Oral lichen planus (OLP) is considered a T cell-mediated chronic inflammatory process activated by an unknown antigen, making basal keratinocytes vulnerable to a cytotoxic cell mediated immune response. The aim of this review is to summarize information on the role and pathways of Epstein–Barr virus (EBV) and immune cells in inducing OLP as an autoimmune lesion. The pathogenesis of OLP is analyzed from immunological aspects of interactions between EBV and oral mucosa. The results of the available studies allow us to assume that EBV can act both as an exogenous and an endogenous antigen in the pathogenesis of OLP. We emphasized the role of antigen-presenting cells (APC), such as dendritic cells (Langerhans cells, LC), in detecting and capturing antigens and modulating the adaptive immune response. Although EBV shows tropism for B cells and epithelial cells, under certain conditions it can infect monocytes, LCs, NK, and T lymphocytes. It means that under some circumstances of the chronic inflammatory process, EBV particles can react as endogenous agents. During the development of the autoimmune process, a decisive role is played by the loss of immune tolerance. Factors like the activity of cytokines, chemokines, and autoantibodies secreted by EBV-positive plasma cells, autoantigens formed due to virus protein mimicry of human proteins, new self-peptides released from damaged tissues, self-reactive B and T cells, dysregulation of LC function, the anti-apoptotic effect of EBV early lytic antigens, and an imbalance between inflammatory and anti-inflammatory immune cells facilitate the development of an autoimmune process.

The presence of human herpesviruses is frequently detected in the oral cavity, yet their disease-specific role in chronic inflammatory oral mucosal disorders remains uncertain. This comparative observational study investigated Epstein–Barr virus (EBV) and human herpesvirus-7 (HHV-7) genomic sequences in saliva and virus-specific antibodies in serum among patients with oral lichen planus (OLP; n = 35), aphthous stomatitis (AS; n = 31), and healthy controls (n = 34). Salivary viral loads were quantified using real-time PCR, while EBV and HHV-7-specific IgG and IgM antibodies were measured using ELISA-based assays. EBV and HHV-7 DNA in saliva were commonly detected across all groups, demonstrating high baseline shedding and marked interindividual variability. Although EBV IgG levels were higher in OLP compared with AS in univariate analysis, multivariate regression revealed that age, rather than disease status, was the primary determinant of EBV IgG levels. After adjustment for age, sex, and discomfort, neither EBV nor HHV-7 salivary loads showed independent associations with OLP or AS. HHV-7 salivary loads were uniformly distributed among groups. These findings suggest that salivary detection of EBV and HHV-7 reflects widespread latent infection rather than disease-specific activity in OLP or AS. Longitudinal and tissue-based studies integrating immunological profiling are warranted to clarify whether herpesvirus reactivation contributes to disease severity in defined patient subgroups.