الفهرس 
Introduction.................................................................................Only 14 pages are availabe for public view
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Abstract
Oral lichen planus is a relatively common chronic immuno-mediated disease affecting oral mucosa and characterized by episodes of exacerbation and remission. The accurate prevalence of OLP is still contradictory and doubtable. The disease has a female gender predilection and usually affecting middle-aged individuals.
The clinical presentations of OLP is diverse and variable subtypes have been describes. The atrophic-erosive subtype is usually associated with pain and burning sensation that affects the patient’s quality of life and interferes with food intake that may lead to serious consequences.
The exact etiology is not clear and many external and internal predisposing factors are associated with its etiology. There are several mechanisms involved in the immuno-pathogenesis of OLP, these mechanisms include: antigen-specific cell mediated immune response and nons-pecific autoimmune responses (cellular or humoral reactions).
Several treatment modalities are introduced for management of symptomatic OLP but all currently available modalities are palliative and not curative.
Topical corticosteroids are the gold standard treatment modality in management of OLP due to their anti-inflammatory and immunosuppressive potential. However, they have many drawbacks as opportunistic candidiasis, mucosal atrophy, and incompetence with some systemic diseases as diabetes, hypertension and decrease in pharmacological effectiveness with prolonged use due to its chronic nature.
Several recent alternatives to topical steroids are currently available. Low level laser therapy (LLLT) is a very promising alternative and can be used in management of OLP without any reported side effects.
Interleukin-6 is one of the inflammatory cytokines involved in the immuno-pathogenesis of OLP and is secreted in both the saliva and serum. IL-6 can be used for monitoring the severity of OLP and evaluate effectiveness of treatment modalities used in management of OLP.
Whole human saliva is a valuable fluid which contains serum constituents, considerable amount of desquamated epithelial cells, microorganisms and cellular components. Salivary samples collection is an easy, non-invasive, cost-efficient and safe method that can be utilized for measuring various salivary biomarkers.
The aim of the current study is to compare between LLLT and topical steroids in management of symptomatic OLP and to evaluate clinical and biochemical outcomes of both treatment modalities by measuring the clinical score, visual analogue scale and salivary level of IL-6.
The participants enrolled into this study were divided into four randomly equally distributed groups of ten participant each: group (I) and (II) are both consisted of clinically and histopathologically confirmed symptomatic atrophic or erosive OLP and managed with topical corticosteroid preparation (triamcinolone acitonide 0.1% in orabase) in group (I) and Low level laser therapy (LLLT) by 810 nm diode laser in group (II). Participants in group (III) are clinically and histopathologically confirmed asymptomatic reticular or papular OLP. In addition to group (IV) which comprised of healthy volunteers presented with normal healthy oral mucosa.
Collection of unstimulated whole saliva (UWS) was performed for all groups, for group (I) and (II) it was collected before and after the treatment, for group (III) and (IV) it was collected once at the baseline.
The salivary samples were analysed using ELISA kit for detection of IL-6 salivary levels in the study groups.
There results of the current study revealed that there was statistically significant difference between clinical score values before and after treatment in both group (I) and (II) denoting that both topical corticosteroid and LLLT can be used effectively in management of OLP.
After treatment, group (II) showed a significantly higher mean value than group (I), thus meaning that topical steroid used in managing OLP in group (I) showed better results than LLLT used in group (II).
Regarding VAS, there was a significantly higher mean value of percentage change of VAS denoting that topical corticosteroid is more effective in reducing pain and give a more rapid enhancement and relief of pain than LLLT
Regarding the salivary IL-6 levels before and after treatment in both groups, the both treatment modalities leads to a statistically significant difference in IL-6 concentrations which indicates that topical corticosteroids and LLLT are biochemically effective in management of OLP (p<0.001).
The results of the present study revealed a moderate positive correlation between clinical score and IL-6 salivary concentration values and also revealed a week positive correlation between pain score and IL-6 salivary concentration values.
All these results suggest that topical steroids are more effective in management of symptomatic OLP than LLLT which can be used as an alternative treatment modality. IL-6 salivary levels are higher in the erosive/atrophic subtype of OLP than the reticular subtype and both are higher than the healthy controls and it can be used as a reliable salivary biomarker for monitoring the effectiveness of OLP treatment modalities.