Fibrosis in Oral Lichen Planus: Incidence, Histology and Clinical Implications

Objectives: The aim of the study is to describe the existence of fibrosis in oral lichen planus (OLP), a complication never described before in OLP.

Incidence, histology and clinical significance of the phenomenon is presented.

Methods: The study was designed as a prospective study.

Clinical examination was conducted to record the presence of fibrotic bands in the buccal mucosa, mouth opening, loss of vestibular depth, presence of gingival recessions, lesion subtype, areas of the mucosa affected, and extra-oral manifestations of lichen planus.

Histologic specimen of a patients with OLP and fibrotic bands is presented.

Results: The study population included 73 consecutive patients, 14M and 59 F, age: 28-84 (mean 61).

Submucosal fibrotic bands (SFB) in the buccal mucosa were palpated in 30.13% (22) of study participants, with bilateral presentation in the majority of cases 59%(13).

Restriction in mouth opening was significantly associated with SFB (p=0.02), as opposed to patients without SFB (36%,11% respectively). In half (11) of the SFB patients flattening of the vestibule (reduced vestibular depth) was noted in dentate area as opposed to 6%(3) in the control group (p=0.0001).

Gingival recessions in the areas adjacent to the SFB were recorded in 13.6 %(3) of subjects.

In the histologic specimen from an OLP patient with fibrotic bands, increased width of connective tissue was observed as opposed to patient without fibrosis clinically evident.

Conclusion: Fibrosis is a common clinical presentation in oral lichen planus patients, and feeling of restricted mouth opening and stiffness is a prevalent complaint among patients with fibrotic bands. Fibrosis is associated with gingival recession and loss of vestibular depth, and therefore recognition of SFB should lead to target more intense periodontal care specifically to these areas. Further research is needed in order to investigate the possible association between fibrosis, chronic inflammation and malignant transformation in OLP.