore, the grading of strength of association between mucosal lesion and amalgam/metal was tested. No significant differences revealed the analysis of the relationship between gender, clinical form of OLP, age, and presentation form between the 4 gradings of Thornhill. Conclusions The oral health-related quality of life is significantly limited in patients with oral lichen planus. But these OHIP scores are not influenced by the restorative materials. Here, pain severity is the most important aspect. We found no statistical differences in the clinical parameters between patients with amalgam or metal restoration and patients without these restorations. It is not necessary to replace amalgam fillings that are not in direct contact with mucosal surfaces. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01622-z.
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Affiliation(s)
- Linda Daume
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Constance Kreis
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Lauren Bohner
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Susanne Jung
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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Healing of Oral Lichenoid Lesions following Replacement of Dental Amalgam Restorations with Feldspathic Ceramic Inlay-Onlay Restorations: Clinical Results of a Follow-Up Period Varied from Three Months up to Five Years. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7918781. [PMID: 30627572 PMCID: PMC6304520 DOI: 10.1155/2018/7918781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/19/2018] [Indexed: 11/17/2022]
Abstract
Objective Previous studies have shown the effect of amalgam removal on the healing of oral lichenoid lesions (OLLs); however, no specific replacement materials have been suggested. The present series evaluated long-term results following the complete replacement of amalgam restorations with feldspathic ceramic inlay-onlay restorations for a group of patients with OLLs whose lesions were suspected to be related to amalgam restorations. Materials and Methods Twenty-four patients who had OLLs suspected to be related to their amalgam restorations were initially recruited. The patients underwent patch tests for a series of dental materials, in addition to clinical and histopathological examination. Sixteen (67%) of the 24 patients had their amalgam replaced with feldspathic ceramic inlay-onlay restorations and were examined within a follow-up period of 3 months to 5 years. Results After 3 months of clinical follow-up, complete healing (63%) was noted in all patients with OLLs whose lesions were in only close contact with their amalgam restorations. Healing was significantly related to the combination of lesions with close contact with the amalgam restoration and a diagnosis of OLL (x2 test, P=0.02). Conclusion Feldspathic ceramic can be safely used as a replacement material for patients with OLLs to diminish adverse reactions to amalgam restorations.
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Abstract
Oral Diseases (2012) Lichen planus (LP) is a common disorder affecting the oral cavity (OLP) and skin. Despite intensive research, LP/OLP etiology and treatment remain controversial. We investigated four controversial topics: (i) Is hepatitis C virus (HCV) infection associated with LP and involved in its pathogenesis? (ii) Should all patients with LP be screened for HCV? (iii) Should patients with OLP have all their amalgam restorations removed? (iv) Are there any new treatments for OLP? Results from extensive literature searches suggested that: (i) Robust evidence from three meta-analyses indicate that HCV is associated with LP and might be involved in OLP pathogenesis (ii) It would be prudent to screen patients with LP/OLP at significant risk with an ELISA for HCV antibodies using country-specific screening strategies (iii) There is no evidence that either OLP or oral lichenoid lesions patients would routinely benefit from having all their amalgam restorations replaced. Weak evidence from potentially very biased, small, non-randomized, unblinded studies suggests that a small fraction of patients may benefit from targeted amalgam replacement. (iv) There is weak evidence that, among new OLP treatments, topical pimecrolimus, aloe vera, and oral curcuminoids may be useful. The development of specific formulations for oral delivery of topical medications is a promising field.
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Affiliation(s)
- L Baccaglini
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, USA Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand Department of Oral Medicine, Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
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Lartitegui-Sebastián MJ, Martínez-Revilla B, Saiz-Garcia C, Eguizabal-Saracho S, Aguirre-Urizar JM. Oral lichenoid lesions associated with amalgam restorations: a prospective pilot study addressing the adult population of the Basque Country. Med Oral Patol Oral Cir Bucal 2012; 17:e545-9. [PMID: 22322507 PMCID: PMC3476013 DOI: 10.4317/medoral.17733] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Indexed: 11/09/2022] Open
Abstract
Oral lichenoid lesions (OLLs) are linked to a heterogeneous group of pathologies involving the oral mucosa that cannot be distinguished from the oral lichen planus excepting the fact that direct causal factors such as silver amalgam restorations (SARs) can be allocated to them.
Purpose: To analyze the prevalence of mucosal lesions associated with SAR in a group of SAR carrying patients in the Basque Country.
Study Design: A clinical prospective study was carried out on 100 adult patients over 30 years of age at the UPV/EHU Clinical Odontology Service whose rear teeth had at least one SAR. Patients were identified and mucosal lesions and amalgam restorations were characterized. Patch tests were performed on patients with lesions and amalgams were replaced with composite material. A statistical and comparative analysis was performed with the resulting data.
Results: OLLs were found in 7 patients whose predominant lesion was bilateral, asymmetrical and asymptomatic white papule-macule. Lesions were related to old and corroded SARs. Patch testing was positive in two cases. SAR substitution produced an improvement in 5 cases.
Conclusions: The presence of lichenoid lesions associated with SARs is infrequent in our environment and is preferentially related to old and corroded restorations.
Key words:Oral mucosa, lichenoid lesions, restoration, silver amalgam, patch test.
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Affiliation(s)
- M-J Lartitegui-Sebastián
- Department of Stomatology, Basque Country University School of Medicine and Dentistry, Sarriena, s/n, 48940 Leioa, Bizkaia, Spain.
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Clinical and histologic healing of lichenoid oral lesions following amalgam removal: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:766-72. [PMID: 22668704 DOI: 10.1016/j.oooo.2011.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/05/2011] [Accepted: 12/13/2011] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to see whether clinical healing after amalgam removal corresponds to histologic healing, i.e., a complete disappearance of any histologic sign of lichenoid lesion. STUDY DESIGN The study evaluated 64 patients with lichenoid lesions and at least one amalgam filling. RESULTS After amalgam removal, complete clinical healing was obtained in 14 patients (22%) and was significantly related to lesion topography (χ(2) 4.7; P < .05) and positive patch test (χ(2) 6.3; P < .01). Complete histologic healing was obtained in only 7 cases (50% of clinically healed patients), and was significantly related to the combination of positive patch test and strict contact with amalgams (Fisher's exact test P < .01). CONCLUSIONS Contact with amalgams and positive patch testing are good but not absolute indicators of the beneficial effect of amalgam replacement. In addition, complete clinical healing does not necessarily mean a disappearance of the histologic characteristics of OLL/OLP lesions.
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López-Jornet P, Camacho-Alonso F. Application of a motivation-behavioral skills protocol in gingival lichen planus: a short-term study. J Periodontol 2011; 81:1449-54. [PMID: 20572768 DOI: 10.1902/jop.2010.100245] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The main objective of the present study was to assess the efficacy of a motivation–behavioral skills protocol for plaque control in patients with gingival lichen planus. METHODS A pre- and post-test descriptive clinical study was made of 40 consecutive white patients with gingival lichen planus: five males (12.5%) and 35 females (87.5%); mean age: 57 years. A motivation–behavioral skills protocol for oral hygiene was applied, with the determination of gingival scores (gingival index, plaque extension, and Community Periodontal Index of Treatment Needs [CPITN]) and patient evaluation after 4 and 8 weeks. RESULTS The clinical parameters in relation to the different forms of gingival lichen planus showed statistically significant improvements for gingival index, plaque extension, and CPITN (P <0.001) as determined 4 and 8 weeks after starting the program. CONCLUSIONS The application of an active prevention program in patients with gingival lichen planus is important because it offers benefits for periodontal health. However, more long-term studies are needed to confirm the results obtained.
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Affiliation(s)
- Pia López-Jornet
- Department of Oral Medicine, Murcia University Dental School, Murcia, Spain.
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Schifter M, Yeoh SC, Coleman H, Georgiou A. Oral mucosal diseases: the inflammatory dermatoses. Aust Dent J 2010; 55 Suppl 1:23-38. [PMID: 20553242 DOI: 10.1111/j.1834-7819.2010.01196.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The oral inflammatory dermatoses is a term used to describe a number of predominantly immune-mediated disorders: lichen planus (LP), erythema multiforme (EM), the vesiculobullous diseases pemphigoid (MMP), pemphigus (PV) and epidermolysis bullosa acquisita (EBA). These conditions are characterized by frequent involvement of the oral mucosa and often associated with extraoral manifestations, particularly of the skin, but can involve the eyes, both the conjunctiva and sclera, the nasal and pharyngeal mucosa, as well as the genitals. Given their frequent, and sometimes initial involvement of the oral mucosa, oral health professionals need to be both familiar with the clinical features and presentations of these conditions, and appreciate their critical role in management. This paper reviews the clinical features and presentation of the oral dermatoses, provides guidance as to the appropriate investigations needed to differentiate and correctly diagnose these conditions, details the aetio-pathology of these diseases and discusses their management.
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Affiliation(s)
- M Schifter
- Oral Medicine/Oral Pathology Unit, Westmead Centre for Oral Health, Westmead Hospital, Sydney.
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Pezelj-Ribarić S, Prpić J, Miletić I, Brumini G, Soskić MS, Anić I. Association between oral lichenoid reactions and amalgam restorations. J Eur Acad Dermatol Venereol 2008; 22:1163-7. [PMID: 18393961 DOI: 10.1111/j.1468-3083.2008.02736.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- S Pezelj-Ribarić
- Medical Faculty, University of Rijeka, Department of Oral pathology, Rijeka, Croatia.
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Schedle A, Ortengren U, Eidler N, Gabauer M, Hensten A. Do adverse effects of dental materials exist? What are the consequences, and how can they be diagnosed and treated? Clin Oral Implants Res 2007; 18 Suppl 3:232-56. [PMID: 17594385 DOI: 10.1111/j.1600-0501.2007.01481.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES All dental biomaterials release substances into the oral environment to a varying degree. Various preclinical biocompatibility test systems have been introduced, aiming at an evaluation of the potential risks of dental materials. Potential pathogenic effects of released substances from dental materials have been demonstrated. For the biocompatibility of a biomaterial, it is not only important that minimal diffusable substances are released when it is in body contact--the material must also fulfill the function for which it has been designed. This is also very much dependent on the material properties and its handling properties. The aim of this review was to generate an overview of the present status concerning adverse reactions among patients and personnel. MATERIALS AND METHODS A systematic review was performed using a defined search strategy in order to evaluate all MEDLINE-literature published between 1996 and 2006. RESULTS The compilation of the literature available has revealed that the majority of studies have been carried out on patients compared with personnel. Adverse reactions towards dental materials do occur, but the prevalence and incidence are difficult to obtain. The results were essentially based on cohort studies. Clinical trials, especially randomized-controlled trials, are in the minority of all studies investigated, with the exception of composite and bonding studies, where clinical trials, but not randomized-controlled trials, represent the majority of studies. Patients and personnel were treated separately in the manuscript. Amalgam studies show the lowest degree of verified material-related diagnosis. Even if objective symptoms related to adverse reactions with polymer resin-based materials have been reported, postoperative sensitivity dominates reports concerning composites/bondings. Verified occupational effects among dental personnel show a low frequency of allergy/toxic reactions. Irritative hand eczema seemed to be more common than in the general population. CONCLUSIONS Patient- and personnel-related studies are of variable quality and can be improved. There is a need for a better description of the content of materials. A registry for adverse effects of dental materials would be useful to detect the occurrence of low-incidence events.
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Affiliation(s)
- Andreas Schedle
- Bernhard Gottlieb University Clinic of Dentistry, Central Research Unit, Medical University of Vienna, Vienna, Austria.
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Abstract
BACKGROUND Oral lichen planus (OLP) is one of the most common oral mucosa disorders. OLP gingival involvement is very frequently observed and is characterized by a wide range of clinical appearance, symptomatology, and locations. The purpose of this study was to analyze the prevalence and clinical aspects of gingival lesions in a series of 213 patients affected by OLP. METHODS We analyzed the prevalence and clinical aspects (location, morphology, and symptomatology) of the gingival lesions in a total of 213 clinically and histopathologically assessed patients affected by OLP. RESULTS Gingival lesions were diagnosed in 38.4% of cases. White lesions were the most frequently observed in the gingiva (42.7%), followed by mixed lesions (31.7%), and red lesions (25.6%). For the three clinical forms, the most frequent gingival location was the simultaneous involvement of the attached and marginal gingiva. None of the white lesions presented symptomatology, whereas most red lesions or mixed forms presented symptoms that varied from discomfort to severe oral pain or a burning sensation. CONCLUSIONS Considering the high frequency of gingival involvement in OLP, the diversity of clinical manifestations, and its potential relationship with general and oral health in patients, periodontists should be familiar with the most common clinical aspects of OLP in the gingiva.
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Affiliation(s)
- Fabio Camacho-Alonso
- Department of Oral Medicine, Faculty of Medicine and Odontology, University of Murcia, Murcia, Spain.
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Al-Hashimi I, Schifter M, Lockhart PB, Wray D, Brennan M, Migliorati CA, Axéll T, Bruce AJ, Carpenter W, Eisenberg E, Epstein JB, Holmstrup P, Jontell M, Lozada-Nur F, Nair R, Silverman B, Thongprasom K, Thornhill M, Warnakulasuriya S, van der Waal I. Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. ACTA ACUST UNITED AC 2007; 103 Suppl:S25.e1-12. [PMID: 17261375 DOI: 10.1016/j.tripleo.2006.11.001] [Citation(s) in RCA: 213] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 11/03/2006] [Indexed: 01/06/2023]
Abstract
Several therapeutic agents have been investigated for the treatment of oral lichen planus (OLP). Among these are corticosteroids, retinoids, cyclosporine, and phototherapy, in addition to other treatment modalities. A systematic review of clinical trials showed that particularly topical corticosteroids are often effective in the management of symptomatic OLP lichen planus. Systemic corticosteroids should be only considered for severe widespread OLP and for lichen planus involving other mucocutaneous sites. Because of the ongoing controversy in the literature about the possible premalignant character of OLP, periodic follow-up is recommended. There is a spectrum of oral lichen planus-like ("lichenoid") lesions that may confuse the differential diagnosis. These include lichenoid contact lesions, lichenoid drug reactions and lichenoid lesions of graft-versus-host disease. In regard to the approach to oral lichenoid contact lesions the value of patch testing remains controversial. Confirmation of the diagnosis of an oral lichenoid drug reaction may be difficult, since empiric withdrawal of the suspected drug and/or its substitution by an alternative agent may be complicated. Oral lichenoid lesions of graft-versus-host disease (OLL-GVHD) are recognized to have an association with malignancy. Local therapy for these lesions rests in topical agents, predominantly corticosteroids.
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Affiliation(s)
- Ibtisam Al-Hashimi
- Salivary Dysfunction Clinic, Baylor College of Dentistry, Houston, TX, USA
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Ortiz-Ruiz AJ, Ramírez-Espinosa M, López-Jornet P. Oral Lichen planus and sensitization to manganese in a dental prosthesis. Contact Dermatitis 2006; 54:214-5. [PMID: 16650098 DOI: 10.1111/j.0105-1873.2006.0775b.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Martin H Thornhill
- Department of Oral & Maxillofacial Medicine & Surgery, University of Sheffield School of Clinical Dentistry, Claremont Crescent, Sheffield, UK
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Affiliation(s)
- Jerri Hoskyn
- Department of Dermatology, University of Arkansas for Medical Sciences, 4301 West Markham Road, Slot 576, Arkansas 72205, USA
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