Disease scoring systems for oral lichen planus; a critical appraisal

Abstract

The aim of the present study has been to critically review 22 disease scoring systems (DSSs) on oral lichen planus (OLP) that have been reported in the literature during the past decades. Although the presently available DSSs may all have some merit, particularly for research purposes, the diversity of both the objective and subjective parameters used in these systems and the lack of acceptance of one of these systems for uniform use, there is a need for an international, authorized consensus meeting on this subject. Because of the natural course of OLP characterized by remissions and exacerbations and also due to the varying distribution pattern and the varying clinical types, e.g. reticular and erosive, the relevance of a DSS based on morphologic parameters is somewhat questionable. Instead, one may consider to only look for a quality of life scoring system adapted for use in OLP patients.

Figure 1

Plaque-type lichen planus on the borders of the tongue; mild symptoms (a,b); same patients after two months; symptoms unchanged as reported by the patient (c,d). How to incorporate the morphological changes in a disease scoring system? A quality of life scoring system may be more useful.

Figure 2

Erosive lichen planus in the upper and lower gingiva; mild symptoms, mainly consisting of bleeding on toothbrushing (a); same patient after six months; symptoms unchanged as reported by the patient (b). How to incorporate the morphological changes in a disease scoring system? A quality of life scoring system may be more useful.