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



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.


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.


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.


Oral lichen planus Oral lichenoid lesions Anxiety Quality of life 



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.


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.


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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

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