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Oral lichen planus is a chronic autoimmune inflammatory condition affecting the lining of your mouth, usually resulting in characteristic lacy white patches. Oral lichen planus occurs most often on the inside of your cheeks but also can affect your gums, tongue, lips and other parts of your mouth. Oral lichen planus sometimes involves your throat or esophagus.

While oral lichen planus usually begins during midlife, it can occur at any age. An initial episode of oral lichen planus may last for weeks or months. But unfortunately, oral lichen planus is usually a chronic condition and can last for many years. Although there's no cure, oral lichen planus can be managed with medications and home remedies.

Oral lichen planus signs and symptoms may include one or more of the following:

• Small, pale raised areas or bumps that form a lacy network on your tongue or inside your cheeks
• Shiny, red, slightly raised patches on your tongue or cheeks
• Red, open sores in your mouth
• Mouth pain
• Burning in your mouth
• Dry mouth
• A sense that your mouth feels rough
• Sore gums
• Sensitivity to hot or spicy foods
• A metallic taste or a blunted taste sensation
• Burning, swelling, bleeding and irritation with tooth brushing

Oral lichen planus usually causes only a limited lacy network of pale, slightly raised areas or shiny, red, raised patches on the sides of your tongue or inside your cheeks. Less commonly, it may turn in to a painful erosive lesion, or ulcer. Sometimes oral lichen planus causes no signs or symptoms other than the raised areas or patches. You may have periods when your oral lichen planus flares up, alternating with periods when you're symptom-free.

When you have oral lichen planus, you may also have the skin form, called lichen planus. You may notice lesions on other parts of your body, including your skin, scalp, nails and genitals.

When to see a doctor
See your doctor or dentist if you:

• Notice sores inside your mouth that don't heal
• Have lumps or white, red or dark patches in your mouth
• Have mouth pain
• Have a loss of feeling inside your mouth
• Have repeated bleeding in your mouth
• Notice any change in the way your mouth looks and feels
• Have lesions or sores on your skin, scalp, nails or genitals

The exact cause of oral lichen planus isn't known. But mounting research evidence suggests that oral lichen planus is an autoimmune condition that arises when your body's immune system triggers a chronic inflammatory process in your mucous membranes. It's thought that this process affects certain skin cells, including some of those in your mouth.

While it's not known what causes oral lichen planus, factors that may increase your risk of the condition include:

• Sex. Women are more likely than are men to have oral lichen planus.
• Medications. Certain medications, such as some of those used to treat arthritis, heart disease, high blood pressure and malaria, may trigger oral lichen planus.
• Allergies. Oral lichen planus can result from an allergic reaction to food, food additives, fragrances, dyes, dental metals or other substances.
• Medical conditions. Certain medical conditions, including other immune disorders, are associated with oral lichen planus. These may include lichen planus of the skin, liver disease, graft-versus-host disease, primary sclerosing cholangitis, lupus erythematosus, primary biliary cirrhosis, Sjogren's syndrome, ulcerative colitis, alopecia areata, and myasthenia gravis.
• Dental issues. Sharp edges on your teeth, dental restorations, ill-fitting dental prostheses, some periodontal surgical procedures, and oral habits such as lip and cheek chewing may raise the risk of oral lichen planus.
• Betel quid. Chewing betel quid — a plant and nut combination common in Southeast Asia — may increase your risk.
• Psychological issues. Stress, depression and anxiety often accompany oral lichen planus and may worsen existing cases.

Besides pain and taste changes that may accompany oral lichen planus, the condition also may cause or be associated with such complications as:

• Squamous cell carcinoma. This is a form of skin or mucous membrane cancer. There's considerable controversy about whether oral lichen planus can increase the risk of this cancer since evidence has been mixed. The risk appears to be heightened with ulcerative forms of oral lichen planus and with tobacco use.
• Oral thrush (Candida albicans). Oral lichen planus and its treatment may increase the risk of this fungus infection. In some cases, it can become resistant to antifungal medications, resulting in a so-called superinfection that's difficult to control.

If you have oral lichen planus symptoms, you can see your dentist, family doctor or general practitioner to start the process of diagnosis and treatment. However, you may need a referral to a specialist in oral conditions or dermatology.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor or dentist.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor or dentist.

Questions to ask
Preparing a list of questions will help you make the most of your time with your doctor or dentist. List, and ask, your questions from most important to least important in case time runs out. For oral lichen planus, some basic questions to ask your doctor or dentist include:

• What is likely causing my symptoms or condition?
• What are other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor or dentist
Your doctor or dentist is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor or dentist may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Frequently, your dentist is the first to notice oral lichen planus symptoms during a routine examination. The condition often can be diagnosed just by examining the affected areas of your mouth. In some cases, though, you may need to see a doctor or dentist who specializes in dermatology or oral medicine for a definitive diagnosis and treatment.

To make a diagnosis, your doctor may:

• Ask about your symptoms
• Discuss your medical history
• Examine your mouth and other areas of your body
• Order tests, such as blood and allergy tests, to rule out other conditions, such as yeast infections and canker sores
• Take a biopsy of your lesions, especially if they're erosive or ulcerated

There's no cure for oral lichen planus. Medical treatment focuses on controlling your pain, reducing lesions and prolonging the periods of time when you're symptom-free.

Mild symptoms
The course of treatment you have for oral lichen planus is based on the severity of your symptoms and the underlying cause, if known. With mild symptoms, you may not need any treatment, other than home remedies. Still, you should have periodic exams to make sure your condition isn't worsening. If an underlying condition is causing your oral lichen planus, treatment for that may improve your symptoms.

More bothersome symptoms
If your symptoms are bothersome or you have erosions or ulcerations, treatment options for oral lichen planus include:

• Corticosteroids. High-potency corticosteroid gels or ointments applied to lesions in your mouth are the most effective medications for oral lichen planus. You may also need to take oral corticosteroid pills. Because these medications can cause candidiasis, or oral thrush, you may need medications for that, too. Lesions that don't get better with topical treatments can be injected with corticosteroids. Talk to your doctor about possible risks associated with long-term corticosteroid use, such as adrenal suppression.
• Medicated mouth rinses or sprays. These can temporarily numb or soothe a painful mouth and may also decrease the size of oral lesions.
• Immunosuppressant medications. If your oral lichen planus doesn't get better with corticosteroids, medications that suppress your immune system may be an option. But because these medications can have serious side effects, and some have been linked to cancer, be sure you understand all of the pros and cons.

It can be difficult to bring oral lichen planus under control. You may need to try several different treatments to find one that's effective. And because oral lichen planus tends to be chronic, you may need treatment for months or even years.

In addition to regular medical and dental treatment, self-care measures may help improve your oral lichen planus symptoms. These include:

• Practicing good oral hygiene. Keep your mouth clean to reduce your symptoms and help prevent infection. Gently brush and floss your teeth daily.
• Avoid alcohol and tobacco products. Alcohol and tobacco may irritate your mouth. They also further increase your risk of oral cancer. If you use alcohol, do so in moderation. Don't smoke or use smokeless tobacco or any other tobacco product.
• Adjust your diet. Consider cutting out spicy or acidic foods if they seem to cause or worsen your symptoms.
• Have regular oral examinations. See your doctor every six to 12 months, or as scheduled, to have your condition monitored and to be screened for oral cancer.
• Take note of your symptoms. If you notice changes in your symptoms, such as new or worsening sores, contact your doctor right away.
• Get appropriate mental health care. Oral lichen planus has been linked to anxiety, stress and depression. If these are issues for you, talk to your doctor or see a mental health provider for treatment.

There's no sure way to prevent oral lichen planus. Getting underlying medical conditions under control may help oral lichen planus from worsening, though. Also, avoiding alcohol and tobacco can help reduce your risk of oral cancer, which has been linked to oral lichen planus.