Oral Medicine 5th year

Reham Al-harataniReham Al-haratani 300075300075

•AGE: 42 years old

•NATIONALITY: Philipino •GENDER: Female

Wants to treat her carious teeth.

MEDICAL HISTORY:

•Rheumatoid Arthritis – Ankle Swelling.. “Voltaren”.

•Hypothyroidism.

•Episodes of headaches and fainting.

•1996, inflammatory lymphadenitis..admitted for surgery.

Extra-oral Examination:

Dental History:

o Bleeding gum.

o Several extractions.

o some fillings.

o TMJ dislocation.

Family History:

oCardiac arrest.

oHypertension.

A.GENERAL : Insignificant

B. Extra-oral : Insignificant

C. Intra-oral Examination :

Pigmented lesion discovered. Otherwise, normal.

INTRA-ORAL EXAMINATION

So…regarding the buccal mucosa (lesion):

-Location: Irregularly distributed, bilaterally.

-Texture:Smooth..Does not disappear upon rubbing nor stretching.

-Color & Shape: Brown pigmentations + white striations (characteristic Wickham’s striae).

-Size:

Brown pigm. All over.

White striations extend from retromolar area up to the commissures. - Lingual gingiva of lower anterior teeth.

-Painless

- No discomfort upon eating nor swallowing.

lichen planus. (Reticular form) with areas of pigmentation.

lichenoid reaction

Physiologic pigmentation.

ORAL LICHEN PLANUS

Reticular asymptomatic type..

مرض الحزاز الفموي المنبسط

Thyroid Function Test to check the hormonal status:

Results:

Within normal range.

Last follow-up was on Sunday 8 - 4 - 2007

Showing stability without any progression

Treatment Plan…Further follow up every 6 months - 1 year

Background: Autoimmune chronic mucocutaneuos condition.

Age: middle-aged personsGender: female predilection

Etiology: T-cell-mediated autoimmune disease.

Clinically:Types Reticular ASYMPTOMATIC

Erosive (ulcerations) Atrophic (erythema)

Bullous (blisters) SYMPTOMATIC – Pre-malignant

OLP associated with patchy brown melanin deposits

28 % have coincident skin lesions..polygonal papules with white lines on surface

HISTOLOGY: 1. Hyperkeratosis.

2. Acanthosis.

3. Saw-tooth Rete Ridges (shortened).

4. Basal cell degeneration (liquefaction).5. Band-like lymphocitic infiltration.

Management :

Asymptomatic type No pharmalogical intervention

Symptomatic Corticosteroids

Topical orabase

Retinoids

+ biopsy and examination every 4-6 months.

Aim : investigate occurrence of skin and oral LP in patients with CLD..

Info. : when 2003

where KAUH

who Dr. Maha Abdel-salam

Dr. Rabab Feteih

Methods Results

94 with CLD

78 HCV +ve

24 HBV +ve

OLP detected in 5 pts

4 HCV +ve

1 HBV +ve

2. Biopsies obtained Confirmed the clinical diagnosis

3. Liver function tests Insignificantly associated

4. Statistical analysis,

assess reliability of liver

enz. to predict OLP

Not predictive

Methods Results

94 with CLD

78 HCV +ve

24 HBV +ve

OLP detected in 5 pts

4 HCV +ve

1 HBV +ve

2. Biopsies obtained Confirmed the clinical diagnosis

3. Liver function tests Insignificantly associated

4. Statistical analysis,

assess reliability of liver

enz. to predict OLP

Not predictive

Methods Results

94 with CLD

78 HCV +ve

24 HBV +ve

OLP detected in 5 pts

4 HCV +ve

1 HBV +ve

2. Biopsies obtained Confirmed the clinical diagnosis

3. Liver function tests Insignificantly associated

4. Statistical analysis,

assess reliability of liver

enz. to predict OLP

Not predictive

Conclusion: OLP … an extrahepatic manifestation of CLD..

Comparison :

when 1997 where Dammam

Differences:

1. Participants diagnosed 1st with OLP then CLD was studied..

2. Claimed a correlation between liver enzymes and OLP

Main conclusion:

OLP CLD Dentist Physician

HCV and HBV screening results...

References:Abdel-salam M. , Feteih R. “Oral Lichen Planus in Patients With Chronic liver disease”. Egyptian Dental Journal, 49, 953 - 958, April, 2003.

El-rifaei A., Fathalla S. “The Prevalence of Indices of HC and HB infection in Patients With OLP in Eastern Saudi Arabia”. Saudi Society of Family and Community Medicine,1997.

Sugerman P. et al. “Oral Lichen Planus”.2005.www.e-medicine.com

Neville B.W. et al. “Oral and Maxillofacial Pathology”.(2nd edition), chp.16, pg 680-685..2003