I suffered from erosive oral lichen planus (OLP) for about 7 years prior to my oral cancer diagnosis. I was told there is no cure for OLP - about all they can do is give you numbing mouthwash.

In my case, the initial spot was noticed by my dentist - I couldn't feel it. He sent me to an oral surgeron who performed a biopsy, and diagnosed it as OLP. Over time, the OLP became erosive and developed into open sores that would remain for weeks or even months at a time on the underside of my tongue.

For anyone not familiar, oral lichen planus is a chronic inflammatory disease that causes bilateral white striations, papules, or plaques on the buccal mucosa, tongue, and gingivae. Erythema, erosions, and blisters may or may not be present (they were present in my case).

Although there is some controversy on this, many doctors belive that OLP makes a person several times more likely to get oral cancer. My doctor believed this, and and a result he had me get a biopsy every year. Every year, the biopsy diagnosis was OLP - no cancer present. Last year however, the biopsy was done and the diagnosis was cancer. The tumor was on the underside of my right lateral tongue area - the same location I'd been suffering from the OLP.

My medical oncologist is quite interested in my case and in studying a link between OLP and oral cancer. I'd be interested in hearing from any of you who have experienced OLP and oral cancer, especially any of you who believe there may have been a link between the two.

thanks....

Hi Steve -
There are a handful of people in here with the same diagnosis, my husband being one of them. His ENT says he has BOTH lichen planus AND leukoplakia, but that the cancers he has had probably erupted from the lichen planus. If you research (Google) these, they say the leukoplakia is more likely to become cancerous than the lichen planus, but not in these cases. As you can see by my "signature", he has had 4 oral cancers, all small enough to be surgically removed without further treatment. He is CONSTANTLY monitored by 2 different ENTs, dentist, oral surgeon, and an oncologist. Being he never smoked,or "chewed", and drinks very little, we of course are puzzled as to the reason behind these eruptions. His latest biopsy a few weeks ago was negative, thank goodness. He has had the lichen planus for decades, by the way. Anyway, the lesions SEEM to have been occuring near crowns or fillings. He has lost 3 teeth with surgeries so far, 2 of them gold crowned teeth. Now he is having the remaining "metal/gold" crowns replaced with porcelain, "just to see" if it makes a difference. It is only SPECULATION, of course, to "blame" the alloys in gold dental work for his L.P. turning cancerous, but time will tell if this stops. Of course, the fact that this happens also indicates a POSSIBLE genetic connection - "gene therapy" is very new and just in its infant stages of discovery, but it could be that he is missing the "tumor suppressing gene" (P53? or LOH - loss of heterozygosity?)which makes his lesions turn cancerous following irritation? Answers are in the future...not too far, I hope. Anyway, that is our story re: oral lichen planus. Feel free to ask us questions. Warmly, JaneP

Just a couple of points. In order to not add bias into all this, you need to list ANY other risk factors that you have besides this one which is not considered a proven risk factor by the American Academy of Oral Pathology.

If there is any meat in the "metal in the mouth" controversy it is NOT about restorations that are gold based. Gold is used as a control in animal implant studies since we know that it is benign in the body. It is the silver filings which contain various base metals, and most notably mercury. The issue with these has been debated for years, and it always comes down to volume of exposure. But even if mercury or other base metal contributes to ill health, is it likekly systemic and not local.

In some areas of the mouth all porcelain crowns versus porcelain fused to precious metal substructures are an inferior restoration as the do not have the inherent strength of something with a metal understructure. That metal understructure is predominantly gold with platinum and palladium and a small amount of rare earths added to it which form the oxides on the surface that the silicone oxides in dental ceramics bond to. The other precious metals raise the melting point of the alloy to one which will withstand the firing temperatures of the overlaying porcelain with out distorting during the process.

LP is a mystery in many respects. They do not know why people get it, and they have no way of treating it except for the symptomology and discomfort.

Thanks Brian, for the clarifications. My husband had an extensive dematologist-provided "patch test" on his back several months ago, and he had a "reaction" to a few of the test patch placements, one of them being mercury. I know that gold is an inert substance, but when used for dental processes, aren't alloys added to strengthen the normally very soft gold? We also realize the porcelain will not provide the strong chewing surface that gold would, but we are just trying to "connect the dots" so to speak. Thanks again for your input.
Warmly, JaneP

In my case I do not have any dental work which would be suspect for the lichen planus. I should also have specified that I have never smoked, never chewed tobacco, and I drink very little alcohol. There's nothing in my history that I can point to as being suspect for causing the OLP.

In an odd twist, my wife believes that perhaps the continued biopsies may have actually contributed to the ongoing nature of my problem. When this all started it was a small, white, painless spot under my tongue. Of course the first biopsy left a sore, which I had a hard time getting rid of. The next outbreak was more erosive and becoming painful. The surgeon attempted to remove the affected tissues through the biopsy. So, then I had a bigger 'sore'. It would flare up and die down a bit from month to month, but over time the flare-ups did gradually worsen, and I seemed to have more and more difficulty in recovering from each biopsy.

I don't think there's any way to know if the OLP would have progressed and become erosive without the tissue 'trauma' from that first biopsy, and then the consecutives ones. I'm not even sure my hindsight is 20/20 in this case - I still think it was better to err on the safe side of having it checked, even if all that tissue cutting from the biopsies may have actually worsened the condition to some degree.

It may be worthwhile to note as well, that at the time of my last biopsy, the oral surgeon all but told me I was being paranoid. He said, "we keep checking this you know, and it's always lichen planus - there's just nothing we can do about lichen planus". I reminded him that it was HE who suggested I continue to have it checked each year. It seemed an odd reversal of the way he had always treated it before. He went ahead with the biopsy (hinting strongly that he was only doing so to pacify me) and sure enough.....this time it was cancer.

Suffice it to say I no longer see him for my oral surgery needs....

First, any dental gold that is under porcelain is essentially removed from soluble contact with the body, the porcelain being impermeable - the couple of other elements in it in small quantities are pretty benign which I listed in my post, and they are added for temperature/melting point issues as well as strength.

Anyone not sensitive to a heavy metal like mercury is probably from another planet, but remember it is about volume of exposure, and how much mercury could leach out over how long a period of time from a small filling? This question has been looked at by the ADA and others, and the material is still being used today after those inquiries.

Also remember that when you think of alloys, that the individual elements are no longer available as their original element, but are now part of a compound, or molecularly bound in a new structure that makes them in most cases unavailable.

It

From the resident dentist....

The switch to capsules containing the alloy of metals and mercury many years ago, has practically eliminated the problem of mercury retention in the office. I'm sure that in the old days, handling of the mercury and alloy mixtures by dentists and assistants, caused some problems. Today, we do very few amalgams, not necessarily due to patient concerns about the mercury, but because people want invisible, white fillings.

As far as all ceramic crowns are concerned, when possible, we are now fabricating all porcelain crowns through CAD-CAM technology, right in the office. They promise to be as strong and as long lasting as pocelain fused to metal crowns. I am now in my third year of doing this and have a great deal of success with them.

Getting back to the topic at hand, amalgam fillings have been blamed for all sorts of medical problems for as long as I have been in practice and many years before. As far as I know, there has never been a study to show any link between amalgams and any diseases.

Jerry

Thanks, Jerry, for the encouraging news about porcelain crowns. I will have to have Dick ask his dentist about the construction of his new crowns. No wonder you are the "man of my dreams"....lol. Thanks again. JaneP.

I have 2 of those new fangled CAD-CAM ceramic crowns as well. It's about a 2 hour process from impressions, reduction, scanning, software tweaking, manufacturing, crown tweaking and bonding. Out here in the west they are about 1 grand each (my insurance pays for half).

My mom also suffered from the same symptoms as you luekeplakia or whatever they refered to it as for 10 years prior to her cancer diagnosis. She had some surgeries laser etc...they gave her a medication acutane which is a medication used to control acne and nothing ever cured her tongue sores. So bascially when my mom was diagnosed she passed out in the doctors office when they said it was cancer. Most times it was just pre-cancerous and something to watch. She did have a really bad tooth and crown right in the same area and that tooth has since been extracted. She has been cancer free for almost 4 years!!!