Chronic Oral Mucosal Disease: Telling Apart Lichen Planus, Burning Mouth, and Recurrent Mouth Ulcers, and Follow-Up

What are the chronic oral mucosal diseases?

Mouth lining conditions that recur or last a long time include oral lichen planus, burning mouth syndrome, and recurrent aphthous ulcers [1]. Oral lichen planus is a chronic inflammatory disease in which white lacy patterns or ulcers persist on the cheek lining, gums, and other areas, while burning mouth syndrome is a sensory disorder in which the tongue and mouth feel like they are burning without any clear lesion [1]. When recurrent ulcers are frequent and appear in several places, distinguishing them from systemic diseases such as Behcet’s disease is also considered [1]. When DentStat analyzed 70 patient comments about chronic mucosal disease and burning sensations in oral surgery, the main emotions were fatigue from repeated recurrence (“I live with mouth sores all the time”), frustration at hard-to-treat symptoms, and anxiety about ruling out systemic disease [3].

What should I look for if mouth ulcers come back several times a month for over 3 weeks?

Mouth ulcers that recur, appear in several places, or last more than 3 weeks are hard to dismiss as a simple immune problem and need to be distinguished from other conditions [1]. Many people put them down to low immunity or a lack of vitamins, but frequent recurrence, several ulcers at once, and ulcers that last a long time are described as signs that call for ruling out Behcet’s disease, lichen planus, potentially premalignant lesions, and others [1][2]. In particular, a pattern that recurs with fatigue or cycles, or ulcers that occur together with eye or genital ulcers, are points checked at a clinic [2]. Rather than deciding the cause on your own, the approach is to have it checked based on how long it lasts and how often it recurs [1].

If oral lichen planus is mild, can I leave it alone?

Oral lichen planus is a condition for which regular follow-up is advised even when symptoms are mild [2]. Some cases of oral lichen planus are classified as potentially premalignant lesions, so even when symptoms are mild or painless, it is described as something to monitor regularly for changes rather than leave alone [2]. Some people leave it hoping it will heal on its own, but it is closer to a chronic condition managed by watching for changes and controlling sources of irritation [1]. That said, lichen planus does not mean cancer, and most cases are managed through follow-up [2].

My tongue feels like it is burning. Which department should I see?

If a burning or stinging feeling continues without any visible lesion, burning mouth syndrome is considered, and this falls under Oral Medicine (orofacial pain) [1]. Unlike surgical procedures such as extractions, which are handled by Oral & Maxillofacial Surgery, mucosal disease, burning sensations, and sensory changes are non-surgical areas often handled by Oral Medicine [1]. A burning sensation can be related to many factors such as anemia, nutritional deficiency, dry mouth, and medications, so the cause is checked broadly [1]. Because the condition is hard to identify from symptoms alone, the cause is distinguished through a clinical exam [2].

Can amalgam cause mucosal lesions?

Lichenoid reactions at sites that touch amalgam (silver fillings) have been reported [2]. If the lesion is limited to the cheek lining or tongue edge that touches the amalgam, a contact lichenoid reaction is considered, and removal and replacement with another material are decided after consultation, based on the lesion’s location and condition [2]. Not every mucosal lesion is caused by amalgam, however, so a decision to replace all old fillings at once should go through a clinical check [1]. It is hard to conclude on your own that amalgam is the cause [1].

Common myths and facts

Some believe chronic mouth ulcers will heal if you just take vitamins or boost immunity, but ulcers that recur, appear in several places, or last more than 3 weeks are signs that need to be distinguished from other conditions and are hard to dismiss as a simple immune problem [1]. Another view is that mild oral lichen planus can be left alone, but because some cases are classified as potentially premalignant, follow-up is advised [2]. On the other hand, the excessive fear that chronic mucosal disease means cancer is also inaccurate, as most cases are managed through care and follow-up [2]. Either way, rather than reaching your own conclusion, it is something to have checked at a clinic based on how long the symptoms persist [1].

You can learn about mucosal disease and the overall scope of oral surgery in the oral surgery guide, and check dental clinics by area in Find a dentist.