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A Retrospective clinicopathological study of 550 patients with oral lichen planus in south-eastern Spain : 

A Retrospective clinicopathological study of 550 patients with oral lichen planus in south-eastern Spain Journal of Oral Pathol Med (2010) 39 : 491-496 A . Bermejo-Fenoll, M.Sanchez-Siles, P. Lopez-Jornet, F.Camacho-Alonso, N.Salazar-Sanchez Journal Club

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What is retrospective study? : 

What is retrospective study?

Correspondence of author for further clarification of study : 

Correspondence of author for further clarification of study Mariano Sanchez-Siles, Clinica Odontologica Universitaria, Medicina Bucal, Hospital Morales Meseguer, Murcia, Avda, Spain Tel : 00 34 968 398588 Fax : 00 34 968 239565 E-mail : marianosasi@yahoo.es

Objective of study : 

Objective of study Describes clinicopathological characteristics of a group of patients with oral lichen planus(OLP) in South-eastern Spain.

Method adopted in study : 

Method adopted in study Retrospective descriptive study made of 550 patients diagnosed both clinically and histopathologically with OLP.

Study carried out : 

Study carried out Department of Oral Medicine of the University of Murcia(Spain). and Private practice setting of one of the authors(ABF) in Elche, Alicante (Spain).

Sample size collected : 

Sample size collected 640 Caucasian Patients clinically diagnosed with OLP. 90 Excluded because of the failure to meet the definite inclusion criteria. 640-90= 550 550

What was involved in exclusion criteria? : 

What was involved in exclusion criteria? Patients with clinicopathological signs of epithelial dysplasia, and drugs and dental restorations implicated in lichenoid reactions.

Period of study : 

Period of study 1991-2007 (16 Years)

Recordings UnderTaken : 

Recordings UnderTaken Patient’s Gender Age Prevalence of Hepatitis C Symptoms Malignization

Classification of clinical forms of lesions : 

Classification of clinical forms of lesions Reticular-Papular. Atrophic-Erosive. Dent.ucla.org;mndental.org

Lichen Planus : 

Lichen Planus Lichen Planus is a chronic inflammatory mucocutaneous disease of uncertain aetiology, although an autoimmune mechanism is known to be involved. Oral Manifestations – Very frequent.

Clinical and histological features of OLP : 

Clinical and histological features of OLP Characteristic. Course of disease : Benign. Potential for Malignant transformation. Other structures affected : Skin, Appendages and mucosal membranes.

Prevalence Rate : 

Prevalence Rate 0.2 to 4% of general population. Initial lesion: Develops at the basal cell layer over a previously susceptible zone. CD4+ and CD8+ lymphocytes no longer recognize the basal cells as being normal and trigger a cytotoxic reaction against them, with the appearance of apoptotic phenomenon.

Prevalence of hepatitis C among patients with OLP : 

Prevalence of hepatitis C among patients with OLP Increased.

Clinical Manifestations : 

Clinical Manifestations Andreasen was the first to classify OLP and postulated the existence of six different clinical forms into:- Reticular Papular Atrophic Erosive

Clinical Manifestations : 

Clinical Manifestations Lichen Planus is multilocular, bilateral disease with certain symmetry of the lesions. The most frequent lesion location is cheek mucosa. Himachaldental.wordpress.com

Histopathologically confirmed diagnosis : 

Histopathologically confirmed diagnosis Clinicopathological criteria of the WHO:-

Histopathology : 

Histopathology

If Lichen Planus patient had OSCC? : 

If Lichen Planus patient had OSCC? For Diagnosis of Oral Squamous Cell Carcinoma in Patients with Lichen Planus, they applied the criteria of Gandolfo et al. A latency time of atleast 6 month between the diagnosis of OLP and the diagnosis of oral carcinoma was considered to exclude concomitant presentations.

Clinical classification : 

Clinical classification Based on the classification of Eisen, the clinical forms of OLP:-

Location of the Lesions : 

Location of the Lesions

Protocols used for the study : 

Protocols used for the study Compiling the clinical history: Same in all patients. Blood Tests (CBC,Biochemistry and hepatitis C Serology), and photographs were obtained of all patients. Incisional Biopsies. Evaluation of histological preparation: same observer.

Results : 

Results

Females criteria : 

Females criteria

Males Criteria : 

Males Criteria

Prevalent systemic disorders included : 

Prevalent systemic disorders included Arterial hypertension : 23.1% Anxiety/depression : 17.6% Rheumatological diseases: 15.8% Gastrointestinal disorders:14.9% Hypercholesterolemia:11.3% Sjogren’s syndrome:6cases(women of 45-69yrs)

Final Results : 

Final Results

Histopathological characteristics : 

Histopathological characteristics

Analysis of results : 

Analysis of results SPSS version 12.0 statistical package (SPSS Inc., Chicago, IL, USA). Qualitative or Quantitative variable

Pearson Chi-Squared Test : 

Pearson Chi-Squared Test Associations between the different qualitative variables were examined Degrees of Freedom : (n-1) Chi-Square critical Value(CV):Standard deviation of sample Cumulative probability :standard deviation of population Χ2 = [ ( n - 1 ) s2 ] / σ2

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www.people.au.edu

Student’s t-Test : 

Student’s t-Test Compare different quantitative variables. Statistical significance was accepted for P<0.05

t-Test : 

t-Test

t-Test : 

t-Test

t-Test : 

t-Test The results of an unpaired t-test performed t= -1.32 sdev= 88.5 degrees of freedom = 16 The probability of this result, assuming the null hypothesis, is 0.20

Discussion : 

Discussion Most authors agree that OLP is more common in women. In turn, the onset of disease appears to be sooner in men than in women. Mean age reported and study showed 50-70yrs. Hepatitis C infection in patients with OLP shows a very heterogenous geographical distribution.

Discussion : 

Discussion Reticular forms are usually asymptomatic, while atrophic-erosive forms generally produce symptoms-particularly pain and itching- depending on extent and aggressive nature of the lesions. Most common location is the cheek mucosa,tongue(dorsal suface) and gums. In single location, it was more common to find erythematous-erosive lesion(44.4%) including desquamative gingivitis, whereas 2-4 affected locations, most frequent lesions are reticular-papular forms.

Conclusion : 

Conclusion Oral lichen planus regarded as “dynamic lesion” in the sense that they change their appearance, form and location with some frequency. Leukoplakia regarded as “adynamic lesion” due to its plaque like lesion. “Vulnerable Epithelium” : stratified squamous epithelium of the mouth of these patients.This epithelium altered by nutritional and oxygenation problems derived from the conflict developing at epithelial-connective tissue junction, loses its protective capacity and causes the mucosa to become more vulnerable to action of different mechanical, physical, chemical and biological factors.

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