Salivary biomarkers to evaluate psychological disorders in oral lichen planus: A systematic review with meta-analysis.

OBJECTIVE: To analyze the use of salivary biomarkers to identify psychological disorders (anxiety, depression, and stress) in individuals with oral lichen planus (OLP). MATERIALS AND METHODS: The search was made in Medline/Pubmed, Scopus, Web of Science, Virtual Health Library, ProQuest, and by cross-reference. Original case-control, cross-sectional, and cohort studies, in human subjects (age ≥18 years) with clinical and histopathological diagnosis, with or without the use of psychometric scales, published until June 2021, were included. Random-effects meta-analyses, subgroup analyses, and sensitivity were performed. Publication bias was measured using the Egger test and visual inspection of the funnel plot. RESULTS: A total of 67 articles were found, of which 12 were included in the meta-analysis. Among the different biomarkers identified, it was only possible to perform a meta-analysis for cortisol. The mean difference between salivary cortisol levels in patients with OLP compared to controls was 3.43 ng/ml (95% CI: 1.20-5.65) with I2  = 98.9%. Studies considered outliers were removed and based on sensitivity analyses, results did not change, therefore, being stable. CONCLUSION: The studies analyzed demonstrated that cortisol was the most quantified biomarker to identify psychological disorders; however, DHEA, IgA, adiponectin, and α-amylase were also evaluated.

Presencia de lesiones orales en pacientes con afecciones psicológicas, atendidos en una institución de salud / Presence of oral lesions in a group of patients with psychological disorders attending a health institution

Introducción: El liquen plano oral, la estomatitis aftosa recurrente y el síndrome boca urente constituyen entidades patológicas bucales que presentan relación con afecciones psicológicas. Objetivo: Describir la presencia de liquen plano oral, estomatitis aftosa recurrente y síndrome de boca urente en pacientes con afecciones psicológicas atendidos en una institución de salud. Métodos: Se realizó un estudio descriptivo de corte transversal, obteniéndose una población de 35 pacientes seleccionados mediante un muestreo no probabilístico por criterio de 26 pacientes aquellos que fueron remitidos del área de psicología (bajo un test de diagnóstico psicológico) al servicio de estomatología, con lesiones orales antes descritas. Bajo la firma de un consentimiento informado fueron tratadas y evolucionadas en un periodo de 16 meses. Se tuvieron en cuenta las consideraciones éticas basadas en la resolución 008430 de 1993, tratado de Helsinki. Resultados: En cuanto a la frecuencia, la lesión bucal que más se presentó fue la estomatitis aftosa recurrente en un 65,3 por ciento, las aftas mayores en un 38,4 por ciento, seguido de un tipo aftas menores en un 26,9 por ciento, entre otras lesiones en menor frecuencia. Los diagnósticos psicológicos evidenciados fueron estrés, depresión y ansiedad, en diferentes proporciones, mostrándose como lesión más frecuente dentro de estas entidades psicológicas, la estomatitis aftosa recurrente. No existió asociación estadística entre las variables orales y las psicológicas por mostrar valores de p >0,005. Conclusiones: Existió la presencia de liquen plano oral, la estomatitis aftosa recurrente y el síndrome boca urente en alteraciones psicológicas como estrés, ansiedad y depresión, con mayor frecuencia la estomatitis aftosa recurrente(AU)

Introduction: Oral lichen planus, recurrent aphthous stomatitis and burning mouth syndrome are oral conditions related to psychological disorders. Objective: Describe the presence of oral lichen planus, recurrent aphthous stomatitis and burning mouth syndrome in patients with psychological disorders attending a health institution. Methods: A descriptive cross-sectional study was conducted of a population of 35 patients, of whom 26 were selected by criterion nonprobability sampling and referred from the psychology service (based on a psychological diagnosis test) to the dental care service due to the presence of the aforementioned oral lesions. Upon granting their informed consent, the patients were treated and followed up for 16 months. Ethical provisions from Resolution 008430 of 1993, the Helsinki Declaration, were complied with. Results: In terms of frequency, the most common oral lesion was recurrent aphthous stomatitis with 65.3 percent. Major aphthas represented 38.4 percent. and aphthas of a minor type 26.9 percent.; other lesions had a lower frequency. The psychological diagnoses achieved were stress, depression and anxiety to various degrees, and the most common lesion for these psychological disorders was recurrent aphthous stomatitis. No statistical association was found between oral and psychological variables, for they showed values of p >0.005. Conclusions: The presence of oral lichen planus, recurrent aphthous stomatitis and burning mouth syndrome was determined in psychological disorders such as stress, anxiety and depression. Of these oral lesions, recurrent aphthous stomatitis was the most common(AU)

Severity of oral lichen planus and oral lichenoid lesions is associated with anxiety.

OBJECTIVES: 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. RESULTS: 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. CONCLUSION: 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.

Psychological disorders and oral lichen planus: A systematic review.

The aim of the present study was to identify and analyze scientific evidence available in the literature to answer the following question: Are psychological disorders associated with the development of oral lichen planus (OLP)? Using scientific databases (PubMed, LILACS, and Science Direct), a literature search was conducted between December 2016 and January 2017, using previously selected keywords. Two independent reviewers critically assessed the results in three stages, strictly obeying the inclusion and exclusion criteria defined in the study protocol. We assessed paper quality based on STROBE (Strengthening The Reporting of Observational studies in Epidemiology). After analysis, we selected 14 papers, of which 10 showed evidence of association between psychological disorders (in particular, stress, anxiety, and depression) and the development of OLP. The paper-quality assessment by means of STROBE showed that 13 papers presented intermediate quality and one paper presented high quality. In the present systematic review, we found an association between psychological disorders and the development of OLP.

Psychopathological profile and quality of life of patients with oral lichen planus.

Oral lichen planus (OLP) is a chronic, multifocal, sometimes painful, inflammatory disease of the oral mucosa. OLP can predispose development of psycho-emotional disorders. Until now, the relationship between the severity of lichen planus and the psychological profile of patients (psychological well-being, perceived stress and pain coping strategies) has never been studied. Study was conducted on 42 OLP patients. Number of sites involved, severity and activity score of OLP were evaluated. Psychological tests were used to evaluate patients' psycho-emotional condition. The mean duration time of symptomatic OLP was 43 months. We detected that the longer the duration of subjective symptoms, the poorer the quality of life and the higher the level of perceived stress (PSS). Also, the higher the PSS results, the greater the anxiety and depression on Hospital Anxiety and Depression Scale (HADS). Likewise, higher level of depression in HADS was strongly correlated with worse quality of life. (p≤0.05). In this study, we detected a relationship between duration of the disease, level of perceived stress and quality of life. The longer the disease lasts, the higher it tends to catastrophize. This may influence development or increase of the anxiety and depression and may decrease patients' quality of life.

Psychopathological profile and quality of life of patients with oral lichen planus

Abstract Objectives Oral lichen planus (OLP) is a chronic, multifocal, sometimes painful, inflammatory disease of the oral mucosa. OLP can predispose development of psycho-emotional disorders. Until now, the relationship between the severity of lichen planus and the psychological profile of patients (psychological well-being, perceived stress and pain coping strategies) has never been studied. Material and Methods Study was conducted on 42 OLP patients. Number of sites involved, severity and activity score of OLP were evaluated. Psychological tests were used to evaluate patients' psycho-emotional condition. The mean duration time of symptomatic OLP was 43 months. Results We detected that the longer the duration of subjective symptoms, the poorer the quality of life and the higher the level of perceived stress (PSS). Also, the higher the PSS results, the greater the anxiety and depression on Hospital Anxiety and Depression Scale (HADS). Likewise, higher level of depression in HADS was strongly correlated with worse quality of life. (p≤0.05). Conclusions In this study, we detected a relationship between duration of the disease, level of perceived stress and quality of life. The longer the disease lasts, the higher it tends to catastrophize. This may influence development or increase of the anxiety and depression and may decrease patients' quality of life.

Emotional assessment of patients with oral lichen planus.

BACKGROUND: Oral lichen planus is a chronic immune-mediated disease with an estimated prevalence of 0.5-2.5% in the general population. Patients with oral lichen planus are often emotionally unstable and anxious and may develop concomitant systemic disorders. The objective of this study was to evaluate emotional characteristics of patients with oral lichen planus. METHODS: Two groups were studied: the first group consisted of 48 patients with a diagnosis of oral lichen planus, and the second group consisted of controls without the disease matched for age and gender at a proportion of 1:1. The emotional state of the patients was evaluated using the State-Trait Anxiety Inventory, SF-36 generic quality of life questionnaire, and the Self Reporting Questionnaire-20. RESULTS AND CONCLUSIONS: The present investigation demonstrated the presence of anxiety and depression in patients with oral lichen planus and a negative impact of the disorder on the patient's quality of life as indicated by impairment of the physical aspect, vitality, mental health, and social aspect domains. This could indicate that associated psychological treatment may be important in the follow-up of these patients.

Factors associated with clinical characteristics and symptoms in a case series of oral lichen planus.

BACKGROUND: Oral lichen planus (OLP) is a relatively common chronic inflammatory disease whose etiopathogenesis is not completely understood. Several factors have been proposed in an attempt to explain the variety of clinical manifestations and periods of exacerbation and remission of symptoms of these lesions. The objective of this study was to associate local factors, systemic diseases, and level of anxiety with clinical characteristics of OLP. METHODS: The following factors were analyzed in 37 patients with OLP: presence of smoking, alcohol consumption, diabetes mellitus, hypertension, and hepatitis C virus infection. Anxiety was measured by the Spielberger State-Trait Anxiety Inventory. These variables were associated with clinical form and symptoms (chi-squared/Fisher's exact test). RESULTS: The erosive form was the most prevalent presentation (57.1%). Symptoms were reported by 45.7% of the patients. Most patients were non-smokers (97.3%), and none of them was an alcoholic. Diabetes and hypertension were present in 10.8% and 16.2% of the patients, respectively. Only one patient was hepatitis C virus seropositive, and 78.4% presented moderate levels of anxiety. No significant association was observed between the variables studied and clinical form or symptoms. CONCLUSIONS: In this study, no association was observed between local and systemic factors or level of anxiety and clinical characteristics of OLP.

Plaque control improves the painful symptoms of oral lichen planus gingival lesions. A short-term study.

BACKGROUND: Lichen planus is a mucocutaneous disease with manifestation in the oral mucosa, the gingiva being one of the most affected regions. In some cases, the lesion may be painful and lead to fragility of the tissues, so that precise diagnosis and adequate treatment are indispensible factors for improving the clinical condition. The aim of this study was to evaluate the effectiveness of plaque control in the improvement of clinical features and painful symptoms of oral lichen planus with gingival involvement. METHODS: Twenty patients diagnosed with gingival lichen planus confirmed by histopathological examination were selected. The patients were evaluated by a trained examiner, with regard to the clinical features of the lesions [Index of Escudier et al. (Br J Dermatol, 157, 2007, 765)]; painful symptoms (Visual Analog Scale); and periodontally, as regards the visible plaque and gingival bleeding indices. Periodontal treatment consisted of supragingival scaling and oral hygiene instruction, with professional plaque removal afterward for a period of 4 weeks. The entire sample was evaluated at the baseline and at the conclusion of treatment, and the results were analyzed by the Wilcoxon nonparametric test. RESULTS: The data demonstrated that the majority of patients were women (90%), with a mean age of 55.9 years. Periodontal treatment resulted in statistically significant reduction (P < 0.05) in the periodontal indices, with consequent improvement in the clinical features and painful symptoms of the lesions. CONCLUSIONS: It was demonstrated that plaque control was effective in improving the clinical features and painful symptoms of oral lichen planus with gingival involvement.

Salivary cortisol and dehydroepiandrosterone (DHEA) levels, psychological factors in patients with oral lichen planus.

OBJECTIVE: The aim of this study was to determine the salivary levels of dehydroepiandrosterone (DHEA) and cortisol and scores of depression, anxiety and stress in patients with oral lichen planus (OLP). STUDY DESIGN: Thirty-one patients with a diagnosis of OLP were selected; they were matched by sex and age with 31 control patients. Symptoms of depression, anxiety and stress were investigated by the instruments Beck Depression Inventory, Beck Anxiety Inventory and Lipp's Inventory of Stress Symptoms for Adults, respectively. Saliva was collected in the morning and at night for the determination of DHEA and cortisol levels by radioimmunoassay. RESULTS: There was no significant difference between the groups with respect to depression (P=0.832), anxiety (P=0.061) or stress (P=0.611), or with respect to morning and night salivary levels of DHEA (P=0.888, P=0.297) and cortisol (P=0.443, P=0.983). CONCLUSIONS: The results suggest an association of OLP with anxiety. However, DHEA and cortisol levels did not differ between groups, which does not support any neuroendocrine aetiology for OLP.

Ansiedad como rasgo de la personalidad de un grupo de pacientes con liquen plano bucal / Anxiety as a personality trait of a group of patients with oral lichen planus

La ansiedad es un sentimiento de recelo o de miedo. La fuente de este desasosiego no siempre se reconoce, lo cual se puede añadir a la angustia que se siente. Numerosos autores han relacionado a entidades como el Liquen Plano Bucal (LPB) o el bruxismo como condiciones psicosomáticas. Cuantificar los niveles de ansiedad/estado y ansiedad como rasgo de la personalidad en una población Venezolana con Liquen Plano Bucal. En el estudio se incluyeron 20 pacientes diagnosticados con Liquen Plano Bucal y 10 sujetos con mucosa bucal sana. Se aplicó el cuestionario de Ansiedad Estado-Rasgo "STAI" (State-Trait Anxiety Inventory). El cuestionario está diseñado para auto aplicación y la misma se hizo de manera individual sin límite de tiempo.Resultados: 17/20 de los pacientes del grupo con Liquen Plano Bucal presentaron un decatipo igual o mayor de 6 en la escala del cuestionario de Ansiedad Rasgo "STAI", indicando que el 85% de los pacientes en este grupo resultaron tener la ansiedad como rasgo en su personalidad. En el grupo control 8/10 presentaron un decatipo igual o mayor de 6 en la escala del cuestionario de Ansiedad Rasgo "STAI", lo que señala que el 80% de los sujetos de este grupo presentaba la ansiedad como rasgo en su personalidad. 15/20 de los pacientes del grupo con LPB presentaron un decatipo igual o mayor de 6 en la escala del cuestionario Ansiedad Estado "STAI" lo que indica que el 75% de los pacientes con LPB se mostraban ansiosos al momento de la aplicación de esta prueba. 9/10 individuos del grupo control presentaron un decatipo igual o mayor de 6 en la escala del cuestionario Ansiedad Estado "STAI", evidenciando que el 90% de los pacientes de este grupo se encontraban ansiosos al momento de la aplicación del cuestionario. No se observó una diferencia estadísticamente significativa entre los dos grupos

Anxiety is a fearing, disquiet feeling, with unknown source, that leads to more anguish for the patient who's suffering the condition. Several authors have related entities like Oral Lichen Planus (OLP) and bruxism with psycho-somatic conditions. To quantify the levels of state-anxiety and trait-anxiety in an OLP Venezuelan population.Materials and Methods: In the present study, 20 OLP patients and 10 healthy oral mucosa individuals were subjected to the STAI questionnaire (State-Trait Anxiety Inventory) applied without time limit. 17/20 OLP patients presented a 6 or greater score in the STAI scale what indicated that 85% of patients have anxiety as a personality feature. 8/10 patient in the control group presented a 6 or greater score in the STAI scale what indicated that 80% of patients in this group have anxiety as a personality feature. 15/20 OLP patients presented a 6 or greater score in the anxiety-state scale what indicated that 75% of the patients were anxious at the moment of test application. 9/10 patients in the control group presented a 6 or greater score in the anxiety-state scale what indicated that 90% of the patients were anxious at the moment of test application. There is not statistical differences between the two groups. In this study, there are more OLP patients with anxiety as a personality feature; nevertheless there is no statistical difference between the two groups. Is a clinical decision to include psychological treatment in each particular case, especially patients with recurrent lesions

Alteraciones psicológicas en la etiopatogénesis de patología de la mucosa oral / Psychological disorders in the etiopathogenesis of the oral mucous pathology

El liquen plano oral, la úlcera recurrente oral y el síndrome de boca urente son tres entidades patológicas de la mucosa oral que se caracterizan por tener una etiología multifactoral y por ser de difícil manejo terapéutico en cuanto a lograr un tratamiento que resuelva el padecimiento. Uno de los factores que probablemente juegue un rol en el desarrollo de estas patologías es el estado psicológico del paciente a través de alteraciones tales como el estrés, ansiedad, depresión. La consideración de aspectos psíquicos en el desarrollo de lesiones de la mucosa oral está sustentada por diversas investigaciones, tanto clínicas como de laboratorio, aunque ninguna ha sido absolutamente concluyente. Sin embargo las evidencias logradas abren una nueva perspectiva tanto en la comprensión de la etiopatogénesis de estas enfermedades como en su prevención y manejo terapéutico