Dear Dr. Mady: I recently had a couple of new partial dentures made by my dentist and they felt great for a couple of months and now I have sores and my entire mouth feels raw inside and the pain at times is unbearable. My family doctor says that he thinks that I have a condition called Lichen Planus in my mouth that I had before on my skin. I think that it may have been caused by switching from plastic partials to metal ones. Can this cause Lichen Planus and if so how can I get rid of it? - A Patient in Agony
Dear Patient: First of all, if Lichen Planus is the correct diagnosis, switching from acrylic based to metal based removable partial dentures would rarely have anything to do with it. If you have had a history of Lichen Planus of the skin, then your physician is most likely correct in his conclusion. If the partial dentures were going to cause sore spots or an allergic reaction to the material used in fabrication, then the symptoms most likely would have appeared right after you took possession of them, not a couple of months later.
Lichen Planus is sometimes difficult to diagnose due to certain factors that it does have in common with other diseases, including pain and presentation. Lichen Planus is pronounced LY-kin-PLAN-us. It is a common and usually chronic disease that can affect both the skin and the inside of the mouth. Approximately one to two percent of the population has it and it may present as either internal or external lesions or both, at the same time or at different times in the individual's life. It is seen most often in women in their fifties but affects middle aged men almost as much. The condition may even disappear for lengthy periods of time and then reappear without warning.
It is important to understand that Lichen Planus is not an infectious disease that is contagious. It is not caused from lifestyle changes (including foods), is not and may not lead to cancer, is not a fungus, and there is no real proof that it is genetic (inherited). In fact, it is a recurrent inflammatory disease and may at times, but less commonly even affect the genital area. There is a possibility of it being immune system related.
Even though no direct causes have been found, I do believe that certain factors may contribute to the condition's progression. These include, but are not limited to very poor oral hygiene, some prescription drugs and stress in one's life, just as in the case of apthous stomatitis or canker sores.
Lichen planus usually presents as white dots and interconnecting lines called straie. These are similar with respect to resemblance, to the way the lichen plant grows on stones and rocks but otherwise unrelated. These white lines at times may be infiltrated by a red, ulcer-like inflammation and usually affected are both cheeks, the tongue and the gums. In the mouth, this disease usually will have a longer duration than on the skin.
There is no known cure for Lichen Planus but many treatments are available to control the pain associated with it. Often a biopsy will need to be done to confirm the diagnosis. In the meantime, stay far removed from spicy acidic foods and beverages. Also try not to use mouthwashes because most contain alcohol.
You know your own condition better than even your doctor and you will educate yourself over time as to what triggers outbreaks in your mouth and on your skin, and then try and avoid these stimuli if at all possible. Document these in a diary for reference. Often no medication will be required unless the pain becomes too severe. Your dentist or physician may prescribe the use of topical applications of ointments or hydrogen peroxide, or certain steroids. No matter what the cause or stage of the disease, do not let the irritation cause you to neglect your oral hygiene or refrain from regular trips to your dentist, who may be able to really help the situation.
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5