Document Type: Original Article


1 Dept. of Oral and Maxillofacial Pathology, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran.

2 Dept. of Clinical Biochemistry, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

3 Dept. of Community Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

4 Dept. of Restorative, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran.

5 Dept. of Periodontics, Faculty of Dentistry, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran.


Statement of the Problem: Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease with unclear etiology while a few cases of disease become malignant.
Purpose: This study aimed to evaluate the level of nitric oxide (NOx) and C-reactive protein (CRP) as oxidative stress and inflammation status in sample of OLP patients.
Materials and Method: In this case-control study, serum and salivary NOx and CRP levels were evaluated in twenty two OLP patients as the case group confirmed by clinical and histopathological diagnosis, and twenty two healthy control groups collected from Tooba oral pathology laboratory in Sari in 2016. The data were analyzed by using independent-samples t-test, Mann-Whitney U-test and Chi-square by using SPSS version 21. The statistical significant level was considered at p < 0.05.
Results: Salivary and serum NOx levels in case group showed statistically significantly higher than healthy control group (p = 0.035 and p = 0.001, respectively). CRP values were significantly higher both in serum (p = 0.001) and in saliva (p = 0.035). A significant correlation was found between CRP and NOx values in serum (r= 0.521, p = 0.0001) and saliva (r= 0.427, p = 0.045).
Conclusion: Oxidative stress causes damage to organs in the human body. Correct understanding of oxidative stress and its association with free radicals and inflammatory markers related to oral disease are important for effective treatments. The results of the study supported the effects of NOx and CRP levels in pathogenesis of OLP. Regarding antioxidant drugs could probably be considered in the treatment of OLP. 


1. Nevil BW, Damm DD, Allen CM, Chi AC. Oral and maxillofacial pathology. 4th ed. Saunders, St Louis, MO : Elsevier; 2016. pp. 416–423. [Google Scholar]

2. Shiva A, Zamanian A, Arab Sh, Boloki M. Immunohistochemical Study of p53 Expression in Patients with Erosive and Non-erosive Oral Lichen Planus. J Dent Shiraz Univ Med Sci. 2018; 19: 118–123. [PMC free article] [PubMed[Google Scholar]

3. Mortazavi H, Safi Y, Baharvand M, Rahmani S. Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree. Int J Dent. 2016; 7278925: 14. [PMC free article] [PubMed[Google Scholar]

4. Gorouhi F, Davari P, Fazel N. Cutaneous and mucosal lichen planus: a comprehensive review of clinical subtypes, risk factors, diagnosis, and prognosis. Sci World J. 2014; 2014: 742–826. [PMC free article] [PubMed[Google Scholar]

5. Parashar P. Oral lichen planus. Otolaryngol Clin N Am. 2011; 44: 89–107. [PubMed[Google Scholar]

6. Feller LL, Khammissa RR, Kramer BB, Lemmer JJ. Oral squamous cell carcinoma in relation to field precancerisation: pathobiology. Cancer Cell Int. 2013; 13: 31. [PMC free article] [PubMed[Google Scholar]

7. Kumar M, Nanavati R, Modi TG, Dobariya C. Oral cancer: Etiology and risk factors: A review. J Cancer Res Ther. 2016; 12: 458–463. [PubMed[Google Scholar]

8. Schlosser BJ. Lichen planus and lichenoid reaction of the oral mucosa. Dermatol Ther. 2010; 23:251–267. [PubMed[Google Scholar]

9. Yardimci G, Kutlubay Z, Engin B, Tuzun Y. Precancerous lesions of oral mucosa. World J Clin Cases. 2014; 2:866–872. [PMC free article] [PubMed[Google Scholar]

10. Sander CS, Cooper SM, Ali I, Dean D, Thiele JJ, Wojnarowska F. Decreased antioxidant enzyme expression and increased oxidative damage in erosive lichen planus of the vulva. BJOG. 2005; 112: 1572–1575. [PubMed[Google Scholar]

11. Mehdipour M, Taghavi Zenouz A, Bahramian A, Gholizadeh N, Boorghani M. Evaluation of serum nitric oxide level in patients with oral lichen planus. J Dent (Shiraz) 2014; 15: 48–51. [PMC free article] [PubMed[Google Scholar]

12. Valko M, Leibfritz D, Moncol J, Cronin MT, Mazur M, Telser J. Free radicals and antioxidants in normal physiological functions and human disease. Int J Biochem Cell Biol. 2007; 39: 44–84. [PubMed[Google Scholar]

13. Fu YC, Jin XP, Wei SM, Lin HF, Kacew S. Ultraviolet radiation and reactive oxygen generation as inducers of keratinocyte apoptosis: protective role of tea polyphenols. J Toxicol Environ Health A. 2000; 61: 177–188. [PubMed[Google Scholar]

14. Aly DG, Shahin RS. Oxidative stress in lichen planus. Acta Dermatovenerol Alp PanonicaAdriat. 2010; 19: 3–11. [PubMed[Google Scholar]

15. Sezer E, Ozugurlu F, Ozyurt H, Sahin S, Etikan I. Lipid peroxidation and antioxidant status in lichen planus. Clin Exp Dermatol. 2007; 32: 430–434. [PubMed[Google Scholar]

16. Páli T, Bencsik P, Görbe A, Ferdinandy P, Csont T. Measurement of NO in biological samples. Br J Pharmacol. 2015; 172: 1620–1632. [PMC free article] [PubMed[Google Scholar]

17. Förstermann U, William C, Sessa A. Nitric oxide synthases: regulation and function. Eur Heart J. 2012; 33:829–837. [PMC free article] [PubMed[Google Scholar]

18. Sunitha M, Shanmugam S. Evaluation of salivary nitric oxide levels inoral mucosal diseases: a controlled clinical trial. Ind J Dent Res. 2006; 17: 117–120. [PubMed[Google Scholar]

19. Michael C, Dillon A, Daniel C, Opris A, Kopanczyk R, Lickliter J, Hayley N, et al. Detection of Homocysteine and C-Reactive Protein in the Saliva of Healthy Adults: Comparison with Blood Levels. Biomarker Insights. 2010; 5:57–61. [PMC free article] [PubMed[Google Scholar]

20. Michael C, Dillon A, Daniel C, Opris A, Kopanczyk R, Lickliter J, et al. Detection of Homocysteine and C-Reactive Protein in the Saliva of Healthy Adults: Comparison with Blood Levels. Biomarker Insights. 2010; 5:57–61. [PMC free article] [PubMed[Google Scholar]

21. Shiva A, Arab SH. Evaluation of Uric Acid, Total Antioxidant and Lipid Peroxidation Parameters in Serum and Saliva of Patients with Oral Lichen Planus. Global Journal of Health Science. 2016; 8: 225–231. [Google Scholar]

22. Al-Hashimi I, Schifter M, Lockhart PB, Wray D, Brennan M, Migliorati CA, et al. Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103 Suppl: S25 1–12. [PubMed[Google Scholar]

23. Shaheer KA, Tharayil KJ, Krishna WP. A Comparative Study of High Sensitivity C-Reactive Protein and Metabolic Variables in Type 2 Diabetes Mellitus with and without Nephropathy. Journal of Clinical and Diagnostic Research. 2017; 11: BC01–BC04. [PMC free article] [PubMed[Google Scholar]

24. Hetrick EM, Schoenfisch MH. Analytical Chemistry of Nitric Oxide. Annu Rev Anal Chem (Palo Alto Calif) 2009; 2:409–433. [PMC free article] [PubMed[Google Scholar]

25. Bogdan C. Regulation of lymphocytes by nitric oxide. Methods Mol Biol. 2011; 677: 375–393. [PubMed[Google Scholar]

26. Niedbala W, Wei XQ, Campbell C, Thomson D, Komai-Koma M, Liew FY. Nitric oxide preferentially inducestype 1T cell differentiation by selectively up-regulating IL-12 receptor beta 2 expression via cGMP. Proc Natl Acad Sci USA. 2002; 99: 16186–16191. [PMC free article] [PubMed[Google Scholar]

27. Brennan PA, Umar T, Palacios-Callender M, Spedding AV, Mellor TK, Langdon JD. A study to assess inducible with severity of chronic periodontitis. J Oral Pathol Med. 2000; 29: 249–254. [PubMed[Google Scholar]

28. Manisundar N, Julius A, Amudhan VA, Hemalatha, Manigandan T. Nitric Oxide as an Inflammatory Biomarker in Oral and Systemic Diseases-A Systematic Review. Middle-East Journal of Scientific Research. 2014; 20: 881–886. [Google Scholar]

29. Agha-Hosseini F, Mirzaii-Dizgah I, Mikaili S, Abdollahi M. Increased salivary lipid peroxidation inhuman subjects with oral lichen planus. Int J Dent Hyg. 2009; 7: 246–250. [PubMed[Google Scholar]

30. Kumar ABS. Altered C- reactive protein Levels in Serum of Oral Precancer Patients in Comparison With Healthy Controls. Int J Oral Maxillofac Pathol. 2011; 2:16–9. [Google Scholar]

31. Ataş H, Cemil BÇ, Kurmuş GI, Gönül M. Assessment of systemic inflammation with neutrophil-lymphocyte ratio in lichen planus. Postepy Dermatol Alergol. 2016; 33: 188–192. [PMC free article] [PubMed[Google Scholar]

32. Arias-Santiago S, Buendía-Eisman A, Aneiros-Fernández J, Girón-Prieto MS, Gutiérrez-Salmerón MT, Mellado VG, et al. Cardiovascular risk factors in patients with lichen planus. Am J Med. 2011; 124: 543–548. [PubMed[Google Scholar]

33. Abhishek J, Pratiti Gh. Altered Hematological Profile of Oral Lichen Planus Patients. Research Journal of Pharmaceutical Biological and Chemical Sciences. 2014; 5: 1271–1277. [Google Scholar]