Oral lichen planus affecting the gingiva is associated with an increased incidence of aggressive periodontal...

Chronic inflammation in the oral cavity has a negative effect on the course of chronic mucosal lesions.

The present study aimed to compare the volume and proportional presence of aggressive periodontal pathogens in patients with oral lichen planus (OLP) accompanied by desquamative gingivitis (DG) vs. those with OLP without gingival involvement. All patients in the cohort were also diagnosed with moderate chronic periodontitis. The observed differences may help explain the higher risk associated with gingival involvement in OLP.

The presence of periodontal pathogens was evaluated in 50 biopsy-confirmed OLP with DG cases and 50 OLP cases without gingival manifestations. All participants presented with chronic periodontitis of comparable severity (moderate: periodontal pocket depth (PPD) up to 6 mm). Aggressive periodontal pathogens were identified and quantified using DNA testing (VariOr®-Dento). The periodontal status was assessed using orthopantomography (OPG) or cone-beam computed tomography (CBCT), in combination with the clinical examination of periodontal pockets.

In comparison with the non-gingival OLP cases, the OLP cases with gingival involvement exhibited a significantly higher proportional presence of aggressive periodontal pathogens (p = 0.0009) and a higher bacterial load (n/μL; p = 0.001). Desquamative gingivitis associated with OLP was also linked to an increased risk of subsequent periodontal resorption. Given the unstable chronic inflammatory environment, careful monitoring of periodontal tissues in OLP cases appears to be essential, as persistent inflammation may contribute to an elevated risk of malignant transformation.

Our findings demonstrate a significant difference in the presence of aggressive periodontal pathogens between OLP cases with and without gingival involvement. The median pathogen volume in the OLP with DG cases was over 7.4 times higher. Chronic inflammation and bacterial by-products may act as cofactors in the development of dysplasia and the malignant transformation of oral lichen with dysplasia (OLD), which may present clinically as DG.