Oral Lichenoid Tissue Reactions and E-Cigarettes: A Cause for Concern?
CR31
Mark Gribben
Rhona Cobb, Kevin Ryan
Introduction
We describe a case of almost complete remission of biopsy confirmed erosive lichenoid inflammation intraorally following cessation of e-cigarette use.
Case Report
A 45-year-old male was referred by his dentist to Oral Medicine reporting painless, unilateral oral ulceration affecting the left buccal mucosa and left lateral tongue. He was an ex-tobacco smoker, but used an e-cigarette daily. Clinically, the left buccal mucosa and tongue showed striated and erythematous lesions with areas of ulceration. No underlying mass was palpable. Amalgam restorations were noted on teeth 36 and 37, and a working diagnosis of Oral Lichenoid Tissue Reactions (OLTR) was hypothesised. Histopathological examination was consistent with OLTR. The patient was advised to consider replacement of the amalgam restorations with a non-metal alternative and use topical corticosteroid treatment. The patient failed to engage with this. The patient attended 6 months following cessation of e-cigarette use, and showed resolution of the ulceration, with only mild lichenoid lesions remaining.
Discussion
E-cigarette use, particularly in young people, has shown a recent exponential increase since their introduction to the UK market in 2007. They use a metal resistance coil to heat and aerosolise mixtures of vegetable glycerin, propylene glycol, nicotine, and flavouring agents. The first known patient to develop an OLTR through e-cigarette use was reported in 2016. Little is known of their long-term harmful effects, including the potential risks of OLTR, defined by the World Health Organisation as a “potentially malignant condition”, with a 1.1% risk of malignant transformation.
Conclusion
It is important for the clinician to obtain a thorough history from the patient, including history of tobacco and e-cigarette use, to educate patients on their increased risk of Oral Cavity Cancer. Further research regarding the link between E-cigarette use and OLTR is required to help inform patients and carry out an adequate risk assessment.
