Transcript aug2001 for #Dental_Study_Club

Log file aug2001 for
Chat room #Dental_Study_Club



.............. Log on aug2001 started at Tue Aug 28 15:41:09 PDT 2001 ...........

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drburkhart Hello all! I would like to take a few minutes to make several announcements

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drburkhart First of all, I would like to thank our web master, Mr. Art Upton, for all the effort and hard work in helping us bring all the discussions to you. He makes it easy for us to just walk right in and sit down.

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drburkhart Thank you, Art
art Hi, folks. Please disregard the "warning" mesage for this time. Welcome!

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jane Type HEREHi Dr Burkhart

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drburkhart Our guest for the evening is Dr. Denis Lynch , DDS, PhD. who is a professor at the Univ. of Tennessee, Memphis. Welcome Dr. Lynch

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DrLynch Thanks. It's nice to be with you.
drburkhart Jane, happy to see you here. You did get on-line

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jane yes
drburkhart Hello, Dr. Rees.
DrRees enis, We appreciate you taking the time to participate. I think you'll have fun.
DrLynch Hi, Terry!
DrRees Hi, Nancy. Here we go again.
drburkhart Sandra, do you have a question for any of us?
drburkhart Jane and Pam, please ask any questions.
Sandra Type HERE How long is the usualy oral outbreak?
DrRees We seem to be a little slow getting started tonight. How many of you already know you have lichen planus?
drburkhart Sandra, could you give us some specific info regarding your problems
Sandra I do
jane is candidas a cause of olp?

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DrLynch Candida doesn't cause LP, but it can be a complicating factor.
drburkhart Hello JP, welcome. Do you have a comment or questions?
Sandra I have lesions and get blisters from time to time
DrRees Sandra. oral lichen planus can last for many years. Strangely enough that's usually not the case with skin lichen planus.
jane does olp cause oral candida?
DrRees Sandra, How do you treat the lesions when you get them? Have you been biopsied to make sure your lesions are OLP?
Sandra Are Dental fillings of the metal kind considered a cause
DrLynch Occasionally denta lfillings can cause a "lichenoid" type of lesion. It looks lke LP but resolves when the filling is removed.
DrRees Sandra, On some occasions they may be. Usually your dentist can tell that by the location of the lesions. However, to really know one needs an allergy test.
pam I have two questions. I recently declined a biopsy. My lichen planus was id'd by my dentist and a periodontist. I'm not sure what the benefits of that would be. I'm also curious about whether anyone has treated their lichen planus successfully with homeopathy. And last question-- has anyone had experience with bleaching their teeth with any effect on their olp? Sorry if this doesn't follow the conversation. It took a while to type!E
JP Type HERECan irritation from a plastic nightguard cause Lp to flare up?
Sandra yes I have had a biospy. I am ususing a mouth rinse that is helping
jane I am just getting into some homeopathic sources to see if they are effective..
DrLynch LP can resemble lots of other conditions and vice versa. I would prefer a microscopic confirmation.

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drburkhart Pam, I will address the bleaching aspect. We have had several patients contact us with this question and we would like to hear from anyone who can give us information regarding their experience. Any irritation in the mouth will usually make the condition worse.

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DrRees Pam, I don't think everyone needs a biopsy but personally I prefer to know for sure what is going on since some other diseases can look like OLP. No luck with homeopathy yet reported in any evidenced based studies.
DrLynch There is not a large body of evidence-based literature on homeopathy, but it also has no significant potential for harm, in and of itself.
drburkhart Mare, welcome, do you have a comment or questions?
DrLynch I expect that bleaching could be irritating, but not otherwise harmful.
aupton POINT OF ORDER: Folks, address your questions to the doctors, and do not ask for a general response from the group. The doctors will start their answer with your name as soon as they can get to your question. Thanx. - art
DrRees I wonder why two of you are trying unproven homeopathic treatment since OLP can usually be managed with meds that have been well documented.
jane Dr Lynch, can olp cause candida?
drburkhart gljamer, welcome, Do you have a question or comment?
DrLynch Jane, LP does not "cause" candidiasis, but may set up an environment that makes candidiasis more likely.
jane oh..I understand
pam I understand the meds are steroids with undesirable side effects. Is that true?
mare Doctors--I had planned to ask the Dentist about bleaching also--the last time I asked he said it would be to irritating--but I really want to have it done
DrLynch Mare, there is no absolute reason NOT to have the bleaching done. I wouldn't avoid it simply because you have LP.
JP Dr.Rees...My aunt was using fluocinolone Acetonide on her skin to treat a problem and was told it could be harmful. I use it in my mouth and now I am frightened. Should I be?
drburkhart Mare, what type of LP do you have? Is it erosive? Ulcer like? Just white lines?
DrRees Pam, systemic steroids can have numerous side effects. There is very little chance of having any with topical steroids escept they may make you more susceptible to yeast infections of the mouth.
Sandra Dr Lynch how can you safely use Fluocinonide in your mouth when it is for external use?
DrLynch JP, I agree with Dr. Rees. Topical steroids are very safe and very effecive in treating symptomatic LP.
mare Dr. Burkhart it is erosive and Thank you for referring me to someone in the Richmond school..I have yet to call but I plan to get in touch with him
DrLynch Sandra, there is no harm in using topical medication like Lidex in the mouth. The manufacturers simply don't market them that way.
pam Are topical steroids used principally if you have a flare-up? My olp is not bothering me at the moment. Seems to be the white line variety.
DrLynch Pam, in general, if the lesions are not symptomatic, then no treatment is necessary.
gljamer Mare, make sure you see the dr. Dr. Burkhart refered you to, I did and saw Dr. Lynch in Memphis and I am must more informed and calm about my olp now!!
JP I seem to be in a remissionperiod...no real problem for months. Do you still recommend biopsy to be done periodically?
drburkhart Mare, we have many patients who contact us wanting someone in their area who has an interest in LP. We are happy to do this and we are developing a good resource list. We also like to get feedback from the patients after they go to the facility
jane I used lidex and it seemed to erode my gingival..amall white "pimples" appeared and then center broke. Then the culture came back and I had candida
DrLynch JP, not unless there is a significant change in clinica lappearnace or some other confounding factor, e.g., tobacco use.
DrRees JP, only if you have active lesions. We are all seeking remission and if you have it we wouldn't know where to biopsy.
mare Doctors--I have had reasonable success with Orabase with Kenalog...however I have to use it every day to avoid a larger flareup..however the bad news is that for the first time I have a large "pimple" on the side of the tongue which has become very sore..
DrLynch Jane, many people have candida in their mouth normally. Steroids occasionally cause the organisms to grow out of control--thus an infection. These are usually easy to treat.
jane mare, that sounds similiar to my reaction to "lidex"
DrRees Jane, we have never seen topical steroids erode the gingiva. However, as we mentioned you may get yeast. Please refer to the web site for some pointers on how to use topicals.

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jane Dr Lynch, I was examined and prescribed lidex at the same visit the culture was taken of my mouth that later came back as candida
DrLynch Mare, I've found Kenalog in Orabase to be too weak for most cases of symptomatic LP. I'd recommend Lidex and if that didn't wotk, then Temovate.
drburkhart Jane, Dr. Rees is so correct, we hear from many patients who are not using the topicals correctly.
JP I used Orabase B for months daily when my LP was active..the only relief that i could get...no harm
drburkhart Sonny, welcome. Do you have a comment or question for us?
DrRees JP, orabase is ok as a dressing but be careful with the B (benzocaine) it can burn tissue.

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gljamer Drs. I have noticed a deterioration of overall health of my mouth since being diagnosed even though I am having my teeth cleaned every 2 months and using care in my dental hygiene. Any suggestions.

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DrLynch Jane, lots of patients have candida present in their mouth and use Lidex without a problem. Some people aren't so lucky. Often, if yo can clear up the candidiasis, you won't get a recurrance
drburkhart gljamer, could you give us more information. Oral hygiene (cleanings) are very important.
DrLynch gljamer, be sure yo're not being too aggressive wit hbrushing and flossing. Yo can actually have too much of a good thing.
jane Dr Lynch, that would be pleasant!
drburkhart gljamer, are you using the biotene toothpaste?

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pam how often are cleanings recommended? I'm getting them every 4 months.
DrLynch Jane, I've had good success with candida prone patients using Peridex or Periogard prophylactically. The down-side is that some folks get a problem with stain.
drburkhart Hello sjl, do you have a comment or question for us? Welcome to the discussion.
JP Can having implants put in activate the LP due to irritation from so much work done by the dentisT?
jane Dr Lynch, I am fanatically hygenic..use biotene products take vitamins..yet I have a candida problem..
DrRees Pam, it is an individual matter. It depends a lot on how sore your gums are. If they keep you from brushing well you may even need cleaning more often than 4 months. Usually not.
jane Dr Lynch, doesnt Periogard contain alcohol?
DrLynch Jane, how have they treated your candidiasis?
gljamer Drs. Gum deterioration mainly, alot of bleeding and sore gums, yes I am using biotene, maybe I am too aggressive

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DrRees JP, Good question. I think that dental treatment can make the lesions worse temporarily but in the long run you will benefit from the dental therapy.
DrLynch Jane, both Peridex and Periogard contain alcohol, which may limit their use.
pam Are there recommendations concerning diet regarding olp?
drburkhart gljamer, how long have you had the lp? How often are evaluated? How often do you have your teeth cleaned? Were you biopsied?
jane Dr Lynch, I recently found out I had this problem..so just the lidex and diflucan.

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jane DR Lynch, is nystatin a good medication for it?
DrRees gljamer, That sounds like gingivitis which can get worse while you have OLP since it is harder to clean well.
aupton Welcome, Sandra. if you have a question, ask away. The doctors will get to it as soon as they can.
Sandra DrRees is this hereditary?
gljamer Dr. Burkhart, diagnosed in April, biospy in June by Dr. Lynch, will see him again in Dec., teeth cleaned every 2 months
drburkhart Pam, the general rule is, if it burns, it is best avoided. We get emails from patients who have problems with so many different foods.
DrLynch Jane, Diflucan is usually effective but has to be prescribed for at least a week. in Ob-Gyn they use a "one tablet" approach thart seems to work for vaginal candidiasis but isn't very helpful in oral candidiasis.
DrRees Sandra, There are a few reports where LP runs in families. However that is very rare.
jane Dr Lynch, I have been given 100mg (15 tabs) first day take 2 tabs...once so far and am requesting a refill..as soon as the pills were gone i begain hurting again..

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drburkhart gljamer, you are doing the right things. Have you tried the really soft Biotene brushes. Some people have really liked these and some people say they are too soft. However, if you have much ulcer, erosion, it may be good for you.
DrLynch Jane, nystaitin only works topically so yo have to either frequently dissovle pastilles, swish a suspension, or dissolve vaginal suppositories. They all work but the "hassle factor" is a pain,
pam does anyone believe olp is brought on by hormonal changes (such as I am experiencing in menopause)?

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DrRees Pam, we've looked at that and were not able to find a connection. However, OLP is far more common among women who have had hysterectomies are been through menopause.
DrLynch Pam, there is a well-rcognized hormonal influence on LP. We don't completely understand it, but we all recognize it.
aupton Welcome, bill, ask any question you may have and the doctors wil answer as soon as they can.
gljamer Drs. How do you know if it is brought on by hormonal changes since most women are not affected until early 50's.

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jane Dr Lynch, I also read that people who have dentures should make sure to soak them in nystatin..as the yeast is active there..I guess that goes for toothbrushes also..
drburkhart Pam, that is a good question. There is no research to support this aspect, but we do see this age range who report lichen planus. This does not explain why men in their 40's have lp or why even children may have lp.
DrRees gljamer. Your point is well taken. It is also true that many women who take hormonal supplements still get OLP.:
jane isnt olp an autoimmune disease?

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DrLynch Jane, I'm not convinced that the expense of nystain rinses for the denture , toothbrushes, etc. is justified. In most cases, good denture hygiene and regular changing of tooth brushes sholdbe sufficient.
DrRees Jane, I think we will all probably answer this, but OLP is probably autoimmune in one respect but it apparently won't happen unless something external triggers the reaction. Sometimes we can identify the trigger mechanism but usually we can/t
jane Dr Lynch, I also read that diluted bleach clean dentures and toothbrushes of candida..but be sure you rinse WELL
mare Doctors-what is the difference in Lidex vs Orabase with kenalog please??
DrLynch Jane, the immune system certainly plays a significant role in LP, but there is no evidence that actual antibodies against some component of a patient's skin or mucosa are made by the immune system. It's more correct to refer to LP as "immunologically-mediated".
drburkhart Dr. Lynch has introduced an important point, how many people change tooth brushes every few months. I even heard someone report that they had the same brush for several years. They should be changed every two months and thrown away if you have had any type of virus.

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DrRees Mare, Lidex is stronger and we like it because if comes in a gel. Kenolog in orabase is ok as long as you respond to it.

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drburkhart Bill, welcome, Do you have a comment or question?
pam RE: triggers: I want to report one flare-up on a recent vacation. The triggers seemed to be some stress, being at the end of a course of antibiotics, and drinking an intense cinnamon coffee.
DrLynch Jane, dilte bleach is fine, but extended use may discolor the denture.
jane I used to change my toothbrush every 3 months..now I feel like I should change more frequently..
mare Does the Lidex come in a paste?

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jane mare.lidex does come in a paste..but be careful how you apply it, as Dr Burkhart mentioned earlier..
DrLynch Mare, Lidex comes in several forms. I've found the gel forms works best for my patients.
DrRees Pam, you have identified at least two factors which may trigger the reaction- the cinnamon and stress. A few antibiotics can trigger but usually the problem with them is they make you susceptible to yeast.
drburkhart Pam, we continue to get reports (here she goes again) that patients really have more problems with their lp during times of stress. We are adding a new page to our site on stress managment and life style changes.
pam that would be helpful to me, thank you!

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DrLynch Pam, I agree regarding the stress aspect. The problem is that stress is both individual and (it seems) unavoidable.
gljamer Drs. I was keeping a journal for awhile but didn't find any real clues, do you suggest I keep this up?
jane Dr Rees, I definately have stress and take xanex for it..bu apparently this hasnt prevented olp from "getting me"
mare Are there any new steroids (such as Lidex) on the Horizon?

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drburkhart To all: yes, stress has become a way of life for all us. There are ways that help us deal with it on a personal level. What is stressful for one person may not be for someone else.
gljamer Drs. I also have been on an antidepressant for many years, is there a clue there?

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jane Dr Rees, In my research about olp I have heard that Drs prescribe xanex type drugs FOR the outbreak of olp..
DrLynch gljamer, a diary is helpful for some patients but if you don't see any trends or relationships after several months it probably isn't going to help much.
DrRees Jane, as Dr. Lynch mentioned stress may play a role but it is an individual thing. I am not much in favor of taking meds to control stress related to OLP since one never knows when to stop taking them.
drburkhart gljamer, a journal is a great idea. Sometimes, it takes some time to see any patterns, if there are any in your case.
DrLynch gljamer, antidepressants also cause dry mouth in many patients. This makes LP even more uncomfortable.

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jane Biotene make a gel for drymouth that helps
DrRees gljamer, Yes there are some clues there. Occasionally antidepressants can cause a lichenoid reaction. More importantly, perhaps, they make your mouth dry and therefore more easily irritated.
DrLynch Jane, all of the Biotene products work very well--especially the OralBalance gel.
jane Dr Lynch, yesllbiotene products made a big difference in my olp
aupton POINT OF ORDER: (THere he goes again!) -- It would help if you could address your questions to SPECIFIC doctors: Either Dr. Lynch, Dr. Rees or Dr. Burkhart. -- art
drburkhart Jane, I agree with Dr. Rees. Often, we are over medicated when diet, exercise and stress reduction are more beneficial. There are only some cases in which depression that needs to be controlled with medication the optimal and only choice of action.
DrLynch To all, someone was talking previously about dentures. Biotene has just come out with a denture adhesive, as well.
mare Yes--I agree the Biotene products help with my OLP also
jane Dr Lynch, I had been using regular toothpaste with salicities(?) and mouthwash with alcohol, and rinsing with hydrogine peroxide ..

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pam Dr. Rees:could olp be caused by being a lifelong mouth-breather? (a habit I started as an asthmatic, though I outgrew the asthma, not the habit of breathing always through my mouth.
gljamer Dr. Lynch I have not met another person in my city with olp since I have been diagnosed , how common is it?
DrLynch Jane, I think what you're referring to is soldium lauryl sulfate or SLS, the foaming agent in most toothpastes. this can be very irritatin in some patients. Biotene toothpaste is SLS-free.
Sandra Dr Lynch where are the Biotene pruducts sold, ?
DrRees Pam, no it wo'nt cause OLP but mouthbreathing dries your mouth and as I mentioned earlier this may make the tissues more easily irritated.
jane dr Lynch, yes thats it :)
DrLynch gljamer, LP is very common--estiamted to be present in 1-2% of teh population (Ithink that's a bit high, but it is very common, none the less)
jane Pam, I am also a mouth breather and it does help irritate the olp..the Biotene mouth gel helps somewhat
pam thanks, jane I'll try some of that
DrLynch Biotene products are available in most pharmacies. I'm sure they'd order some for you. They also have a nice web site. I believe it is www.Laclede.com
gljamer Dr. Burkhart, does scar build up inside the mouth ever necessitate surgery?
drburkhart Jane and Pam, yes, I have gotten reports from patients who use the gel before going to sleep and think that it works well.
aupton TIME CHECK: About 15 Minutes to Go, everyone.
jane Dr Burkhart, thats the best time to use it
jane because saliva isnt as much when we sleep..
drburkhart Jane, anytime, but for mouth breathers, it is especially beneficial at night.
mare Sandra-Rite-Aide pharmacies are a good source for the Biotens as well.
jane Dr Lynch, getting back to the candida connection..why is it that when taking diflucan..all pain stops..from olp?
pam RE: journal writing, I will keep track during the next month of stress and it's effect on my olp and report back in a month if I see any patterns worth noting.
DrLynch To all, I've noticed a number of my LP patients have LP of the scalp with no other skin or genital symptoms. The scalp LP masquerades as "dandruff", seborrhea, etc. Has anybody elso noticed this?
DrRees gljamer, I think Dr. B didn't see your question so I'll give you my view. OLP usually does not leave scars apparently because the lesions are relatively superficial. I have never seen a patient who required surgery to remove scars caused by this disease.
drburkhart gljamer, we have not had too many reports related to scar tissue. Do you have a specific question about your own mouth? Did you have previous surgery or is it related to just the chronic lp lesions over a period of years?
DrLynch Jane, the discomfort is probably from the candida, not the LP. When you're on Diflucan the candida is gone--so no symptoms. Unfortunately, when yo go off the Diflucan the candida comes back.
mare Dr Lynch--no
pam DrLynch: I have noticed more "dandruff" than previously so perhaps I am one
jane Dr. Lynch,do you think olp is exacerbated by a colder, damp climate?
drburkhart Pam, it is important to notice the difference in your body. As we said, some things may stress you that you may consider just routine. Sometimes it is not only events, but certain people.
jane Dr Lynch, could my one biopsy that said olp..be mistaken for candida?
DrLynch Jane, I don't think cliimate has anything to do with LP being worse or better unless you get "stressed" about the climate itself.

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drburkhart Denis, good point.
mare Jane-I live in the hot, humid South!!!
drburkhart Twiz, welcome. I think that you are from the UK, right? Do you have a question or comment?
jane Mare..I sued to but when I moved to NC the olp got worse..
DrLynch Jnae, a pathologis wouldn't confuse LP with candidiasis. He/she could always go back and restain the slide specifically for candida to see if it was presnt in the bioppsy specimen. Sometimes it's not all that apparent.
DrRees Mare and Jane- I work in Texas and it gets a little warm here also.
pam drburkhart, thank you for those suggestions. I will scan not only the events like upcoming travel for work, but the routine as well and I might have overlooked that.
jane Dr Lynch, can pollution be a problem for olp?
DrLynch Jane, I don't know of any established relationship between LP and pollution.
drburkhart Jane, we have not had any reports related to the climate. We get emails/letters from all over the world.
jane Dr Lynch, a pathologist i going to look at the biopsy to check for that..I think
twiz Type HEREYes,are there certain chemical things in food that afffect OLP,or make your mouth sore,it's just that I keep being surprised at what I can't eat!

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DrRees twiz, what are some of the things you can't eat?
aupton TIME CHECK: 5 MINUTES TO GO, folks. Please begin wrapping up your conversations. I will leave the room open for about 5 minutes past the hour for the exchange of email addresses, etc. The transcript for tonights session should be on the web site in the morning.
DrLynch Jane, again let me remind you that the presence of candida organisms on a slide doessn't necessarily mean you have candidiasis. I wouldn't automatically base anticandida therapy on the demonstration of organisms just on a slide. That's only one piece of the puzzle.

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drburkhart Pam, I have found that many of the OLP patients may have been under chronic stress for so long that they may not know what the body is like when it is not stressed. This is not true in all cases, but there does seem to be a pattern.
jane Dr Lynch, I dont think I have candidiasis..just a problem with candida in the oral cavity

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mare Dr Burkhart-I will e mail you when I get that appointment with the patholigist(Dr. Svirsky) in Richmond, Va
drburkhart Twiz, what types of foods make the condition worse?

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jane Dr Burkhart, that sounds familiar :)
drburkhart Mare, yes, please do. As I understand, there are several really good people at that facility.
twiz any curry or spicey food-yesterday my mouth blistered straight away-and it must be ciitrus juice also becauseI have been drinking orange juice for my cold.What can you drink and it is just painful or does it exacerbate OLP. Any research?
sjl Type HEREhi
DrLynch Jane, if you're symptoms go away when you are on anti-fungal medication, it would seem that you do have "candidiasis". It can be a tricky problem to both "nail down" in terms of diagnosis and occasionally treat, as well.
Sandra Doctors thank you for your information and concern
gljamer Thanks again for being out there. I reaally appreciate you all!
mare Doctors-yes thank you for your time and making this site available for us!!!
pam DrBurkhart, did you say the stress management page exists yet?
sjl Hello
drburkhart twiz, the foods that you report are common problems. We get many emails from people in India related to the curry.
jane Dr Lynch, is there a test to diagnose candidosis?
DrRees twiz, the things you mention are often discussed by others as well. They probably just make the sore tissue burn most of the time but you are right, sometimes something like curry will make the lesions worse.
aupton THANKS TO EVERYONE FOR PARTICIPATING TONIGHT. PLEASE BEGIN SIGNING OFF. THE TRANSCRIPT WILL BE ON THE WEB SITE IN THE MORNING.
drburkhart Pam, Art is putting it together on the site right away. Keep checking

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sjl Can You see my typing
DrLynch Jane, there are several, some chair-side, some microscopic, and some utilizing a culture.
jane thank you Dr Lynch,Burkhart,Rees
DrRees Thanks to you all for joining us tonight. We hope this has been of some service to you.
sjl hello
DrLynch To all, thanks from Memphis!
pam thank you, all. this was my first web chat ever and it was very helpful.
drburkhart Thank you Denis-very good session. Thanks to all of you. Let us hear your suggestions. Thanks Terry and Art. Talk with you soon
sjl dont leave
DrRees Denis, we greatly appreciate you joining in. I told you it would be fun!
aupton sjl, the session is over for tonight. Drop us a note on the web site.
jane slj..its too late..sorry
drburkhart sjl, you can contact me by email-on the site and I will be here.
DrLynch Terry and Nancy, thanks for the invite. We'll do a "command performance" in the future!
DrRees Nancy, I'm sure we'll talk by e-mail tomorrow. Good session.
sjl thank you

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aupton Dr. Lynch, thanks very much for our participation!
jane slj Dr Burkhart is wonderful, she will help alot
DrLynch Art, good job!
twiz I have not had a biopsy yet,but go to the specialist next week,should I insist - they assure me that it is "just" olp. Couldthey be wrong,could it be allergy?

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jane twiz, they will know it is olp from the biopsy..

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jane email dr burkhart about any concerns..she is wonderful and so helpful
jane bye twiz..dont worry
twiz Thanks,I think I got the time zones wrong
aupton KEEP CHECKING HERE FOR NEWS OF THE NEXT LIVE DISCUSSION WITH DOCTORS FROM BAYLOR COLLEGE OF DENTISTRY. THANKS FOR DROPPING BY!

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