| .............. Log on may00 started at Wed May 24 15:24:57 PDT 2000 ........... | |
| ............................ shoogs joined............. | |
| ............................ drburkhart joined............. | |
| shoogs | Hi Art and Nancy |
| ............................ drrees joined............. | |
| drburkhart | Hello Dr. Sugerman, how are you? Thanks for joining us tonight. |
| shoogs | Please, call me shoogs! |
| ............................ MJ joined............. | |
| ............................ sadietwo joined............. | |
| drburkhart | Philip, do you mind if we address you as Dr. Sugerman, otherwise the patients will be confused because of all the other names. Thanks |
| drrees | Type HEREshoogs- Welsome to the chat room. We look forward to working with you. There seems to be quite a bit of interest in any research going on regarding OLP |
| shoogs | No worries! That's OK with me. |
| drburkhart | sadietwo, how are you? do you have a question for anyone? |
| MJ | What time is it in Brisbane right now? |
| shoogs | I looked at previous transcripts - it seemed that there was considerable interest in the latest OLP research |
| shoogs | Time in Brisbane is 9:00 am Thursday |
| drburkhart | Yes, could you tell us what you are working on at the present? |
| MJ | Thanks - sort of back to the future for us on Wednesday! |
| drburkhart | MJ, do you have oral lichen planus? |
| sadietwo | Type HERe I have LP involving my fingernails. I've never had oral LP. From reading your transcripts I don't think you deal with my type of LP. |
| shoogs | We have data that chemicals released from inflammatory cells (called matrix metalloproteinases) cause basement membrane disruption in OLP |
| ............................ prez joined............. | |
| MJ | Dr. Burkhart - No - just an interest - Dr. Wathen tipped me off on the session - I am a general dentist - http://www.jensendds.com - It is a pleaseure to "listen in" on this great session. Thanks |
| ............................ Wathen joined............. | |
| drburkhart | Prez-how are you? Do you have a question? |
| drrees | sadietwo. You are right, our primary interest is oral lichen planus. We do often encounter patients however, who have skin or fingernail lesions. How are yours being managed. |
| drburkhart | Hello Dr. Wathen, Thanks for joining us. |
| aupton | Greetings, Dr. Wathen, et al. Welcome aboard! |
| prez | Type HEREDoes OLP affect the throat as well as the mouth. i have had a sore throat for six months. |
| Wathen | Hi, all. Glad to be with you. |
| ............................ Mio joined............. | |
| MJ | Dr. Sugerman, is there any evidence that an ultrasonic toothbrush either helps or harms oral tissues in OLP patients? |
| aupton | Welcome, mio. The doctors will answer your questions as soon as they can. Good to have you. |
| drrees | prez, most of our patients do not hqve throat involvement although it can happen. Since your throat has been sore for 6 months you probably should have an ENT doctor take a look.I |
| drburkhart | Prez, we have some articles on LP and the throat area, we will send you some. Contact me after the session. |
| drburkhart | Dr. Sugerman, what do you suggest for erosive lichen planus? |
| sadietwo | I was told that cortisone injections could be tried. But there is no guarantee that this would help or if it did help that the improvement might only be temporary. Since my diagnosis last Sept I have done nothing medically for the four nails that are affected. I'm hoping that they will eventually return to normal. As of now they show no indication of improvement. Any suggestions? |
| shoogs | The only data of which I am aware is that periodontal surgery can exacerbate existing gingival OLP - we recognise the Koebner phenomenon in OLP i.e. mechanical trauma/irritation can trigger a lesion in a patient who is susceptible to OLP. One could speculate that, with enough ultrasound, a similar effect might be seen. However, there is data that clean teeth can reduce the severity of gingival OLP. So the ultrosonic brush may not be so bad afterall if used wisely. |
| MJ | Thanks! |
| drrees | MJ- I know you asked Dr. Sugarman about untrasonics and I know he will reply but I'll share with you that we have had patients who did not do well with ultrasonic brushes. They seem to vibrate the surface epithelium away if lesions are severe. |
| ............................ Anne joined............. | |
| Mio | Type HERE Dr. Burkhart, I have joined from Gainesville ... am reading along. |
| drburkhart | Hello Anne. How are you? Please feel free to ask any questions. |
| drrees | Hi Anne, do you have oral lichen planus? Do you have questions? |
| drburkhart | Mio, good to have you. Do you have any specific questions? Feel free also to just listen. |
| Anne | Thanks, I am always interested in new research in the field. I have recently been put on plaquenil. |
| drburkhart | Dr. Sugerman, do you see a large of number of patients in your practice with OLP? |
| Anne | I have had oral lichen planus for about 15 years. The plaquenil is for vaginal lp-- |
| shoogs | For erosive OLP, our routine is (i) remove local exacerbating factors - rough restorations etc, (ii) check/modify the drug intake (iii) treat empirically with topical, intralesional or systemic steroids (iv) check for local allergic reactions e.g. dental filling materials - the aim of treatment is to reduce the severity of lesions back to a hyperkeratotic pain-free state |
| MJ | Dr. Sugerman: Do you suggest any specific types of toothpaste for LP that may reduce problems, such as Rembrandt which minimizes apthous ulcers? |
| drrees | Anne, we are very interested in plaquenil for LP. What has been your experience so far? |
| ............................ prez left............. | |
| ............................ prez joined............. | |
| prez | Type HEREI I got disconnected. Am back. My ENt can find nothing wrong . any suggestionbs on how to cope with the throat problem? |
| Anne | I have been on the plaquenil for 6 months. This week my dentist felt there had been some improvement. |
| drrees | Anne- have your oral or vaginal lesions been biopsied? |
| drburkhart | Prez, why do you think that you have LP of the throat? |
| ............................ Wathen left............. | |
| ............................ Wathen joined............. | |
| Anne | Yes, both have been and determined to be lp. Also had biopsy of areas on my back which are lp. |
| prez | Because they cannot find any other reason for soreness. |
| drrees | Anne, Has your physician tried any other systemic medications? If so, what? |
| drburkhart | Prez, the only sure way to know that you have LP is through a biopsy. Many lesions may have the appearance of LP. Has anyone suggested a biopsy? |
| prez | Dr.B. I need agood doctor or dentist in New Jersey who understands this problem and will monitor it carefully for me. I live in Monmoutn County |
| ............................ Moni joined............. | |
| shoogs | OLP is definately the most common non-infectious oral mucosal disease in adult patients referred to our Oral Pathology clinics. our recent survey showed 14% of referred patients had OLP. A similar survey in London showed 32% of referred patients had OLP. |
| ............................ sadietwo left............. | |
| Anne | I used lidex gel for years for oral lp. Tried temovate ointment for the vaginal, helped but did not clear it up. Then tried plaquenil. |
| Moni | Type HERE Moni Hi My first time on |
| shoogs | I think that the blandest toothpast available should be tried in the first instance |
| drburkhart | Prez, contact me for through email (on the page site) and I will send you a name. We have established a network of practitioners throughout the world and will have no problem sending you a contact. |
| ............................ sadietwo joined............. | |
| aupton | Welcome, Moni! Ask if you have a question, fire away. The Doctors will answer as soon as they can |
| drburkhart | Moni: welcome. Do you have oral lichen planus? Do you have any specific questions? |
| ............................ Mio left............. | |
| prez | Dr.B. I have had a biopsy of the inner cheek. confirmed OLP. it does skip around. The pain is in one part and then another . the worst is the tongue. I live on Orabase b. |
| Anne | what's orabase b? |
| drburkhart | Prez: how long have you been under treatment? |
| ............................ MJ left............. | |
| Moni | Moni Yes I have Oral Lp Ihave read most of your posted chat discussions . I have had it for over three years |
| ............................ Mio joined............. | |
| ............................ MJ joined............. | |
| drrees | Anne, Orabase B is a topical coating which has an numbing agent in it. It may sooth the lesions but it will not make them better. |
| drburkhart | Dr. Carpenter is having trouble getting connected to our discussion. Hopefully, the California lines will become less concentrated soon and he will join us. |
| Mio | My patient is on a long list of medications re: cardiac problems/by-pass surgery. Are these multiple medications a causative factor? |
| prez | I have had this since january. I have been using the Orabase since late February. It is a substance in a tube which can stick inside the mouth. The B stands for "with Benzacayne". It really just gives relief because it numbs the area. |
| ............................ William joined............. | |
| drburkhart | Hello William. We are glad to have you join us. Do you have a question? |
| drrees | Mio. Yes, a relatively large number of meds can cause a lichenoid reaction. If you'll contact us by direct e-mail we can send you a list. |
| drburkhart | Prez: Tell us about your history. |
| William | Well I've suffered Lichen Planus for about two years and am just looking for information |
| shoogs | Regarding throat involvement, my personal view is that lichen planus, like graft-versus-host disease following bone marrow transplantation, can affect any epithelially-lined surface including mucosa (oral, genital, bladder, respiratory), skin, scalp, nails and maybe the gut and liver - the problem is, no one to my knowledge has looked at many of these sites |
| drburkhart | William, you have come to the right place. Hopefully, we can provide some answers. |
| ............................ Wathen left............. | |
| William | I am all ears |
| ............................ Wathen joined............. | |
| drburkhart | William, what type of tx are you currently receiving? |
| drrees | Prez, If your dentist is interested we would be happy to discuss some specific treatments which you might try. He or she can contact us |
| William | None to speak of. My dentist said he knew nothing about the whole thing and threw up his hands |
| drburkhart | Dr. Sugerman, this is so true> We need more research in these areas. |
| prez | Dr. B . my history is really that I got this condition after being told that I had a nodule on the Tyroid gland. I wound up having surgery. The nodule was benign but I still have the OLP> I gather from reading past chats that you are a strong believer in a stress relationship. True? |
| Moni | Moni This is moving too fast for me,I have found a oral pathologist just two weeks ago thu one of your chat group I'm doing a little better now I have sores in my cheek and on my tongue have lost a lot of weight. I live in a small town ,no one seemed to know what it was. |
| shoogs | Obviously, collaboration with other medical specialties is required to examine other sites |
| ............................ Anne left............. | |
| drburkhart | Prez, Yes, I do believe that stress management can help many patients. We have been able to recognize some stress factors in certain individuals. Do you have any techniques to reduce stress? Have you tried any stress reduction classes? |
| ............................ sadietwo left............. | |
| ............................ sadietwo joined............. | |
| Moni | Moni has any one else had this lp years ago ?? Or is it new ? |
| William | About two years ago the problem started in one side of my mouth at the rear around the gum and on the cheek (inside) where my molars were removed many years earlier. Only basically on one side originally and it happened after a rough tooth cleaning episode. |
| drrees | Moni- glad to know you have found someone who may be able to help. Our experence is that most patients with OLP can be helped. The lesions don't always go away but it may be possible to make you more comfortable. |
| prez | I worry about this condition leading to a more serious one. Any studies to show this? I am looking into stress management but am not really sure it is the problem. I think this is the most bixzarre thing I nave ever experienced. |
| drburkhart | Dr. Sugerman, could you elaborate on what your opinion is regarding stress and disease> |
| drrees | Moni, it was first described over 100 years ago. It does seem to be increasing in incidence however. That may be because we are living longer or it may have to do with our lifestyle, medications, and things such as mouthrinses and toothpastes etc. |
| prez | Is an oral surgeon or a periodondist best equipped to deal with OLP? |
| ............................ Mio left............. | |
| drburkhart | Prez: this is what we commonly hear from most patients. It is very irritating to everyone. Anytime you have a condition that chronic, the disease begins to cause you anxiety. |
| ............................ Mio joined............. | |
| drrees | prez- It all depends on how much exposure your specialist has had to oral medicine. Both have some knowledge regarding the disease. |
| Moni | Moni I am always under a lot of stress also a very nervous person. But I have a partiar dental and this all started about 2 years after I got it ,My dentist laughed at me when i asked if this might cause the sores . Could this be my problem? |
| prez | I feel alone in this. I will definitely email Dr. B. to get a referral in Monmouth County, NJ |
| drrees | Moni-On rare occasions we have seen OLP as an allergic reaction to dental materials including metals. One way to find out would be to leave the partial out for a while and see if things get better. Also, an allergist can often test you to see if you are allergic to dental materials. |
| shoogs | Psycholoigal stress is probably an important exacerbating factor in many OLP patients. This is similar to oral aphthous ulceration (canker sores). I, for one, get a canker sore or two before talking in front of a live audience and I think that OLP might behave in the same way. My experience is that many patients do not identify many "every day" events as stressful - such as planning a holiday or some other change in the "normal routine". I do emphasize that psycholog |
| ............................ Wathen left............. | |
| MJ | Dr. Rees - what alloys are the most common offenders for OLP...? |
| ............................ Wathen joined............. | |
| drburkhart | Prez, this is what a support group provides to the members-a feeling of social support. Others feel the same way that you do. |
| ............................ aupton left............. | |
| drrees | MJ-mercury is most common with nickel next. However, we have seen reactions to precious metals such as gold and palladium |
| ............................ aupton joined............. | |
| prez | Do other people in the group find that the pain can be on top of the tongue one day and on the tip another or on the lip. It even has calm days but never totally gone. |
| drburkhart | Dr. Sugerman, thanks-I could not have said it better myself. |
| Moni | Am I the only older person with this Lp ? I am over 65. Seems like its a baby boomer thing. I am a very active person and have no other series problems except arthritis and allergies to some drugs and the sun |
| drburkhart | Moni, we receive email from all age groups. From someone who is 20 to another who is 87. |
| ............................ William left............. | |
| ............................ sadietwo left............. | |
| drrees | Moni-it is not just for baby boomers. The average age of our patients is 56 and many are well over 65 when they first develop symptoms. |
| shoogs | Dr Burkhart, what can be done to reduce psychological stress in OLP patients - are there studies to show that this reduces the severity of lesions? |
| ............................ William joined............. | |
| ............................ sadietwo joined............. | |
| William | I understand that cholestrol reducing drugs might have some effect on the condition. I have been on Pravachol and later Baycol most of the time that the condition has been bad. I am retired so stress should not be a major factor. Aloe Vera juice seems to keep it somewhat under control but it comes back relatively fast. |
| prez | Moni, I am 56. I am a runner and have many interests. Now I am so devistated that I haven't been out running in a month. you are not alone. |
| drrees | Moni, I should add that if you take medications for your arthritis it is possible that the meds play a role, especially non-steroidal anti-inflammatory drugs. |
| prez | Can HRT drugs such as Estrace be a contributor? |
| drrees | William, aloe vera is an anti-inflammatory agent and it may help some but it is usually not strong enough to be of much benefit. |
| drrees | prez-not that we know of unless Dr. Sugarman has some other information. |
| ............................ Mio left............. | |
| Moni | drrees Moni Yes ,I just read that and I was on Motrin for 3 years for a neck injury . What could I take in place . I do need some thing? |
| ............................ Mio joined............. | |
| William | I suppose that is why it comes right back, but I haven't found anything that will help much short of taking steroids which I hesitate to get involved in. |
| drburkhart | Dr. Sugerman, no there really is no concrete data on stress and oral lichen planus. Some studies have indicated higher rates of anxiety, but I would like to see more in this area. I have interviewed many patients over the past ten years and I do believe that there may be connected to the way certain individuals handle chronic stress. I am always facinated by the fact that most individuals with LP do not believe that they are truly stressed. This is not always the case |
| Moni | prez Moni I know what you mean I used to be an avid gardener and I'm too rundown too do this now. |
| shoogs | Prez, many of our patients are on HRT although there are no reports of HRT triggering a lichenoid response. |
| drrees | Moni, you have asked a very difficult question. Often one needs to experiment. However there is a new class of drugs newly available for arthritis which your physician can tell you about and perhaps try So far I don't think there has been a OLP reaction reported. physicin |
| ............................ Wathen left............. | |
| ............................ Wathen joined............. | |
| shoogs | Dr Burkhart, a confounding factor is that chronic illness probably raises psychological stress in many patients. |
| prez | I started on HRT in july of 1999. I began my OLP problem in January 2000. I am really trying to umderstand this whole thing. Is it related to herpes? |
| ............................ aupton left............. | |
| ............................ aupton joined............. | |
| drrees | prez. It does not appear to be related to herpes or other viruses but someday we may discover that all diseases such as this do have a microbial origin. |
| Moni | drees Moni i am on Pednisone now ,I go back to Dr Zunt in 2 weeks I will be back on here again if I'm invited to tell you what happened and how i am doing |
| aupton | This is SysOp Art, L&G. We have ten minutes left in this session. You may wish to get your final questions ready. |
| ............................ MJ left............. | |
| ............................ sadietwo left............. | |
| ............................ MJ joined............. | |
| MJ | Thanks so much for the great International session on LP - I appreciated it all greatly! I have to go now, so - THANKS AGAIN! Bye! |
| ............................ sadietwo joined............. | |
| William | Is there a non-steriodal treatment for the condition at this time? |
| drburkhart | Dr. Sugerman, Yes this is true. I think that chronic illness is especially difficult because of the expectation in society of "a cure" for any medical condition. In addition, anytime that you have pain, it is a constant reminder. |
| ............................ MJ left............. | |
| drrees | Moni, you certainly are invited and we will look forward to what Dr. Zunt tells you. Please tell her I said hi. |
| Mio | Thanks for letting me join the session. I will be in contact with dr.burkhart and drrees via e-mail or telephone |
| shoogs | A viral aetiology for OLP has been proposed, although there is little direct evidence in support. The herpes viruses are among many that can infect the oral mucosa but they are not recognised to cause lichenoid lesions. |
| Moni | My e-mail address is ronol@psci.net ,if some wants to get in touch I have a long stry and woud love to hear from you. This is a great comfort to me that someone else know what I;m going thru |
| drrees | William, there are a few things which show promise but large scale studies are yet to be done. Someone mentioned plaquinil a little earlier. It has been reported to be of benefit to some patients but like most systemic medications there may be side effects or medical contraindications. |
| drburkhart | Thank you all for joining. Dr. Carpenter has been trying all evening to join us, but has not been able to enter. We are sorry, but he may be with us next session. If any of you have additional comments or questions, please email me at the address on the page. We hope to have future sessions every month or two. |
| William | Thanks for the info and will look forward to a future session. |
| aupton | Thanks to everyone for another fine session. The transcripts should be up on the web site by tommorrow afternoon. http://www.tambcd.edu/lichen Five minutes. Last call. |
| drburkhart | Dr. Sugerman, Please continue to provide us with updates on your research and please join us for another session. This was very informative. |
| Wathen | Good show, all! |
| Moni | Moni Yes Please keep us updated Bye Now |
| ............................ Mio left............. | |
| drrees | Wathen- Thanks Bill. Now come home! |
| drburkhart | Thanks Dr. Wathen. We really miss you . |
| ............................ William left............. | |
| Wathen | I'll be there soon! Keep the engine running |
| ............................ sadietwo left............. | |
| drrees | Thanks to everyone. This has been a good session for us and I hope you enjoyed it too. Stay tuned for future chat room sessions. Also, please read the information on the web site regarding OLP. Goodnight. |
| ............................ prez left............. | |
| aupton | I'll leave the room open for a few minutes after the hour. Thanks so much to everyone, and let us hear suggestions you may have for the future of these sessions. |
| ............................ drrees left............. | |
| ............................ drburkhart left............. | |
| ............................ shoogs left............. | |
| ............................ Wathen left............. | |
| .............. Log stopped at Wed May 24 16:47:44 PDT 2000 ........... |