Lichenoid mucositis

by Jason Wasserman MD PhD FRCPC
July 31, 2025

Lichenoid mucositis is a pattern of inflammation that affects the inside of the mouth. It is caused by the immune system attacking the cells that line the surface of the oral cavity. This condition can lead to redness, white patches, pain, or a burning sensation in the mouth. Lichenoid mucositis is not a single disease, but rather a pattern that can be observed in several different conditions, including autoimmune diseases, allergic reactions to medications, and reactions to dental materials or flavoring agents.

What are the symptoms of lichenoid mucositis?

The most common symptoms of lichenoid mucositis include:

  • Red or white patches on the inside of the cheeks, lips, tongue, or gums.

  • Pain or tenderness in the mouth.

  • A burning or itching sensation, especially when eating spicy or acidic foods.

  • Difficulty swallowing or speaking in more severe cases.

These symptoms may come and go or persist over time, depending on the cause.

What causes lichenoid mucositis?

Lichenoid mucositis can be caused by a variety of factors. In many cases, the immune system is responsible for damaging the tissue inside the mouth. Conditions associated with this immune response include oral lichen planus and mucous membrane pemphigoid.

In other cases, lichenoid mucositis is a reaction to certain medications, chemicals, or dental materials. Identifying and removing the underlying cause often leads to improvement or resolution of symptoms.

What types of medications are associated with lichenoid mucositis?

Lichenoid mucositis can be triggered by many commonly used medications. These include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.

  • Blood pressure medications (antihypertensives).

  • Antimalarials.

  • Antibiotics.

  • Antifungals.

  • Anticonvulsants.

  • Antiretrovirals used in the treatment of HIV.

  • Medications for diabetes and anxiety.

  • Biologic agents used to treat autoimmune conditions.

If lichenoid mucositis is suspected to be caused by a medication, your doctor may consider adjusting your treatment plan.

What chemicals or substances are associated with lichenoid mucositis?

Some cases of lichenoid mucositis are caused by contact with certain substances inside the mouth. These include:

  • Dental materials, such as silver (amalgam), gold, or acrylics used in fillings, crowns, and dentures

  • Flavoring agents in toothpaste, mouthwash, or chewing gum, particularly cinnamon, mint, and menthol

If lichenoid mucositis is caused by a contact reaction, removing the trigger may lead to improvement.

Is lichenoid mucositis cancer?

No. Lichenoid mucositis is not a type of cancer. However, if the condition lasts a long time and causes ongoing damage to the cells that line the mouth, there may be a small risk of developing dysplasia, a precancerous condition. Dysplasia can only be diagnosed after a biopsy is performed and the tissue is examined under a microscope.

How is this diagnosis made?

The diagnosis of lichenoid mucositis is based on both the appearance of the mouth and the microscopic features seen in a biopsy. A small sample of tissue is removed from the affected area during a procedure performed by your doctor or dentist. The tissue is then examined by a pathologist to look for changes that are characteristic of lichenoid mucositis.

What does lichenoid mucositis look like under the microscope?

When examined under the microscope, lichenoid mucositis shows a distinctive pattern of inflammation:

This pattern helps pathologists distinguish lichenoid mucositis from other types of inflammation or mouth conditions.

What is the treatment for lichenoid mucositis?

Treatment depends on the underlying cause. If a medication or dental material is suspected, your doctor may recommend removing or replacing the suspected trigger. If the cause is an autoimmune condition like oral lichen planus, treatment may include:

  • Topical corticosteroids to reduce inflammation.

  • Mouth rinses with soothing or anti-inflammatory ingredients.

  • Systemic medications in more severe cases.

Good oral hygiene and avoiding irritants like tobacco, alcohol, and spicy foods can also help manage symptoms.

Questions to ask your doctor

  • What caused the lichenoid mucositis in my case?

  • Are any of my medications or dental materials likely triggers?

  • What treatment options are available to reduce symptoms?

  • How often should I have follow-up exams to monitor for dysplasia?

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