Synergistic Efficacy of Plaque Control with Intralesional Triamcinolone Acetonide Injection on Erosive Non-Gingival Oral Lichen Planus: A Randomized Controlled Clinical Trial

Abstract

This study is the first time to assess the synergistic efficacy and safety of plaque control on erosive non-gingival oral lichen planus (OLP). A randomized, controlled, clinical trial with blind evaluation was designed, and 48 OLP patients with erosive non-gingival OLP lesions were randomly assigned to the experimental group (n = 25, receiving intralesional triamcinolone acetonide injection, periodontal scaling, and oral hygiene instruction) and the control group (n = 23, only receiving intralesional triamcinolone acetonide injection) once a week for 2 weeks. Erosion size, pain level, plaque index, and community periodontal index were measured at every visit. Patients cured of erosion were followed up for 3 months to evaluate the recurrence rate. Adverse reactions were also recorded. At day 14 ± 2, the experimental group showed a higher completely healed percentage of erosion, a greater reduction of erosion size and pain level. However, no significant difference was observed in the recurrence rate. No participants had any severe adverse reactions. In conclusion, an improvement was observed in patients with plaque control, and future studies with larger sample sizes are needed to reinforce the external validity of this study.

Keywords: erosive non-gingival lesions; intralesional injection; oral lichen planus; plaque control; triamcinolone acetonide.

Figure 1

The flow diagram of the trial.

Figure 2

The hypothesis of “cross-talk” between periodontal and mucosal inflammation in OLP patients with non-gingival lesions. On one hand, bacteria and yeast-associated dental calculus or plaque could promote E-cadherin degradation, oral keratinocyte cell death, apoptosis, and necrosis, aggravating mucosal damage. On the other hand, cytokines stimulated by bacteria (MMP-1, MMP-9) and yeast (IL-1b, IL-6, IL-13, IL-17, TNF-α) could accelerate inflammation in periodontal tissue and mucosal tissue. Removement of dental calculus and plaque could reduce yeast, bacteria, and inflammatory cytokines, subsequently, contributing to the healing of mucosal erosion and the alleviation of periodontitis. Meanwhile, the healing of OLP erosion also reduced cytokines that promoted the development of periodontitis, with an improvement of the periodontal condition.