Hawley retainer and lichenoid reaction: a rare case report

Abstract

BackgroundOral lichenoid reaction (OLR) is a type IV cell-mediated immune response in the oral cavity. There is an established relationship between various dental materials and OLR, but few cases reports reported the occurrence of a lichenoid reaction in association with the use of a Hawley retainer.Case presentationA female patient (twenty years of age) has been complaining of a reddish painful area on the tongue, which started one year ago and has been increasing in size over time. The patient completed orthodontic treatment two years ago and has been using a Hawley retainer for orthodontic retention since then. After performing histological analysis and patch test, the lesion was diagnosed as a lichenoid reaction to the Hawley retainer. Topical corticosteroids were prescribed, and the patient was asked to stop using the retainer and followed for six months.ConclusionsIt is difficult to diagnose lichenoid lesions and even more challenging to differentiate between OLP and OLR, therefore it is essential to do a full intraoral and extraoral examination. OLL can occur in association with Hawley retainer, which we believe could be because it is made of an acrylic based material. Generally, OLL resolves after removal of the cause.

Orthodontic Retainers—A Critical Review

“…More rarely, mucosal lesions may be more challenging to diagnose because they imitate common oral inflammatory lesions. Nevertheless, the disturbing immune response readily resolves after the removal of the cause [117].…”

Use of liquid-based cytology samples reveals genomic instability and cell death in patients undergoing orthodontic treatment

“…Friction between brackets and the buccal mucosa is a form of chronic trauma that can cause ulceration, which is one of the most common complaints of patients during orthodontic treatment. Some lesions result from acute traumatic injury, but others can result from longlasting low-intensity irritation that usually precedes chronic conditions known as reactive lesions, such as white lesions (e.g., frictional keratoses) and lichenoid reactions, at times in association with tobacco and alcohol use, when they may be confused with potentially malignant disorders such as leukoplakia [21,[25][26][27]. Studies of the association between "burning mouth syndrome" and fixed dental appliances have produced contradictory results, and investigation of hypersensitivity has been recommended when evaluating patients with these symptoms [21].…”

Oral Lichenoid Contact Lesions - Clinical Presentations and Dental Implications

“…Similarly, a case report describes the resolution of a lesion after the replacement of a eugenol temporary restoration with glass ionomer [7]. Moreover, resin monomers (i.e., HEMA, Bis-GMA, EGDMA methacrylate) present in composites and some lab made dental appliances have been reported to cause OLCLs [7,[22][23][24][25]. However, free-monomer rates in composite after light curing are scant which could explain the low incidence of OLCLs associated with resin dental material [15].…”