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González-Moles MÁ, Ramos-García P. An Evidence-Based Update on the Potential for Malignancy of Oral Lichen Planus and Related Conditions: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:608. [PMID: 38339358 PMCID: PMC10854587 DOI: 10.3390/cancers16030608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
A systematic review and a meta-analysis is presented on published articles on the malignant transformation of oral lichen planus (OLP) and related conditions, which, based on current evidence, updates an earlier systematic review published by our research group that included publications until November 2018. In this updated study (Nov-2023) we searched MEDLINE, Embase, Web of Science, and Scopus. We evaluated the methodological quality of studies (QUIPS tool) and carried out meta-analyses. The inclusion criteria were met by 101 studies (38,083 patients), of which, 20 new primary-level studies (11,512 patients) were published in the last 5 years and were added to our updated study. The pooled malignant transformation ratio was 1.43% (95% CI = 1.09-1.80) for OLP; 1.38% (95% CI = 0.16-3.38) for oral lichenoid lesions; 1.20% (95% CI = 0.00-4.25) for lichenoid reactions; and 5.13% (95% CI = 1.90-9.43) for OLP with dysplasia. No significant differences were found between the OLL or LR groups and the OLP subgroup (p = 0.853 and p = 0.328, respectively), and the malignant transformation was significantly higher for the OLP with dysplasia group in comparison with the OLP group (p = 0.001). The factors that had a significant impact with a higher risk of malignant transformation were the presence of epithelial dysplasia, a higher methodological quality, the consumption of tobacco and alcohol, the location of lesions on the tongue, the presence of atrophic and erosive lesions, and infection by the hepatitis C virus. In conclusion, OLP behaves as an oral potentially malignant disorder (OPMD), whose malignancy ratio is probably underestimated as a consequence essentially of the use of inadequate diagnostic criteria and the low methodological quality of the studies on the subject.
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Affiliation(s)
- Miguel Ángel González-Moles
- School of Dentistry, University of Granada, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Pablo Ramos-García
- School of Dentistry, University of Granada, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
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García-Pola M, Rodríguez-Fonseca L, Suárez-Fernández C, Sanjuán-Pardavila R, Seoane-Romero J, Rodríguez-López S. Bidirectional Association between Lichen Planus and Hepatitis C-An Update Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5777. [PMID: 37762719 PMCID: PMC10531646 DOI: 10.3390/jcm12185777] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Lichen planus (LP) is a chronic, inflammatory mucocutaneous disorder associated with systemic diseases such as hepatitis C (HCV). The objective of this study is to evaluate the association between LP and HCV bidirectionally through a systematic review and meta-analysis. A comprehensive search of studies published was performed in the databases of PubMed, Embase, and Web of Science. Out of 18,491 articles, 192 studies were included. The global prevalence of HCV positive (HCV+) in LP patients registered from 143 studies was 9.42% [95% confidence interval (CI), 7.27-11.58%], and from these, 84 studies showed HCV+ 4-fold more frequent in LP than a control group (OR, 4.48; 95% CI, 3.48-5.77). The global prevalence of LP in patients HCV+ recorded from 49 studies was 7.05% (95% CI, 4.85-9.26%), and from these, 15 registered a 3-fold more LP in HCV (OR, 3.65; 95% CI, 2.14-6.24). HCV+ in LP patients showed great geographic variability (OR, 2.7 to 8.57), and the predominantly cutaneous location was higher (OR, 5.95) than the oral location (OR, 3.49). LP in HCV+ patients was more frequent in the Eastern Mediterranean (OR, 5.51; 95% CI, 1.40-15.57). There is a higher prevalence of HCV+ in LP and vice versa than in the control group, especially in certain geographical areas that should be taken into consideration when doing screening in countries with an upper prevalence of HCV among the general population.
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Affiliation(s)
- María García-Pola
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
| | - Lucia Rodríguez-Fonseca
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
| | - Carlota Suárez-Fernández
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
| | - Raquel Sanjuán-Pardavila
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
| | - Juan Seoane-Romero
- Department of Surgery and Medical-Surgical Specialties, School of Medicine and Dentistry, University of Santiago de Compostela, 15780 Santiago de Compostela, Spain;
| | - Samuel Rodríguez-López
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
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Li JW, Li KY, Chan BWA, McGrath CP, Zheng LW. Rate of Malignant Transformation Differs Based on Diagnostic Criteria for Oral Lichenoid Conditions: A Systematic Review and Meta-Analysis of 24,277 Patients. Cancers (Basel) 2023; 15:cancers15092537. [PMID: 37174004 PMCID: PMC10177058 DOI: 10.3390/cancers15092537] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES This systematic review and meta-analysis aims to evaluate the evidence on the malignant potential of oral lichenoid conditions (OLCs) including oral lichen planus (OLP), oral lichenoid lesions (OLL), and lichenoid mucositis dysplasia (LMD). In addition, it aims to compare the rate of malignant transformation (MT) in OLP patients diagnosed according to different diagnostic criteria, and to investigate the possible risk factors for OLP MT into OSCC. MATERIALS AND METHODS A standardized search strategy was applied across four databases (PubMed, Embase, Web of Science, and Scopus). Screening, identification and reporting followed the PRISMA framework. Data on MT were calculated as a pooled proportion (PP), subgroup analyses and possible risk factors for MT were pooled as odds ratios (ORs). RESULTS Among 54 studies with 24,277 patients, the PP for OLCs MT was 1.07% (95% CI [0.82, 1.32]). The estimated MT rate for OLP, OLL and LMD was 0.94%, 1.95% and 6.31%, respectively. The PP OLP MT rate using the 2003 modified WHO criteria group was lower than that using the non-2003 criteria (0.86%; 95% CI [0.51, 1.22] versus 1.01%; 95% CI [0.67, 1.35]). A higher odds ratio of MT was observed for red OLP lesions (OR = 3.52; 95% CI [2.20, 5.64]), smokers (OR = 1.79; 95% CI [1.02, 3.03]), alcohol consumers (OR = 3.27, 95% CI [1.11, 9.64]) and those infected with HCV (OR = 2.55, 95% CI [1.58, 4.13]), compared to those without these risk factors. CONCLUSIONS OLP and OLL carry a low risk of developing OSCC. MT rates differed based on diagnostic criteria. A higher odds ratio of MT was observed among red OLP lesions, smokers, alcohol consumers, and HCV-positive patients. These findings have implications for practice and policies.
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Affiliation(s)
- Jing-Wen Li
- Division of Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Kar Yan Li
- Clinical Research Centre, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Bik Wan Amy Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Colman Patrick McGrath
- Division of Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Li-Wu Zheng
- Division of Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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Zahed M, Goli A, Zamirian E, Zahed S, Azad A, Aghaei F. Spatial Evaluation of Oral Lichen Planus Patients Referred to Shiraz Dental School, Iran: a Medical Geography Approach. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2022; 23:361-368. [PMID: 36588969 PMCID: PMC9789343 DOI: 10.30476/dentjods.2021.90760.1519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/05/2021] [Accepted: 09/29/2021] [Indexed: 05/17/2023]
Abstract
STATEMENT OF THE PROBLEM Oral lichen planus (OLP) is an important inflammatory disease concerning its tendency to malignancy. The etiopathogenesis of this disease is still unknown. Medical geography uses geographic techniques to study factors related to location that cause uneven distribution of disease. PURPOSE This study was conducted to map OLP in patients referred to Shiraz Dental School with medical geography techniques and investigate any possible relationship between the number of dentists and health-centers in different regions of Fars province with the number of referrals. MATERIALS AND METHOD In this cross-sectional study, we evaluated the records of OLP patients referred to Shiraz Dental School from 2007 to 2018. Age, sex, place of residence, occupation, level of education, location of involvement, duration, and cutaneous involvement were recorded. The number of dentists and healthcare centers was obtained from the statistical records of Fars province. A Geographic Information System was used for the assessment of the spatial distribution of OLP. Ordinary least squares (OLS) and geographically weighted regression (GWR) indices were used for evaluating the relationship between the number of dentists and health centers with the number of referrals. RESULTS From 1006 records, 457 were studied, from which 71% were female (age range of 41-60). The regression coefficient was 0.937 for the number of dentists in each county compared to OLP referrals indicating a strong relationship. The regression coefficient was 0.983 for the number of health-centers. According to GWR analyses in Shiraz neighboring counties like Marvdasht, Sepidan, and Sarvestan, there is a positive relationship between the number of dentists and OLP patients. CONCLUSION The results revealed that dentists and health care centers had a good cognition of referring patients with OLP (as a premalignant lesion) for definite diagnosis in Fars counties. But both groups need more education in this matter. Moreover, referrals from settlements near Shiraz were more common because of their easier access.
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Affiliation(s)
- Maryam Zahed
- Oral and Dental Disease Research Center, Dept. of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Goli
- Dept. of Sociology and Social Planning, College of Economics, Management and Social Sciences, Shiraz University, Shiraz, Iran
| | - Elaheh Zamirian
- Undergraduate Student, Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeid Zahed
- Dept. of Sociology and Social Planning, College of Economics, Management and Social Sciences, Shiraz University, Shiraz, Iran
| | - Azita Azad
- Oral and Dental Disease Research Center, Dept. of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Aghaei
- Postgraduate Dept. of Restorative, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Faghihian E, Taghvaee R, Etemadi M, Ghalayani P. Comparison of clinical indices and therapeutic effect of a mucoadhesive system containing Melissa 1% and triamcinolone 0.1% on lichenoid reactions. Dent Res J (Isfahan) 2022; 19:2. [PMID: 35308455 PMCID: PMC8927956 DOI: 10.4103/1735-3327.336687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/05/2021] [Accepted: 07/13/2021] [Indexed: 11/04/2022] Open
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González-Moles MÁ, Warnakulasuriya S, González-Ruiz I, Ayén Á, González-Ruiz L, Ruiz-Ávila I, Ramos-García P. Dysplasia in oral lichen planus: relevance, controversies and challenges. A position paper. Med Oral Patol Oral Cir Bucal 2021; 26:e541-e548. [PMID: 34162824 PMCID: PMC8254877 DOI: 10.4317/medoral.24610] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/13/2021] [Indexed: 12/26/2022] Open
Abstract
Background Patients with oral lichen planus (OLP) have an increased risk of oral cancer. For this reason, OLP is classified as an oral potentially malignant disorder. However, the precise personal (or individual) risk is unknown. Recent meta-analytical studies have reported that dysplastic OLP may transform to cancer in around 6% of cases, while the rate of transformation is lower (<1.5%) in non-dysplastic cases. The presence of epithelial dysplasia has emerged as the most powerful indicator for assessing cancer risk in oral potentially malignant disorders in routine practice. However, the general acceptance of epithelial dysplasia as an accompanying histologic feature in OLP is subject to great controversy. Many pathologists consider the presence of dysplasia as a criterion to exclude OLP when routinely reporting on this disease. This practice, widespread among oral pathology professionals, has resulted in the underestimation of the potential for malignancy of OLP. Material and Methods A review of the literature was carried out in order to critically analyze the relevance, controversies and challenges encountered across the diagnosis of epithelial dysplasia in OLP. Results 12 studies have been published examining dysplastic changes in OLP, reporting Figures ranging from 0.54% to 25% of cases with dysplasia in the first diagnostic biopsy. The diagnosis of dysplasia in the OLP poses an additional difficulty due to the fact that the affected oral epithelium per se develops changes related to autoimmune aggression. Among the most frequent histological features of OLP that develops dysplasia are basal cell hyperplasia with basaloid appearance, loss of basal cells polarity, cellular and nuclear pleomorphism and irregular stratification. Conclusions Epithelial dysplasia should not be considered an exclusion criterion for OLP; its evaluation requires experienced pathologists in this field. Key words:Oral lichen planus, epithelial dysplasia, oral cancer.
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Affiliation(s)
- M-Á González-Moles
- Oral Medicine Department, School of Dentistry, University of Granada Granada, Paseo de Cartuja s/n, 18071 Granada, Spain
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Li C, Tang X, Zheng X, Ge S, Wen H, Lin X, Chen Z, Lu L. Global Prevalence and Incidence Estimates of Oral Lichen Planus: A Systematic Review and Meta-analysis. JAMA Dermatol 2020; 156:172-181. [PMID: 31895418 DOI: 10.1001/jamadermatol.2019.3797] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Importance Integrated information on the global prevalence and incidence of oral lichen planus (OLP) is lacking. Objective To examine the global prevalence and incidence of OLP in a systematic review and meta-analysis. Data Sources A systematic review of population-based studies and clinic-based studies reporting the prevalence and incidence of OLP was performed using 3 electronic medical databases (Cochrane Database of Systematic Reviews, Embase, and MEDLINE) from their inception to March 2019. The search terms included "(lichen planus or LP) and (prevalence or incidence or epidemiology)." No language restriction was applied. Study Selection Observational descriptive studies investigating the prevalence and incidence of OLP were included. Data Extraction and Synthesis Data were extracted by continent, sex, and other characteristics. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence Data using random-effects models to synthesize available evidence. Main Outcomes and Measures The primary outcome was the prevalence (with 95% CIs) of OLP among the overall population and among subgroups. Between-study heterogeneity was assessed using the I2 statistic. Results Among 46 studies, the overall pooled estimated prevalence of OLP was 0.89% (95% CI, 0.38%-2.05%) among the general population (n = 462 993) and 0.98% (95% CI, 0.67%-1.43%) among clinical patients (n = 191 963). Among the 15 population-based studies, the prevalence of OLP was 0.57% (95% CI, 0.15%-2.18%) in Asia, 1.68% (95% CI, 1.09%-2.58%) in Europe, and 1.39% (95% CI, 0.58%-3.28%) in South America. Among the 31 clinic-based studies, the prevalence was 1.43% (95% CI, 1.12%-1.83%) in Africa, 0.87% (95% CI, 0.61%-1.25%) in Asia, 1.03% (95% CI, 0.51%-2.09%) in Europe, 0.11% (95% CI, 0.07%-0.16%) in North America, and 3.18% (95% CI, 0.97%-9.95%) in South America. The pooled prevalence of OLP by sex was 1.55% (95% CI, 0.83%-2.89%) for women and 1.11% (95% CI, 0.57%-2.14%) for men in the population-based studies and 1.69% (95% CI, 1.05%-2.70%) for women and 1.09% (95% CI, 0.67%-1.77%) for men in the clinic-based studies. In 5 clinic-based studies providing the age distribution of patients with OLP, the prevalence by age was 0.62% (95% CI, 0.33%-1.13%) among patients younger than 40 years and 1.90% (95% CI, 1.16%-3.10%) among patients 40 years and older. Conclusions and Relevance This study identified the global prevalence and incidence of OLP in terms of its spatial, temporal, and population distribution. The overall estimated pooled prevalence of OLP was 0.89% among the general population and 0.98% among clinical patients. A higher prevalence of OLP was found in non-Asian countries, among women, and among people 40 years and older. The findings should be considered with caution because of the high heterogeneity of the included studies.
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Affiliation(s)
- Changchang Li
- Department of Dermatology, Wenzhou Hospital of Integrated Chinese and Western Medicine, Zhejiang University of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Xiaoqiong Tang
- Anhui University of Traditional Chinese Medicine, Anhui, China
| | - Xiaoyan Zheng
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuqi Ge
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hao Wen
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoqiong Lin
- Department of Dermatology, Wenzhou Hospital of Integrated Chinese and Western Medicine, Zhejiang University of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Zhiwei Chen
- Department of Dermatology, Wenzhou Hospital of Integrated Chinese and Western Medicine, Zhejiang University of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Liming Lu
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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Sethi Ahuja U, Puri N, More CB, Gupta R, Gupta D. Comparative evaluation of effectiveness of autologous platelet rich plasma and intralesional corticosteroids in the management of erosive oral Lichen planus- a clinical study. J Oral Biol Craniofac Res 2020; 10:714-718. [PMID: 33088702 DOI: 10.1016/j.jobcr.2020.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/28/2020] [Indexed: 01/07/2023] Open
Abstract
Purpose Oral Lichen planus is a potentially malignant autoimmune disorder, characterized by burning and pain in the affected mucosa which reduces the quality and comfort of patient's life. Various treatment modalities have been documented for OLP but due its malignant potential the alternative therapeutic approaches with least or no side effects are being in demand. One of such, yet unexplored treatment is Platelet rich plasma (PRP). This study aims to evaluate the effectiveness of intralesional PRP as compared to the Intralesional corticosteroids in the management of erosive OLP. Materials and methods The study sample consisted of 20 clinically and histopathologically confirmed patients of Erosive OLP among which 10 patients were given intralesional corticosteroids and 10 patients were administered intralesional PRP. All the patients were given weekly injections for 2 months and were followed up till 4 months for assessing the parameters such as pain/burning, erythema and size of the lesions. Results The patients in both the groups showed a statistically significant reduction in all the assessed parameters of erosive lichen planus from baseline till 4 months of treatment and follow up. However, on comparison of the pain reduction, size of lesion and erythema scores between the two groups, the difference was found to be statistically insignificant. Conclusion The intralesional PRP was found to be of comparative effectiveness with respect to intralesional triamcinolone acetonide in the management of erosive OLP and with an added advantage of having less recurrence and no adverse effects.
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Affiliation(s)
- Upasana Sethi Ahuja
- Department of Oral Medicine & Radiology, I.T.S Dental College, Muradnagar, Ghaziabad, India
| | - Nidhi Puri
- Department of Oral Medicine & Radiology, I.T.S Dental College, Muradnagar, Ghaziabad, India
| | - Chandramani B More
- Department of Oral Medicine and Radiology, K.M.Shah Dental College and Hospital, Vadodara, India
| | - Ritu Gupta
- Department of Public Health Dentistry, I.T.S Dental College, Muradnagar, Ghaziabad, India
| | - Deepak Gupta
- Department of Oral Medicine and Radiology M.M College of Dental Sciences, Mullana, Ambala, India
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Mahmoud SAM, Latif MKA, Dahmoush HM, Hussein EA. Diagnostic accuracy of colposcopic examination in patients with oral dysplastic lesions. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:692-699. [PMID: 32981873 DOI: 10.1016/j.oooo.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/08/2020] [Accepted: 08/16/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Colposcopy is a direct microscopic method and is the gold standard tool to detect early cervical dysplastic lesions. In the past, many attempts have been made to use gynecologic methods to examine the oral mucosa. The aim of this study was to detect the diagnostic accuracy of oral colposcopy in diagnosing oral dysplastic lesions in comparison with microscopic evaluation based on biopsy and compare Reid's Colposcopic Index (RCI) and the Swede scoring system in diagnosing oral dysplastic lesions. STUDY DESIGN Twenty-five patients who presented for diagnosis of oral leukoplakia to the Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University (Cairo, Egypt) and met the selection criteria were recruited in this study. Each patient was subjected to colposcopic examination, followed by biopsy to confirm the results of colposcopy. The sensitivity and specificity of oral colposcopy were calculated after colposcopic assessment by using the Swede scoring system and the RCI. RESULTS The diagnostic accuracy of oral colposcopy with use of the Swede scoring system was superior to that of oral colposcopy with the use of the RCI. CONCLUSIONS Colposcopic examination using the Swede scoring system is very specific for diagnosing oral epithelial dysplasia and for using the "see-and-treat" method, whereas the RCI is a very sensitive screening method for the diagnosis of oral epithelial dysplasia in oral potentially malignant disorders.
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Affiliation(s)
- Sarah Ahmed Mohamed Mahmoud
- Assistant Lecturer of Oral & Maxillo-facial Pathology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | | | - Heba Mahmoud Dahmoush
- Professor of Oral & Maxillofacial Pathology Department, Faculty of Dentistry, Cairo University
| | - Eman Aly Hussein
- Assistant Professor of Gynecology, Faculty of Medicine, Cairo University
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Idrees M, Kujan O, Shearston K, Farah CS. Oral lichen planus has a very low malignant transformation rate: A systematic review and meta‐analysis using strict diagnostic and inclusion criteria. J Oral Pathol Med 2020; 50:287-298. [PMID: 31981238 DOI: 10.1111/jop.12996] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Majdy Idrees
- UWA Dental School The University of Western Australia Nedlands WA Australia
| | - Omar Kujan
- UWA Dental School The University of Western Australia Nedlands WA Australia
| | - Kate Shearston
- UWA Dental School The University of Western Australia Nedlands WA Australia
| | - Camile S. Farah
- Australian Centre for Oral Oncology Research and Education Nedlands WA Australia
- Oral, Maxillofacial and Dental Surgery Fiona Stanley Hospital Murdoch WA Australia
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González-Moles MÁ, Ruiz-Ávila I, González-Ruiz L, Ayén Á, Gil-Montoya JA, Ramos-García P. Malignant transformation risk of oral lichen planus: A systematic review and comprehensive meta-analysis. Oral Oncol 2019; 96:121-130. [PMID: 31422203 DOI: 10.1016/j.oraloncology.2019.07.012] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate current evidence on the malignant transformation of oral lichen planus (OLP), oral lichenoid lesions (OLLs), and oral lichenoid reactions (LRs) and to determine the variables with greatest influence on cancer development. MATERIAL AND METHODS We searched PubMed, Embase, Web of Science, and Scopus for studies published before November 2018. We evaluated the quality of studies (QUIPS tool). We carried out meta-analyses to fulfill our objectives. We examined the between-study heterogeneity and small-study effects, and conducted sensitivity studies and subgroup analyses. RESULTS Inclusion criteria were met by 82 studies (26,742 patients. The combined malignant transformation rate was 1.14% for OLP (95% CI = 0.84-1.49), 1.88% for OLLs (95% CI = 0.15-4.95) and 1.71% for LRs (95% CI = 0.00-5.46). Subgroup analysis revealed a higher malignant transformation rate in studies when the presence of epithelial dysplasia was not an exclusion criterion (p = 0.001), when both clinical and histopathological criteria were used for diagnosis (p < 0.001), when the follow-up was at least 12 months (p = 0.048), and when there was lower risk of potential bias (p = 0.002). Malignant transformation risk factors were: tongue localization (RR = 1.82, 95% CI = 1.21-2.74, p = 0.004), presence of atrophic-erosive lesions (RR = 4.09, 95% CI = 2.40-6.98, p < 0.001), tobacco use (RR = 1.98, 95% CI = 1.28-3.05, p = 0.002), alcohol consumption (RR = 2.28, 95% CI = 1.14-4.56, p = 0.02), and hepatitis C virus infection (RR = 4.46, 95% CI = 0.98-20.22, p = 0.053). CONCLUSIONS The malignant transformation rates of OLP, OLLs and LRs are underestimated due essentially to restrictive diagnostic criteria, inadequate follow-up periods, and/or low quality of studies.
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Affiliation(s)
- Miguel Ángel González-Moles
- School of Dentistry, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria. Granada, Spain.
| | - Isabel Ruiz-Ávila
- Instituto de Investigación Biosanitaria. Granada, Spain; Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Granada, Granada, Spain.
| | - Lucía González-Ruiz
- Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
| | - Ángela Ayén
- School of Medicine, University of Granada, Granada, Spain.
| | - José Antonio Gil-Montoya
- School of Dentistry, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria. Granada, Spain.
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DeAngelis LM, Cirillo N, McCullough MJ. The immunopathogenesis of oral lichen planus-Is there a role for mucosal associated invariant T cells? J Oral Pathol Med 2019; 48:552-559. [PMID: 31172572 DOI: 10.1111/jop.12898] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 12/12/2022]
Abstract
Oral lichen planus (OLP) is a chronic, T-cell-mediated, immune condition of unknown cause. OLP may present with painful symptoms requiring treatment, as well as lesions outside the oral cavity. It is likely that what initiates the OLP disease process is a complex interaction of host susceptibility and environmental triggers. While it is possible that OLP represents a true autoimmune condition against an epithelial autoantigen, the mechanisms that lead to this immune dysregulation are still poorly understood. In this review article, we discuss current concepts relating to the immunopathogenesis of OLP, as well as the potential contributory roles the oral microbiota and mucosal-associated invariant T (MAIT) cells.
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Affiliation(s)
- Lara M DeAngelis
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
| | - Nicola Cirillo
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
| | - Michael J McCullough
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
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13
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Otero Rey EM, Yáñez-Busto A, Rosa Henriques IF, López-López J, Blanco-Carrión A. Lichen planus and diabetes mellitus: Systematic review and meta-analysis. Oral Dis 2018; 25:1253-1264. [PMID: 30203902 DOI: 10.1111/odi.12977] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/25/2018] [Accepted: 09/05/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to perform a systematic review and meta-analysis answering the following questions: (a) "What is the prevalence and risk of oral lichen planus among patients with diabetes mellitus?" and (b) "What is the prevalence and risk of diabetes mellitus among patients with oral lichen planus?". MATERIAL AND METHODS A bibliographic search was conducted in PubMed/Medline and Scopus database from 1966 to March 2018, using the following terms: "Lichen planus" AND "Diabetes mellitus" AND "Prevalence" AND "Oral mucosal lesions". RESULTS Twenty-two studies were included in this review. Twelve studies assessed the prevalence of diabetes mellitus among patients with lichen planus. The prevalence reported ranges from 1.6% to 37.7% with a relative risk of 2.432. Ten studies assessed the prevalence of lichen planus among patients with diabetes mellitus which showed a prevalence of lichen planus ranging from 0.5% to 6.1% with a relative risk of 1.4. CONCLUSIONS Contradictory results were found when analyzing the relationship between lichen planus and diabetes mellitus. Diverse factors should be considered when studying this association for a correct interpretation of results. Diabetes mellitus has high prevalence and morbidity, which is why new case-control studies are needed to further investigate this association.
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Affiliation(s)
- Eva María Otero Rey
- Stomatology Department, School of Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Anabel Yáñez-Busto
- Stomatology Department, School of Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Inés Filipa Rosa Henriques
- Stomatology Department, School of Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José López-López
- Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, Barcelona, Spain.,Dentistry Hospital University of Barcelona (HOUB), University of Barcelona, l'Hospitalet de Llobregat, Barcelona, Spain.,Oral Health and Masticatory System Group (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Andrés Blanco-Carrión
- Stomatology Department, School of Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
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14
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Mostafa B, Zakaria M. Evaluation of Combined Topical Ozone and Steroid Therapy in Management of Oral Lichen Planus. Open Access Maced J Med Sci 2018; 6:879-884. [PMID: 29875865 PMCID: PMC5985865 DOI: 10.3889/oamjms.2018.219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 12/21/2022] Open
Abstract
AIM: The present study aims to assess the therapeutic effect of the combination of topical ozone and steroid therapy in comparison to topical ozone alone versus topical steroid as a control in the management of atrophic - erosive oral lichen planus (OLP). METHODS: Sixty-six patients are having atrophic-erosive OLP were included in the study. They were randomly divided into three equal groups to be treated with topical corticosteroids alone (steroid group) as control, topical ozone alone (ozone group) or combination of topical steroids and ozone (combined group). Assessment of pain and sign scores was done before and after each treatment modality. RESULTS: The results revealed that the greatest significant percentage of change and subsequent improvement in pain and sign scores were recorded in the combined group. CONCLUSION: Reported data in this study using the combination of ozone and steroid therapy could provide a new promising safe and effective adjunct therapy for management of OLP.
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Affiliation(s)
- Basma Mostafa
- Surgery and Oral Medicine Dep., Oral and Dental Research Division, National Research Centre, Cairo, Egypt
| | - Mai Zakaria
- Oral Medicine and Periodontology Dep., Faculty of Dentistry, Cairo University, Cairo, Egypt
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15
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Othman NA, Shaker OG, Elshenawy HM, Abd-Elmoniem W, Eldin AM, Fakhr MY. The effect of diode laser and topical steroid on serum level of TNF-alpha in oral lichen planus patients. J Clin Exp Dent 2016; 8:e566-e570. [PMID: 27957272 PMCID: PMC5149093 DOI: 10.4317/jced.52665] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 05/22/2016] [Indexed: 12/26/2022] Open
Abstract
Background Oral lichen planus (OLP) is a common chronic inflammatory mucosal disease with a multifactorial etiology. It is a T-cell mediated autoimmune disease in which the cytotoxic CD8+T cells trigger apoptosis of the basal cells of oral epithelium. Various treatment regimens have been employed for management of symptomatic OLP. This study was carried out to evaluate the effect of topical steroids as well as laser on the clinical signs and symptoms detected by reticular, atrophic, erosive score (RAE score) and tumor necrosis factor- α (TNF-α) level in the serum of patients with symptomatic OLP. Material and Methods The study was conducted on twenty-four patients (18 females and 6 males) with symptomatic OLP that were allocated into two groups. Each included twelve patients. The first group treated either with diode laser (970nm SIROLaser Advance class IIIb, SIRONA The Dental Company, Germany) twice weekly with maximum of ten sessions while the second group were treated with topical corticosteroids (0.1% triamcinolone acetonide orabase, Kenacort-A Orabase Pomad, DEVA HOLDING A.Ș, Istanbul, Turkey) for four weeks. Results Corticosteroids group showed less clinical signs and symptoms of reticular, atrophic, erosive RAE score (p=0.02) and TNF-α serum level (p=0.028) than diode laser group with no reported therapy side effects or complications in any of the treated patients. Conclusions Topical steroids reduce pain, reticular, atrophic, erosive RAE score and TNF-α serum level more than laser treatment. Moreover, laser treatment can be used as an alternative treatment when steroids are contraindicated for the treatment of symptomatic OLP. Key words:Oral lichen planus, diode laser, topical steroid, RAE score, TNF-α.
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Affiliation(s)
- Nagwa-Abdelhamid Othman
- Prof, Dr. Department of Oral Medicine and Periodontology, Faculty of Oral and Dental Medicine, Cairo University
| | - Olfat-Gamil Shaker
- Prof, Dr. Department of Biochemistry, Faculty of Medicine, Cairo University
| | | | - Wessam Abd-Elmoniem
- Associate, Prof,Dr. Department of Oral Medicine and Periodontology, Faculty of Oral and Dental Medicine, Cairo University
| | - Amany-Mohy Eldin
- PhD. Department of Surgery and Oral Medicine, National Research Center
| | - Mariam-Yehia Fakhr
- PhD. Department of Oral Medicine and Periodontology, Faculty of Oral and Dental Medicine, Cairo University
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