Advertisement

Severity of oral lichen planus and oral lichenoid lesions is associated with anxiety

  • Miriane Lucindo Zucoloto
  • Matheus Eiji Warikoda Shibakura
  • Jefferson Veronezi Pavanin
  • Fernanda Teixeira Garcia
  • Paulo Sérgio da Silva Santos
  • Aloizio Premoli Maciel
  • Camila de Barros Gallo
  • Nathalia Vilela Souza
  • Lara Maria Alencar Ramos Innocentini
  • Janaina Silva Martins Humberto
  • Ana Carolina Fragoso MottaEmail author
Original Article
  • 38 Downloads

Abstract

Objectives

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are chronic inflammatory diseases whose symptoms can impair patient’s quality of life (QoL). Psychological factors seem to play an important role in these diseases. This study aimed to determine the impact of oral health and anxiety levels on the QoL of patients with OLP and OLL.

Patients and methods

This was a cross-sectional study composed of OLP and OLL patients and a control group matched by age and sex with no autoimmune/inflammatory or malignant oral lesions. Anxiety levels and oral health impact on QoL were assessed using the Hamilton Anxiety Scale (HAM-A) and the Oral Health Impact Profile-14 (OHIP-14), respectively. The instruments were filled through personal interview before starting the treatment for oral lesions.

Results

A total of 87 patients diagnosed with OLP (n = 45) and OLL (n = 42), and 87 controls were included in the study. Statistical differences were observed for the psychic and somatic anxiety dimensions between severities of diseases. Patients with OLP or OLL had higher scores for the OHIP-14 dimensions physiological discomfort and social limitation compared with controls. In addition, higher scores for physical pain, physical disability, social disability, and handicap were detected among patients with greater severity.

Conclusion

Greater severity of OLP and OLL seems to be associated with increased levels of anxiety, higher scores of oral health impact profile, and decreased QoL.

Clinical relevance

Patients with severe OLP/OLL may benefit from additional therapeutic treatments, such as psychological and/or psychiatric management, concomitant to treatment specific to oral lesions.

Keywords

Oral lichen planus Oral lichenoid lesions Anxiety Quality of life 

Notes

Acknowledgments

The authors thank all of the investigators involved in this study, in particular Dr. Laura Cavalcanti de Oliveira, Dr. Laura de Almeida Costa, Dr. Leandro Dorigan de Macedo, and Dr. Marlívia Gonçalves de Carvalho Watanabe for assisting with patients’ examinations and Prof. Maria José Alves da Rocha for contributing with the study design. We are grateful to all patients who volunteered to participate in the study.

Author contributions

M.L.Z., M.E.W.S., and J.V.P. contributed to the study design, sample analyses, and interpretation of data and drafted the manuscript; F.T.G., P.S.S.S., A.P.M., C.B.G., N.V.S., and L.M.A.R.I. contributed to the clinical data and drafted the manuscript; J.S.M.H. and A.C.F.M. contributed to the study design and data analyses and drafted the manuscript; and all authors contributed to analysis and interpretation of data and critical review of the manuscript.

Funding

The work was supported by the São Paulo Research Foundation–FAPESP (Grant Nos.: 2014/11883-3 and 2014/14576-4). Matheus Shibakura was supported by an undergraduate scholarship from the Institutional Scientific Initiation Scholarship Program (Grant No.: 498/2018) and the Unified Scholarship Program from the University of São Paulo (Grant No.: 647/2018).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (CAAE No.: 33703114.8.0000.5419).

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Eisen D (2002) The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients. J Am Acad Dermatol 46(2):207–214CrossRefGoogle Scholar
  2. 2.
    Au J, Patel D, Campbell JH (2013) Oral lichen planus. Oral Maxillofac Surg Clin North Am 25(1):93–100, vii.  https://doi.org/10.1016/j.coms.2012.11.007 CrossRefGoogle Scholar
  3. 3.
    Artico G, Freitas RS, Santos Filho AM, Benard G, Romiti R, Migliari DA (2014) Prevalence of Candida spp., xerostomia, and hyposalivation in oral lichen planus--a controlled study. Oral Dis 20(3):e36–e41.  https://doi.org/10.1111/odi.12120 CrossRefGoogle Scholar
  4. 4.
    Kramer IR, Lucas RB, Pindborg JJ, Sobin LH (1978) Definition of leukoplakia and related lesions: an aid to studies on oral precancer. Oral Surg Oral Med Oral Pathol 46(4):518–539CrossRefGoogle Scholar
  5. 5.
    Al-Hashimi I, Schifter M, Lockhart PB, Wray D, Brennan M, Migliorati CA, Axell T, Bruce AJ, Carpenter W, Eisenberg E, Epstein JB, Holmstrup P, Jontell M, Lozada-Nur F, Nair R, Silverman B, Thongprasom K, Thornhill M, Warnakulasuriya S, van der Waal I (2007) Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103(Suppl):S25 e21–S25 e12.  https://doi.org/10.1016/j.tripleo.2006.11.001 Google Scholar
  6. 6.
    van der Meij EH, van der Waal I (2003) Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications. J Oral Pathol Med 32(9):507–512CrossRefGoogle Scholar
  7. 7.
    Rad M, Hashemipoor MA, Mojtahedi A, Zarei MR, Chamani G, Kakoei S, Izadi N (2009) Correlation between clinical and histopathologic diagnoses of oral lichen planus based on modified WHO diagnostic criteria. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107(6):796–800.  https://doi.org/10.1016/j.tripleo.2009.02.020 CrossRefGoogle Scholar
  8. 8.
    Yamanaka Y, Yamashita M, Innocentini LMA, Macedo LD, Chahud F, Ribeiro-Silva A, Roselino AM, Rocha MJA, Motta AC (2018) Direct immunofluorescence as a helpful tool for the differential diagnosis of Oral lichen planus and oral lichenoid lesions. Am J Dermatopathol 40(7):491–497.  https://doi.org/10.1097/DAD.0000000000001071 CrossRefGoogle Scholar
  9. 9.
    Lodi G, Porter SR (1997) Hepatitis C virus infection and lichen planus: a short review. Oral Dis 3(2):77–81CrossRefGoogle Scholar
  10. 10.
    Walsh LJ, Savage NW, Ishii T, Seymour GJ (1990) Immunopathogenesis of oral lichen planus. J Oral Pathol Med 19(9):389–396CrossRefGoogle Scholar
  11. 11.
    Payeras MR, Cherubini K, Figueiredo MA, Salum FG (2013) Oral lichen planus: focus on etiopathogenesis. Arch Oral Biol 58(9):1057–1069.  https://doi.org/10.1016/j.archoralbio.2013.04.004 CrossRefGoogle Scholar
  12. 12.
    Scully C, Beyli M, Ferreiro MC, Ficarra G, Gill Y, Griffiths M, Holmstrup P, Mutlu S, Porter S, Wray D (1998) Update on oral lichen planus: etiopathogenesis and management. Crit Rev Oral Biol Med 9(1):86–122CrossRefGoogle Scholar
  13. 13.
    Van Dis ML, Parks ET (1995) Prevalence of oral lichen planus in patients with diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 79(6):696–700CrossRefGoogle Scholar
  14. 14.
    McCartan BE (1995) Psychological factors associated with oral lichen planus. J Oral Pathol Med 24(6):273–275CrossRefGoogle Scholar
  15. 15.
    Rojo-Moreno JL, Bagan JV, Rojo-Moreno J, Donat JS, Milian MA, Jimenez Y (1998) Psychologic factors and oral lichen planus. A psychometric evaluation of 100 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86(6):687–691CrossRefGoogle Scholar
  16. 16.
    Soto Araya M, Rojas Alcayaga G, Esguep A (2004) Association between psychological disorders and the presence of Oral lichen planus, burning mouth syndrome and recurrent aphthous stomatitis. Med Oral 9(1):1–7CrossRefGoogle Scholar
  17. 17.
    Chaudhary S (2004) Psychosocial stressors in oral lichen planus. Aust Dent J 49(4):192–195CrossRefGoogle Scholar
  18. 18.
    Alves MG, do Carmo Carvalho BF, Balducci I, Cabral LA, Nicodemo D, Almeida JD (2015) Emotional assessment of patients with oral lichen planus. Int J Dermatol 54(1):29–32.  https://doi.org/10.1111/ijd.12052 CrossRefGoogle Scholar
  19. 19.
    Vallejo MJ, Huerta G, Cerero R, Seoane JM (2001) Anxiety and depression as risk factors for oral lichen planus. Dermatology 203(4):303–307.  https://doi.org/10.1159/000051777 CrossRefGoogle Scholar
  20. 20.
    Marshall GD Jr, Agarwal SK, Lloyd C, Cohen L, Henninger EM, Morris GJ (1998) Cytokine dysregulation associated with exam stress in healthy medical students. Brain Behav Immun 12(4):297–307.  https://doi.org/10.1006/brbi.1998.0537 CrossRefGoogle Scholar
  21. 21.
    Fleck MP, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, Pinzon V (1999) Application of the Portuguese version of the instrument for the assessment of quality of life of the World Health Organization (WHOQOL-100). Rev Saude Publica 33(2):198–205CrossRefGoogle Scholar
  22. 22.
    Ni Riordain R, Meaney S, McCreary C (2011) Impact of chronic oral mucosal disease on daily life: preliminary observations from a qualitative study. Oral Dis 17(3):265–269.  https://doi.org/10.1111/j.1601-0825.2010.01734.x CrossRefGoogle Scholar
  23. 23.
    Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32(1):50–55CrossRefGoogle Scholar
  24. 24.
    Kummer A, Cardoso F, Teixeira AL (2010) Generalized anxiety disorder and the Hamilton anxiety rating scale in Parkinson’s disease. Arq Neuropsiquiatr 68(4):495–501CrossRefGoogle Scholar
  25. 25.
    Slade GD (1997) Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 25(4):284–290CrossRefGoogle Scholar
  26. 26.
    Almeida AALC, Araújo VE (2004) Um estudo transcultural de valores de saúde bucal utilizando o instrumento OHIP-14 (Oral Health Impact Profile) na Forma Simplificada. Parte I: Adaptação cultural e lingüística. UFES Revista de Odontologia 6:6–15Google Scholar
  27. 27.
    Oliveira BH, Nadanovsky P (2005) Psychometric properties of the Brazilian version of the oral health impact profile-short form. Community Dent Oral Epidemiol 33(4):307–314.  https://doi.org/10.1111/j.1600-0528.2005.00225.x CrossRefGoogle Scholar
  28. 28.
    Harman KE, Seed PT, Gratian MJ, Bhogal BS, Challacombe SJ, Black MM (2001) The severity of cutaneous and oral pemphigus is related to desmoglein 1 and 3 antibody levels. Br J Dermatol 144(4):775–780CrossRefGoogle Scholar
  29. 29.
    Wiriyakijja P, Fedele S, Porter SR, Mercadante V, Ni Riordain R (2018) Patient-reported outcome measures in oral lichen planus: a comprehensive review of the literature with focus on psychometric properties and interpretability. J Oral Pathol Med 47(3):228–239.  https://doi.org/10.1111/jop.12604 CrossRefGoogle Scholar
  30. 30.
    Ivanovski K, Nakova M, Warburton G, Pesevska S, Filipovska A, Nares S, Nunn ME, Angelova D, Angelov N (2005) Psychological profile in oral lichen planus. J Clin Periodontol 32(10):1034–1040.  https://doi.org/10.1111/j.1600-051X.2005.00829.x CrossRefGoogle Scholar
  31. 31.
    Adamo D, Cascone M, Celentano A, Ruoppo E, Leuci S, Aria M, Mignogna MD (2017) Psychological profiles in patients with symptomatic reticular forms of oral lichen planus: a prospective cohort study. J Oral Pathol Med 46(9):810–816.  https://doi.org/10.1111/jop.12577 CrossRefGoogle Scholar
  32. 32.
    Radwan-Oczko M, Zwyrtek E, Owczarek JE, Szczesniak D (2018) Psychopathological profile and quality of life of patients with oral lichen planus. J Appl Oral Sci 26:e20170146.  https://doi.org/10.1590/1678-7757-2017-0146 CrossRefGoogle Scholar
  33. 33.
    Lopez-Jornet P, Camacho-Alonso F (2010) Quality of life in patients with oral lichen planus. J Eval Clin Pract 16(1):111–113.  https://doi.org/10.1111/j.1365-2753.2009.01124.x CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Miriane Lucindo Zucoloto
    • 1
  • Matheus Eiji Warikoda Shibakura
    • 2
  • Jefferson Veronezi Pavanin
    • 2
  • Fernanda Teixeira Garcia
    • 2
  • Paulo Sérgio da Silva Santos
    • 3
  • Aloizio Premoli Maciel
    • 3
  • Camila de Barros Gallo
    • 4
  • Nathalia Vilela Souza
    • 4
  • Lara Maria Alencar Ramos Innocentini
    • 2
    • 5
  • Janaina Silva Martins Humberto
    • 2
  • Ana Carolina Fragoso Motta
    • 2
    Email author
  1. 1.Department of Social Medicine, Ribeirão Preto School of MedicineUniversity of São PauloRibeirão PretoBrazil
  2. 2.Department of Stomatology, Public Oral Health and Forensic Dentistry, Division of Oral Diagnosis, School of Dentistry of Ribeirão PretoUniversity of São PauloRibeirão PretoBrazil
  3. 3.Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of DentistryUniversity of São PauloBauruBrazil
  4. 4.Department of Stomatology, School of DentistryUniversity of São PauloSão PauloBrazil
  5. 5.Division of Dentistry and Stomatology, Ribeirão Preto Clinical Hospital, Ribeirão Preto School of MedicineUniversity of São PauloRibeirão PretoBrazil

Personalised recommendations