Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1086 Oral Cancer Oral Lichen Planus

complications and prognosis

■prognosis good for early-stage lesions; less than 50% for advanced

lesions

■xerostomia requires frequent water sips/rinses, sugarless gum, top-

ical lubricants (e.g., Oral Balance), and sialogogues (pilocarpine,

cevimeline)

■candidiasis requires antifungal medications (systemic or topical)

■necrosis requires analgesics, antibiotics, possible surgery and hyper-

baric oxygen

■dental decay requires restorative dentistry

■extractions require antibiotic coverage and may cause an osteora-

dionecrosis

■optimal oral hygiene is essential; fluoride dentifrices helpful

■dietary consult to maintain weight

■maxillofacial prosthetic consultation to ensure optimal function

■patients on bisphosphonates are at risk for osteonecrosis following

an invasive dental procedure (i.e., extraction)

ORAL LICHEN PLANUS

SOL SILVERMAN Jr, DDS

history & physical

■reticular form: lace-like white changes

■atrophic form: reticular changes with erythema

■erosive form: reticular+atrophic forms+ulcerations

■immunologic (autoimmune) etiology; sudden and spontaneous

onset

■usually no family history

■primarily adult onset

■can be mucocutaneous

■small risk for malignant transformation; not contagious

tests

■clinical recognition

■biopsy

differential diagnosis

■epithelial dysplasia, carcinoma, candidiasis, hypersensitivity, ery-

thema multiforme