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South African Dental Journal

versión On-line ISSN 0375-1562
versión impresa ISSN 0011-8516

S. Afr. dent. j. vol.74 no.10 Johannesburg nov. 2019 



Physician and Dental Surgeon's roles in diagnosing hypertension in association with Lichen Planus and Geographic Tongue - The perspective of a Clinician



VK Vaishnavi VedamI; G SivadasII

IMDS, Senior lecturer, Faculty of Dentistry, Asian Institute of Medicine, Science and Technology (AIMST) University, Malaysia
IIMDS, Senior lecturer, Department of Pedia-tric Dentistry, Faculty of Dentistry, Asian Institute of Medicine, Science and Technology (AIMST) University, Malaysia




Dear Editor,

Hypertension is a serious medical condition resulting in a high degree of mortality if undiagnosed and untreated in the early stages of its progression. Although public awareness of this cardiac manifestation has increased, asymptomatic cases still go undetected and untreated, resulting in complications.

The General Physician (GP) is the first line of interaction with patients presenting varying degrees of hypertension. The Dental Surgeon (DS) encounters a wide range of patients with oral manifestations of Lichen Planus and Geographic Tongue (Benign migratory glossitis, erythema migrans).1

Liaison between the GP and DS in the management of these patients is rare as they usually limit themselves to the principal problems of patients. However, current researchers suggest a possible link between the occurrence of Lichen Planus, Geographic tongue and hypertension in adults.

Cardiovascular Diseases (CVD) have over the last few decades dominated the Malaysian National Health Survey as being the leading cause of morbidity and mortality and that statistic is likely to continue. Of all the risk factors contributing to CVD, hypertension poses the greatest risk for all genders, based on the latest literature.2

The relationship between high blood pressure (hypertension) and the risk of cardiovascular events is continuous, consistent and independent of other risk factors and it may lead to myocardial infarction, heart failure, stroke and kidney diseases.

The latest National Health and Morbidity Survey (NHMS) for risk factors for non-communicable diseases (NCD) showed an overall prevalence of hypertension of 35.3% among adults 18 years and above.2



Jchen Planus and Geographic tongue in hypertensive patients have been reported infrequently in the literature. Jchen Planus (a chronic inflammatory disorder) and hypertension may interchangeably contribute as risk fac-ors with alterations in the underlying immune system.

Notably, Lichen Planus could have occurred as an adverse reaction to the Anti-hypertensive ACE Inhibitor drugs and Statins.3 Reports also suggest that in chronic inflammation, reactive oxygen species and cytokines Tumour necrosis factor TNF, Interleukins IL-2, IL6) are eleased during keratinocyte degeneration in the pa-hogenesis of lichen planus. These may be implicated n the rise of dyslipidemia in hypertensive patients.4

Geographic tongue is an asymptomatic inflammatory disorder of the tongue of uncertain aetiology, but which may be associated with several factors such as /itamin deficiency, congenital anomaly, asthma, systemic diseases such as psoriasis, anaemia, gastrointestinal disturbances, candidiasis, hormonal imbalance and psychological conditions.5

Some of these, such as anaemia and vitamin deficiency, are secondary to underlying hypertension and may 'esult in the development of Geographic tongue. Cases inking the occurrence of Lichen Planus or Geographic :ongue with hypertension may have been under-repor-:ed in the Malaysian population, but that does not weaken the importance of the present discussion.



In view of the rise in the CVD mortality cases with hypertension in adults, the authors believe new associations may pave the way to a potential strategy for General Physicians and Dental Surgeons to identify hypertension at the earliest stages, decreasing the number of missed diagnoses.

An integrated approach is essential in routine clinical practice in the diagnosis, either directly or indirectly, of patients involved with hypertension and/or CVD. An awareness of the clinical and oral manifestations observed in the patient may lead to an effective and early diagnosis.

Both the General Physician (GP) and the Dental Surgeon (DS) could reduce the prevalence of the national problem by diagnosing undetected hypertensive cases and, indirectly, the CVD cases, with the help of the associated, although not common, oral manifestation of Lichen Planus or Geographic tongue.

Yours faithfully,

Dr VK Vaishnavi Vedam & Dr G Sivadas


The authors declare no conflict of interest.



1. Kumar P, Mastan KMK, Chowdhary R, Shanmugam K. Oral manifestations in hypertensive patients: A clinical study. Journal of Oral and Maxillofacial Pathology 2012; 16(2): 215-21.         [ Links ]

2. Management of Hypertension. Clinical Practice Guidelines, Malaysian Society of Hypertension, 5th edition; 2018: 26-27. MOH/P/PAK/391.18(GU).         [ Links ]

3. Farzin M, Derafshi R, Ghapanchi J, Kafsh AZ Rezaiee M. Oral manifestations of hypertension and rheumatic heart disease: a cross sectional study in elderly patients. Asian Journal of Medical and Pharmaceutical Researches 2016; 6(2): 09-13.         [ Links ]

4. Arias-Santiago S, Buendía-Eisman A, Aneiros-Fernández J, Girón-Prieto MS et al. Cardiovascular risk factors in patients with Lichen Planus The American Journal of Medicine 2011; 124, 543-8.         [ Links ]

5. Shah N, Kariya P, Dave B, Thomas P. Geographic Tongue: A case report with review of literature. Adv Hum Biol. 2016; 6: 142-4.         [ Links ]



Venkata K Vaishnavi Vedam
Faculty of Dentistry Asian Institute of Medicine, Science and Technology (AIMST)
University, Malaysia.



Author contributions:
1 . Venkata K Vaishnavi Vedam: Primary author - 60%
2 . Ganapathy SIvadas: Secondary author - 40%

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