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      Liquen plano oral: recomendaciones para su diagnóstico y tratamiento Translated title: Oral lichen planus: recommendations for diagnosis and treatment

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          Abstract

          RESUMEN El liquen plano corresponde a una enfermedad crónica de naturaleza inmuno-inflamatoria que puede presentarse en piel y mucosas, siendo la mucosa oral de las zonas más frecuentemente afectadas, incluso como primera única manifestación de la enfermedad. Su etiología no se encuentra totalmente dilucidada, sin embargo, se atribuyen mecanismos autoinmunes como principal causa de la enfermedad. El liquen plano oral (LPO) presenta un amplio espectro de manifestaciones clínicas, pudiendo presentarse como lesiones rojas, blancas o combinaciones de ambas. Sus diversas formas de presentación en la mucosa oral, en conjunto con una histopatología a veces poco específica, determinan que en varios casos su diagnóstico sea complejo para clínicos no familiarizados con la enfermedad. El tratamiento del LPO se enfoca en reducir los síntomas asociados a las lesiones, siendo los corticoides tópicos los fármacos de primera línea. En caso de que el tratamiento con corticoides tópicos no logre controlar la sintomatología, el tratamiento de segunda línea incluye inhibidores de calcineurina o corticoides sistémicos, los que deben ser utilizados con precaución debido a los efectos adversos asociados a estas drogas. La OMS clasifica al LPO como un desorden potencialmente maligno con una tasa de malignización anual estimada en 1.5%-5%, lo que realza la importancia de un correcto diagnóstico y control rutinario, aún en aquellas formas clínicas asintomáticas. Esto último con el fin de poder detectar de manera oportuna cambios clínicos que sugieran su progresión hacia un carcinoma oral de células escamosas.

          Translated abstract

          ABSTRACT Lichen planus is a chronic immunological disorder affecting skin and mucous membranes, being the oral cavity one of the more affected areas even as a first or only manifestation of the disease. Its etiology is unclear, but it has been associated with the activation of autoimmune mechanisms. Oral lichen planus (OLP) has a wide spectrum of clinical manifestations including a variety of white lesions, red lesions or a combination of both. In addition, its histopathological features are not always specific. Because of the above, the diagnosis of OLP can be challenging, especially for clinicians who are not entirely familiarized with the disease. OLP treatment is aimed in reducing pain and discomfort, usually with topical steroids. If treatment with topical steroids is unsuccessful, second line treatments include calcineurin inhibitors and systemic steroids. Care has to be taken when using these drugs as they can have considerable adverse side effects. OLP is classified by the WHO as a potentially malignant disorder with a malignant transformation rate estimated between 1.5% and 5%. Thus, its correct diagnosis and proper follow-up are essential even in asymptomatic forms of the disease. This to detect early clinical changes indicative of malignant transformation to an oral squamous cell carcinoma (OSCC).

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          Most cited references39

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          Diagnosis of oral lichen planus: a position paper of the American Academy of Oral and Maxillofacial Pathology.

          Despite being one of the most common oral mucosal diseases and recognized as early as 1866, oral lichen planus (OLP) is still a disease without a clear etiology or pathogenesis, and with uncertain premalignant potential. More research is urgently needed; however, the research material must be based on an accurate diagnosis. Accurate identification of OLP is often challenging, mandating inclusion of clinico-pathological correlation in the diagnostic process. This article summarizes current knowledge regarding OLP, discusses the challenges of making an accurate diagnosis, and proposes a new set of diagnostic criteria upon which to base future research studies. A checklist is also recommended for clinicians to provide specific information to pathologists when submitting biopsy material. The diagnostic process of OLP requires continued clinical follow-up after initial biopsy, because OLP mimics can manifest, necessitating an additional biopsy for direct immunofluorescence study and/or histopathological evaluation in order to reach a final diagnosis.
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            Improving the oral health of older people: the approach of the WHO Global Oral Health Programme.

            The proportion of older people continues to grow worldwide, especially in developing countries. Non-communicable diseases are fast becoming the leading causes of disability and mortality, and in coming decades health and social policy-makers will face tremendous challenges posed by the rapidly changing burden of chronic diseases in old age. Chronic disease and most oral diseases share common risk factors. Globally, poor oral health amongst older people has been particularly evident in high levels of tooth loss, dental caries experience, and the prevalence rates of periodontal disease, xerostomia and oral precancer/cancer. The negative impact of poor oral conditions on the quality of life of older adults is an important public health issue, which must be addressed by policy-makers. The means for strengthening oral health programme implementation are available; the major challenge is therefore to translate knowledge into action programmes for the oral health of older people. The World Health Organization recommends that countries adopt certain strategies for improving the oral health of the elderly. National health authorities should develop policies and measurable goals and targets for oral health. National public health programmes should incorporate oral health promotion and disease prevention based on the common risk factors approach. Control of oral disease and illness in older adults should be strengthened through organization of affordable oral health services, which meet their needs. The needs for care are highest among disadvantaged, vulnerable groups in both developed and developing countries. In developing countries the challenges to provision of primary oral health care are particularly high because of a shortage of dental manpower. In developed countries reorientation of oral health services towards prevention should consider oral care needs of older people. Education and continuous training must ensure that oral health care providers have skills in and a profound understanding of the biomedical and psychosocial aspects of care for older people. Research for better oral health should not just focus on the biomedical and clinical aspects of oral health care; public health research needs to be strengthened particularly in developing countries. Operational research and efforts to translate science into practice are to be encouraged. WHO supports national capacity building in the oral health of older people through intercountry and interregional exchange of experiences.
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              Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications.

              Confirmation of a clinical diagnosis of oral lichen planus (OLP) by means of histopathologic study of a biopsy specimen is generally advised. However, hardly any data exist about the correlation between clinical and histopathologic diagnoses of OLP. The aim of the present investigation was to study the correlation between the clinical and histopathologic assessment of OLP, and to propose diagnostic refinements, if appropriate. Clinical and histopathologic data of two previously published studies were used for this purpose. The number of clinical cases in which all clinicians agreed as well as the number of microscopic slides on which all reviewing pathologists agreed were calculated and compared with each other in order to assess the clinicopathologic correlation. In 42% of the cases in which all clinicians agreed about the clinical diagnosis being diagnostic of OLP, there appeared to be no consensus on the histopathologic diagnosis. Conversely, in 50% of the cases in which all pathologists agreed about the histopathologic diagnosis being diagnostic of OLP there was a lack of consensus on the clinical diagnosis. Based on the findings of the present study, there appears to be a lack of clinicopathologic correlation in the diagnostic assessment of OLP. We therefore propose a set of revised diagnostic criteria of OLP and oral lichenoid lesions, based on the WHO definition of OLP, including clinical as well as histopathologic aspects.
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                Author and article information

                Journal
                odonto
                Avances en Odontoestomatología
                Av Odontoestomatol
                Ediciones Avances, S.L. (Madrid, Madrid, Spain )
                0213-1285
                2340-3152
                March 2022
                : 38
                : 1
                : 30-39
                Affiliations
                [1] Viña del Mar orgnameUniversidad Andrés Bello orgdiv1Facultad de Odontología orgdiv2Departamento de Cirugía y Patología Oral Chile
                Article
                S0213-12852022000100006 S0213-1285(22)03800100006
                ece7a478-682d-4e69-b7b4-46ab02bd9077

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 24 September 2020
                : 03 November 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 39, Pages: 10
                Product

                SciELO Spain

                Categories
                Artículos

                Liquen plano oral,oral cancer,oral lichenoid lesion,oral potentially malignant disorder,Oral lichen planus,cáncer oral,lesión liquenoide oral,desórdenes potencialmente malignos

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