Changes in the Oral-Health-Related Quality of Life of Thai patients with oral lichen planus after topical corticosteroid treatment: a 1-month longitudinal study

Kengtong et al. BMC Oral Health (2023) 23:898 https://doi.org/10.1186/s12903-023-03603-w BMC Oral Health Open Access RESEARCH Changes in the Oral-Health-Related Quality of Life of Thai patients with oral lichen planus after topical corticosteroid treatment: a 1-month longitudinal study Witchapat Kengtong1,2, Pornpan Piboonratanakit2,3* and Sudaduang Krisdapong4 Abstract Background Oral lichen planus (OLP) is a chronic inflammatory disease of the oral cavity that affects many patients’ daily living activities. Topical corticosteroids are the first-line drug for treating OLP. The Oral Impact on Daily Performances index (OIDP) is an Oral-Health-Related Quality of Life (OHRQoL) measure developed to assess the ultimate impacts. The aims of this study were to evaluate the clinical, pain and OHRQoL responses after treating OLP patients with topical corticosteroids for 1 month, and secondly to assess the relationships of changes in the clinical sign score, pain score, and OHRQoL. Methods Seventy-two OLP patients were treated by topical corticosteroids based on their dentists’ clinical judgments. Clinical and patient-based outcomes were assessed at baseline and follow-up visit. The clinical outcomes were evaluated by the highest and total Thongprasom sign score. Patient-based outcomes were evaluated by numeric rating scale (NRS) and OIDP. The self-rated overall changes in quality of life during the 1-month treatment period using the Patient Global Impression of Change (PGIC) were also recorded at the follow-up visit. Results This study comprised 59 women and 13 men. All clinical and patient-based outcomes were significantly reduced after 1-month treatment with topical corticosteroids (P < 0.01). The most commonly affected activities were Emotional stability, followed by Eating and Cleaning the oral cavity. Forty-six percent reported the same or up to moderately improved, while 54% had a greatly improved quality of life as assessed by PGIC. There were no significant differences in the improvement of clinical and patient-based outcomes between these groups. There were significant relationships between the differences in the highest Thongprasom sign score and the differences in total Thongprasom sign score (r = 0.293; P < 0.05), and the differences in total OIDP percentage score and the difference in pain score (r = 0.427; P < 0.001). The differences in the total Thongprasom sign score also significantly related to the difference in the total OIDP percentage score (r = 0.335; P < 0.01). *Correspondence: Pornpan Piboonratanakit Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Kengtong et al. BMC Oral Health (2023) 23:898 Page 2 of 10 Conclusions Topical corticosteroids were significantly effective after 1-month treatment of OLP based on the clinical and patient-based outcomes. The OHRQoL improvement was significantly related to the reductions in pain and clinical severity. Trial registration The trial was registered at the Thai Clinical Trials Registry (TCTR identifier: TCTR 20221110001). Keywords Oral lichen planus, Quality of life, Oral-health-related quality of life, Oral impact on daily performances index, OIDP, Topical corticosteroid treatment Background Oral lichen planus (OLP) is a common chronic inflammatory disease of the oral cavity that affects the daily living activities in many patients. Most OLP patients are middle-aged women; the most common lesion sites are the buccal mucosa followed by the tongue, and gingiva [1]. OLP occurs in several forms, with the classic forms being white lesions presenting as reticular, papular, or plaque-like patterns and red lesions presenting as atrophic and ulcerative areas [2]. The main symptoms of OLP are a burning sensation when eating hot and spicy foods or severe chronic pain in the oral cavity [3]. The goal of treating OLP is to relieve symptomatic pain and reduce inflammation. The first-line drugs for treating OLP are corticosteroids taken in topical forms that can be used in various types and preparations, such as fluocinolone acetonide oral paste and dexamethasone mouthwash [4–6]. The advantages of topical corticosteroids are the lower risk of systemic steroid effects, such as hypertension, gastric ulcers, bone mineral loss, or adrenal suppression, however, they have an increased risk of oral candidiasis when used over a prolonged period [7]. Currently, OLP clinical trials should use a tripartite approach comprising clinical signs, symptoms, and quality of life [8]. Chainani-Wu et al. [9] recommended using an instrument that was sensitive and easy to apply when evaluating the signs of OLP. For clinical evaluation, several OLP studies in many countries including Thailand have applied the Thongprasom sign scoring system [5, 10–12]. This scoring system takes the size and clinical severity of each OLP lesion into account. However, the weak point of the Thongprasom sign scoring system is that it does not take into account the number of lesions. Only the highest score is assigned for a patient regardless of the number of lesions. Because OLP was a chronic inflammatory disease that is very difficult to completely cure, patients suffer from a burning sensation, pain, and discomfort [13]. Pain rating scales, e.g. numeric rating scale (NRS) and visual analog scale (VAS), are widely accepted and are more useful for assessing OLP symptoms [9]. Several OLP longitudinal studies used these scales for assessing OLP symptoms [11, 14–16]. Moreover, the concept of patientbased outcome measures has been used to determine impaired oral health from the patient’s perspective using the Oral-Health-Related Quality of Life (OHRQoL) [17]. These perspectives can be measured by several indices, such as the Oral Health Impact Profile (OHIP), Oral Health-Related Quality of Life (OHQoL) and Chronic Oral Mucosal Disease Questionnaire (COMDQ) [18]. Several OLP long (...truncated)