Clinical Experience of Local Hypothermia Usage in the Comprehensive Treatment of Oral Lichen Planus

Abstract

Subject. Lichen planus (LP) is one of the most common pathologies of the oral mucosa (OM). The optimization of LP treatment retains its relevance and significance. The methods of physiotherapy have proven themselves well, as an addition to basic treatment plan. Cryotherapy is of special interest to doctors, because this procedure can have analgesic, anti-inflammatory and reparative effects. 
 Objectives. To evaluate the dynamics of clinical scores of the oral mucosa state in patients with LP if used local hypothermia. 
 Methodology. 21 patients with bullous and erosive-ulcerative clinical forms of LP were examined and treated, who were prescribed comprehensive treatment, including local hypothermia (3 procedures). Examination and evaluation of the oral mucosa condition of patients were carried out before treatment, 3, 7 and 14 days after its start. A specially designed scoring system was used to study the timing of arresting of inflammation symptoms (pain, hyperemia, swelling) and the dynamics of the erosive lesions epithelialization. The intensity of the pain syndrome was assessed using a visual analogue scale (VAS). 
 Results. The positive dynamics was registered by the 3rd day of therapy: there was a significant decrease in hyperemia and swelling symptoms of the affected areas of the oral mucosa, compared with the scores registered before treatment (p < 0.05). The epithelialization of erosive lesions proceeded at a good speed, which was associated with the normalization of tissue microcirculation. Similar trends were noted at all follow-up periods: a statistically significant difference in these clinical indicators persisted throughout the entire treatment period (p < 0.05). Against the background of arresting of inflammation symptoms, the level of pain response of patients also decreased, up to the disappearance of pain by the 14th day of observation in 66.7% of patients. 
 Conclusions. The local hypothermia technique is a minimally invasive and painless procedure that is well tolerated by patients with oral lichen planus. Cryotherapy has demonstrated its high clinical efficiency, which allows expanding the indications for its usage in dental practice.

On the question of choosing the most valid methods for diagnostics of pulpal hyperemia

“…Это связано с тем, что под воздействием тепла жидкость в дентинных канальцах расширяется, стимулируя С-волокна. Также при гангренозном пульпите сосудисто-нервный пучок содержит бактерии, способные продуцировать газы, которые под действием тепла расширяются, что в условиях ограниченного пространства стенок дентина приводит к раздражению чувствительных нервных волокон и нарастанию болевого симптома [7].…”