Oral Lichen Planus

Overview

What is Oral Lichen Planus on the Gums?

Oral lichen planus affecting the gums (desquamative gingivitis) is a chronic inflammatory autoimmune condition causing red, eroded, or white striations on the gingival tissues. The gums may become tender, painful, and prone to sloughing.

• Chronic autoimmune condition
• Causes desquamative gingivitis
• Red, eroded gums with white striae
• Can be painful and affect oral hygiene
• Requires long-term management

Overview of the Condition

When oral lichen planus affects the gums, it causes a condition called desquamative gingivitis. The gingival tissue becomes red, glazed, and may have areas of erosion. White lacy patterns (Wickham's striae) may also be present.

References

• NCBI - Oral Lichen Planus
• AAOMP - Oral Pathology

Symptoms and Causes

Symptoms

• Red, inflamed gums
• White lacy patterns on gums
• Peeling or sloughing of gum tissue
• Pain and soreness
• Bleeding gums
• Sensitivity to spicy or acidic foods
• Difficulty with oral hygiene due to pain
• May affect attached and free gingiva

Causes

• T-cell mediated autoimmune response
• Exact trigger unknown
• Possible genetic predisposition
• Hepatitis C association
• Drug-induced lichenoid reactions (similar appearance)
• Contact reactions to dental materials

Diagnosis and Treatment Options

Diagnosis

• Clinical examination of gingival appearance
• Look for characteristic white striae
• Check other oral sites for involvement
• Biopsy for histopathological confirmation
• Direct immunofluorescence testing
• Hepatitis C screening

Treatment Options

• Topical corticosteroids (first-line)
• Custom trays for medication delivery
• Topical calcineurin inhibitors
• Systemic medications for severe cases
• Gentle oral hygiene modifications
• Regular monitoring for malignancy

Non-Surgical Care

Medical Management

Treatment focuses on reducing inflammation and managing symptoms. Topical corticosteroids are the mainstay of therapy. Custom trays can help deliver medication directly to the gums.

Home Care Recommendations

1. Use prescribed topical medications consistently
2. Use soft toothbrush and gentle technique
3. Avoid irritating toothpastes (SLS-free preferred)
4. Avoid spicy, acidic, or crunchy foods during flares
5. Use alcohol-free mouthwash
6. Maintain oral hygiene despite discomfort

Surgical Care

When is Surgery Needed?

Surgery is not a primary treatment for gingival lichen planus. Biopsy is performed for diagnosis. If lesions become suspicious for malignancy, excision may be indicated.

Anatomy and Affected Areas

Anatomy Overview

Gingival lichen planus affects both attached and marginal gingiva. The epithelium becomes atrophic and eroded, with characteristic white striae often visible at the margins of affected areas.

Distribution

• Attached gingiva (commonly involved)
• Free gingival margin
• Often bilateral
• May also involve buccal mucosa, tongue

Frequently Asked Questions

Frequently Asked Questions

QuestionAnswerWhy are my gums peeling?The autoimmune process causes the surface layer to slough off.Is this different from gum disease?Yes, it's autoimmune, not caused by bacteria.Will it go away?It's chronic and managed rather than cured.Can I still brush my teeth?Yes, but gently with a soft brush.Is there a cancer risk?Small risk (1-2%), so regular monitoring is important.Will my gums be permanently damaged?Proper treatment can maintain gum health.

Prevention Tips

Prevention Strategies

• Cannot prevent autoimmune condition
• Avoid known personal triggers
• Manage stress
• Maintain good oral hygiene
• Regular follow-up with dental provider
• Avoid irritating oral care products

Related Conditions

Related Conditions

• Cutaneous lichen planus
• Mucous membrane pemphigoid
• Pemphigus vulgaris
• Lichenoid drug reactions
• Lupus erythematosus

Desquamative Gingivitis

Desquamative gingivitis is a clinical description, not a diagnosis. Lichen planus is the most common cause, but mucous membrane pemphigoid and pemphigus must be ruled out through biopsy.