Transcript jan2003 for #Dental_Study_Club

Log file jan2003 for
Chat room #Dental_Study_Club



.............. Log on jan2003 started at Tue Jan 21 05:01:17 PST 2003 ...........
aupton The Doctors will join us for the discussion in in approximately 35 minutes. Please do not "cross chat" until the discussion begins officially. Thank you.

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wray Hello

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aupton Good morning, Dr. Wray!

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wray Its actually the afternoon

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drburkhart Hello everyone and welcome Dr Wray.

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aupton Weclcome, Dona, cbt, jane and Betsy. The doctors will take you questions now, and answer as soon as they can.
drburkhart While we are waiting for everyone to join, I want to call attention to our reading list on the site. We have added many new articles, books and tapes that are beneficial for everyone.

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aupton Hi, Ruthy -- the doctors will take your questions and answer as soon as they can.

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drburkhart Please make any comments or ask questions.

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Dona Good morning Dr. Wray.. I have noticed that my L/P has gotten so much better in my mouth and gums, since I have stopped using Relafen for anti inflamatory .. Do you think that may have had some bearing on the oral erosion ??
aupton Welcome joel and gljamer. The doctors will answer questions as soon as they can get to them.
JoeI Hello and thank you
fs Treatment: not yet started with a gel to be applied (to lesions) via gauze strips; Problem: where to apply - generally to all visible / reachable gum tissue?
wray Hi Dona, any cases of LP are lichenoid reactions to drugs or other allergens such as amalgam. Antiinflammatories are particularly bad and this is more likely if you have erosions. Changing to another drug may help.
Dona Thank you
DrRees Fs-For the most part you should only apply the steroid gel to areas where you have lesions. Sometimes you may not know exactly where those are so confirm with your dentist or physician as to what areas they want you to include.
jane Does this desease have any effecto on your teeth?

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drburkhart fs-Be sure to read our section on the site on how to apply corticosteroids.

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aupton Jft and Mary, welcome, the doctors will respond to questions in order, and as soon as they can
wray No Jane. LP is purely a mucosal condition
Ruthy Type hereHi,and Thanks. I have added protopic along withtriamcinalone dental paste.I notice that the past week most of the white loose stuff on my gums have fallen away. Feel better. Is this a good sign?

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DrRees Jane- AS far as we know it has no effect on teeth. However, it may be associated with gum disease if you are unable to brush properly for prolonged periods of time.
fs will do; thank you - off to a meeting; will see how things progress ASAP
drburkhart Jane Be sure to read our material on Guidellines for Recall Appointments on the site also.
cbt I use 600mg twice a day of ibuprofen......could this be causing the outbreak of l/p?
aupton hi ollie. The docs will address questions and concerns in order and as soon as they can.
DrRees cbt- That's possible. Can you relate the onset of your olp to when you started using the ibuprofen?
Ruthy Also I read that cancer is a danger. Being cancerphobic as most of us are can you offer some help re this fear?
drburkhart Everyone, just ask any questions that you may have for us.
wray Yes cbt. If you change to another anti inflammatory then it might go away as people react differently to different drugs
JFT I also took ibuprofen often, before my original outbreak of OLP
Dona I have also lost hearing in both ears due to scar tissue of L/P.. Many years of seeing Dr.s, and finally had ear surgery on Nov of 2001. Lasered out scar tissue that had closed my ear canals from L/P From the ear drum in , ears are perfect for hearing.. Have you heard of L/P EVER causing this????

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jane I find I have more vaginal inflamation than oral. I have had many biopsies and they cant seem to come back with any firm diagonsis.
JoeI I have had oral LP for thirty years. It has now begun to attackthe insides of my cheeks, which is quite painful when eating, especially anything acidic. What do you recommend?
cbt no.....i used it for years with no problems and stopped. In a year, had to restart and now have the l/p
aupton hi cm, the doctors will respond as soon as they can.

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gljamer How often are biopsies necessary? in oral lp
DrRees Dona- I am aware of only one case report describing lichen planus of the inner aspect of the ears. You have had a rare experience.
drburkhart Ruthy, the important point to make is that OLP should be checked and if you notice any changes yourself, go back to your healthcare provider and be evaluated. Any irritation should be checked carefully.

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Ruthy Also what are the foods to avoid. My beloved tomatoes...do they have to go?? I have not had a tomato in months
drburkhart Joel, what are you doing for homecare, use of dental products?
cm If one dr. says the lichen planus is ok, get a second opinion if you notice changes
JFT I use the biotene mouth wash and the biotene toothpaste it helps and is almost soothing
DrRees CBT- Do you take other medications that make your mouth dry. Sometimes that seems to cause a lichenoid reaction that would not happen if you had good salivary flow.
cm Suiggle toothpaste i s mild
aupton cm, no cross chatting please. Address your questions directly to the doctors. Thanks.
drburkhart cm-what is suiggle toothpaste?

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Ruthy I see my Dermatologist once a month. Is this a forever ailment and does it ever go away
cm Do a serch for enamel saver and you can find a source. If has floride and stuff, but doesn't burn!
wray Some women also get vaginal LP. It can also be a condition called lichen sclerosis so that will be why there is some doubt about the diagnosis. If you have oral and vaginal lesions its more likey to be LP. It often in these cases affects the gums: the so called vulvo-vaginal gingival syndrome.
Dona Regarding Vaginal problems.. I too, have had a biopsy done and it came back as L/P or sometimes they call it L/S. Lichen Sclerouis.. I am seeing a VULVA Clinic for this .. Have had it 15 years.. I am 69 ..
aupton cm -- let the doctors give advice.

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JoeI I brush with Biotene Toothpast, as it does not burn when brushing as all other toothpastes do. I use Triamcinolone when necessary and have also been prescribed Temovate with little benefit.
Ollie All very frustrating...Still no cause identified...and no cure...no silver bullets. We just wave at the symptoms and hope it slides into some kind of remission. Is there any focussed research happening in this area? Any glimmers of relief?
drburkhart Dona, I have some good articles that I can send you on vaginal LP-if I have not done so in the past.
Barry Doctors, what do yu thnk about the children;s flavored toothpastes. They do not burn.
Mary Type hereDr Burkhart I would like the articles on vag/l/p as well

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drburkhart Barry, I get periodic emails from patients who do use some of the child paste and they work for some people. The Biotene appears to work for most everyone.

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DrRees Ollie, sure! there are are studies attempting to determine the triggering mecanism and certainly a lot being done right now regarding better treatment methods. Unless one discovers the cause of any disease, however, it will tend to return when treatment is stopped. The thing about OLP is to get it under control and then it should be possible to keep it that way with only occasional treatment of early lesions.
Mary Any answers to Ollies question re research?
Dona That would be great Dr. Burkhart.. You sent me the article on L/P of the ears and my ENT. Dr. said I was helping him with that article you sent..He was glad to get it . He had never had a case like mine and was sooooo sure he could help me get my hearing back..

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Goldenfawn im taking plaquenil and its been a mircle for me
drburkhart Mary send me your address and contact me after the session-also Donna. Dr. Drore Eisen has conducted research in this area and has been a guest of ours previously so be sure to read the past transcripts.
wray Barry, Locally we see a lot of people with gingival lichen who are allergic to toothpastes. Childrens toothpastes will have the same flavourings or more so you should not use them but use either simple bicarbonate or use it with dilute peroxide.
Ruthy Please,send me an article on vaginal LP. I have noticed a burning sensation and eruptions of herpes on my buttocks
JFT I have had my OLP for a little over a year, I'm 58. It's been biops and confermed. My mouth is not dry...never has been. Is dry mouth just a sympton but not everyone has it?
drburkhart Anyone, if you want articles on specific topics, email me after the session.
JoeI I have tried everything over the past thirty years to no avail and my OLP continues to spread. What can I do to stop it from spreading?
JoeI I am concerned that my OLP will next attack my throat.
Goldenfawn i recommend Plaqunil.. mine is almost gone!
DrRees JFT- No that is not what I meant. When you have reduced saliva you lose some of the protection that saliva provides and then are more likely to have an allergic reaction. Some OLP appears to be of allergic origin as
JFT I would also like the article on vaginal LP...just for information...better to know the symptoms now in case
Ruthy Why no research on OLP
DrRees Dr. Wray has noted
cbt are you suggesting that the ibuprofen taken at a younger age but with a greater saliva flow did not cause a problem but now at 57, with less saliva, i may be having a problem from the ibuprofen?

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Ollie Regarding the research...Are we any closer to identifying the nature of LP and its triggers? I agree that managing the symptoms is very important...but I don't sense that any progress is being made on the main front.

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drburkhart Ruthy, Dr. Philip Sugerman just published an article in The Australian Dental Journal (listed on our reading list) that speaks to the issue of research on OLP. The article addresses some of the issues being considered with OLP.

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Goldenfawn Plaquinil has been the answer for me
DrRees cbt- I can't say that with certainty but it is a possibility. Saliva has many protective properties that helps to control oral lesions. When it is absent the lesions may get worse.
wray Allergy occurs as a sensitization to something so you are never allergic to something the first time oyu take it. It happens after using it for some time

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aupton For newcomers: welcome, your questions will be addressed a soon as possible. please keep comments brief
Dona If anyone lives in the Sacramento, Ca area, a good place for L/P or L/S is U.C Davis. A teaching hosp.. The Vulva Clinic there is a Life Saver..
jane This is the first time I've joined this discussion. Its scary. We can send men to the moon but cant cure OLP?????
Ollie Any doctor comments on plaquenil? My doc poo poo'ed it.
cm How often does LP result in cancer?
DrRees Jane- Nor a lot of other things. But we are trying and making progress.
Goldenfawn irs worked great for me! wish I had known about it when I as first diagnozed

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gljamer Drs., the doctors in my area just seem to not recognize lp or say just let it go, there's nothing you can do. Any suggestions?
Goldenfawn worls great that is
DrRees Ollie- As goldenfawn pointed out it is quite effective for some patients. Unfortunately it is a relatively potent drug as must be monitored closely with blood studies.

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drburkhart Jane, chronic disease is difficult for anyone. In today's society we want instant cures and it is difficult to deal with a disorder that continues for any length of time. It is important to keep up with current tx. and products that are used.
aupton welcome newcomers. please keep you questions brief -- the doctors will respond as soon as they can. Thanks.

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Goldenfawn i haveto have blood work and get my eyes checked periodically... but its worth it... my OLP was very disabilitating...
Dona They say there is No cure for L/P or L/S, but steroids and cortisones.. We need more studies done.

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DrRees gljamer- One of the purposes of this discussion session is to let people know that something can be done. We would be happy to discusss with your dentist of physician if they would like.
Mary which doctor to see? one for each area affected? or just internist?

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Goldenfawn i see a dermatologist

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Ann what is the cause?

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drburkhart Goldenfawn, there is a great benefit in just hearing that the disease is under control and knowing that periodic checks verify this finding. The psychological aspect with any chronic disease is important.
cbt Have you ever used oral injections of steroids?
DrRees Mary- since this is a disease that affects the skin, mouth and genitalia it is probably best to see a dermatologist, dentist and/or gynocologist.

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Ruthy There is a small comfort in numbers.....How many of us are sufferes in the US?
JoeI I see a dermatologist and an oral surgeon
DrRees Ann-We don't fully understand the cause but sometimes it appears to be an allergic reaction.
drburkhart Mary, I agree with Dr. Rees. It is important to make sure that all your healthcare providers know that you have LP and that they are all on the same page.

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wray Oral injections of steroids can dramatically heal a longstanding ulcer even if it is an inch or more. The steroid also improves other areas since it is absorbed
Lenny Hello to everyone I can only stay for a few minutes. I have to get to work. Anything new in the war against OLP
aupton welcome newcomers. please keep your comments brief, the docs will respond as soon as they can.

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Dona Type here I saw my Gyn for many years and he did not have a clue on what the problem was .. sent me to Mt. Zion in San Francisco for help.. Gyn thought it was a yeast infection ..
DrRees Lenny- That question is a little too broad. Can you be more specific regarding your status?
drburkhart Lenny, there are some new articles on OLP out there and if you contact me after the session, I can get them to you.
Barry ;I see Dr. Silverman at UCSF, He is a Stomatologist
Ann what is the most effective treatment for LC
DrRees Dona- That happens. The information regarding frequency of vaginal lichen has only recently been acquired and not all gynocologist are aware of it yet.
Goldenfawn i need to get going, I just wanted to come on and let everyone know what a miricle Plaquinil has been for me..
jane If anything, you made me see that I have to go back to my dermatolagist. I havent been for a while.
gljamer Do medications such as Pamelor which cause dry mouth cause the problem or just make it worse?
drburkhart Dona, many women complain about yeast infections and discover the relationship later on. That is why it is important to let all the people treating you know about the LP no matter where it is in the body. This means orally or vaginally.

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aupton welcome newcomers. the doctors will be with you as soon as they can.
jake Type lidocaine viscous 2% oral solution provides me with some relef of pain, jake
DrRees Ann- There are a wide variety of treatments that can be used that are effective. We usally start with the one that is associated with the fewest problems and that is a high potency topical corticosteroid.

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Ruthy Any more info re Protopic. I use on one lesion on my ankle and the lesion is healing.

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DrRees gljamer- One or two of those drugs can cause a lichenoid reaction but most just make your mouth dry.
JoeI I have used Protopic on the few sores I get on my body with good effect.
Dona Dr Burkhart, I have been there and done that and for the last 15 years have vag closing. My Vulva Dr. is trying to keep me out of the O.R with using dilators. etc. I am not a Happy camper for sure..
JFT I am of the belief that my OLP is from some type of alergy...but the Dr's (good ones up on OLP) don't think so! It started when I was having a lot of dental work done and just hasn't gone away
DrRees Ruthy- I wish we could say that Protopic is the magic bullet. However, it doen't help everyone. Still it is a great addition to the medications that may help.

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JoeI Is there any relationship between OLP and the mrecury in tooth fillings?
Dona This L/S is not just a womens disease.. It effects children and Men also.

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Ann can you recommend a doc to treat LC in thhe Tallahassee, Fla area
jake my olp started when i was having dental work done.
DrRees Ann- We will try to find someone for you. Contact Dr. Burkhart by e-mail.
Mary How about a knowledgable doctor in Rhode Island?
drburkhart Dona, I hear similar stories from patients who contact us. We try to encourage patients to be checked for vaginal problems if they have OLP.
Ruthy Is there an average age of onset for OLPI am 81,have been healthy all my life until this year with the OPL
DrRees Mary, Same thing-contact us and we will try to find someone to see you.

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JFT Wouldn't you know if you had vaginal lp?

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wray It is the mercury in the amalgam fillings which is the allergen. Allergy testing is not that helpful. The most reliable indicator that LP is due to amalgam is if it is in contact with a filling. Many patients get better if they have all their amalgam removed or at least the fillings in contact with the LP
Lenny This is a very good exchange of information. I have tried several doctors and several different medications, with no improvement. I wanted to stop in and show my apprerciation. I will leave for work , then read the transcripts.THANK YOU DOCTORS! Specially you Dr. Burkhart!
Mary What about gold crowns?
DrRees Joel- Some people are allergic to mercury as well as most other types of filling materials. You should be tested by an allergist or dermatologist however, before even thinking about having the mercury fillings removed.

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drburkhart JFT, most women get yeast infections from time to time and really do not think much about the problem. But, if you have frequesnt problems, you should raise the issue. If you have OLP, them you should see someone and ask the question.
JFT Could it be from some material in a new denture or an dental implant?

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aupton welcome newcomers. the doctors will address your questions and concerns as soon as they can. please keep comments brief.
gljamer My OLP started when I retired and moved to another state. I changed dentists of coarse, could that be related?
wray Gold fillings are usually safe. Allergy testing to gold is quite sucessful.
DrRees Mary-We have found some patients who were allergic to gold crowns. Please read Dr. Wray's comments above. They really apply to all types of filling materials and crowns with the possible exception of porcelain.
Dona There is a help program for L/S on Yahoo run by a great person.. I get so much infor. from it.. Go to Yahoo/Lichen Sclerosis and sign up.
loulou daughter had oral lichen planus for 1 year finally a dermatologist put her on planquenil. The results have been great
JFT I've had a hyseretomy 15 years ago. They took uter. & cervix....the discharge wouldn't be as noticeable if I did, I guess. But I have no signs of any problem
DrRees JFT- We have only seen one allergic reaction to a titanium implant and it did not cause lichen planus.
vic my olc started when I quit smoking about 5 yrs ago
drburkhart gljamer, the location probably has nothing to do with it unless you have some allergic reaction that is from that location such as tress, etc. However, just a move to another state is stressful and sometimes stress may cause a decrease in the immune function.
vic excuse me, olp
loulou She is aware of the side effects of the medicine. The dermatologist has her blood work done several time and is keeping a check on her eyes. Has anyone else had such luck with that medicine?
DrRees Vic-Interesting comment. I am not aware of a relationship such as this with smoking cessation. AT any rate, better to stop smoking and deal with lichen planus or continue smoking and die.
vic what side effects re: planquenil?

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wray smoking immunosuppresses you so stopping smoking may be associated with the start of a disease. This is most noticeable with canker sores. This is not a suggestion to start again!
joni Type here I have been off & on Predisone for over a year & only since I had a full upper denture I have been having a mouth full of sore white spots. I was treated with Diflucan for a week & still have places. can you offer any help?
Ann is stress a major cause of lp

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vic there have been times I'm tmpted to start smoking again...especially when I get thrush

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loulou eye problems and also the medicine works thru the liver. As long as you keep on top of these possible adverse effects things should be ok
gljamer Drs., I was kind of thinking getting off medications if possible is the way to go not adding additional ones. Am I barking up the wrong tree here?
DrRees Vic-Plaquenil can affect blood cells and function of some organs. Careful monitoring will detect any changes before serious damage occurs usually but the cost of treatment is increased markedly due to all the tests.

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vic i get relief from Lidex
JFT What about material in dentures? This all started with a sore from a new denture...confinse me it's not caused FROM the dental work or dentures...this is very frustrating
DrRees Vic- Smokers get thrush more often than non-smokers so don't even think about it.
vic but does the Lidex cause the thrush?
Dona Run , not walk to a Vulva Clinic and not waste time IF your Dr.s do not know what it is you have.. Early treatment with Steroids, like Clobetasol and Estrogen Creams is helpful for Vaginal
wray Prednisolone can cause thrush under a denture. Leaving the denture out at night and rinsing with half strength Peridex would perhaps help
JFT convince (typo)
DrRees Vic- Certainly it might. We often prescribe an anti-yeast medication along with the steroid to try to control this.
vic nystatin?
Betsy DrWray, My OLP began 4 yrs ago after a temp crown that irritated my tongue. Am about to be tested for allergy to nickel in the amalgam. What should be the upshot if this is indeed the diagnosis?

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drburkhart Ann, trying to suggest that stress causes OLP is difficult to do. However, anyone who knows/treats olp patients will tell you that the patient has more of a problem when a stressful event occurs. That is why we have the "lifestyle section" on the site with some tips that promote changes.

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Dona What do you think of Kenalog injection that last three months..?? Any news on this?
drburkhart I would like to suggest stress managment, yoga and Tai Chi as helpful relaxation techniques.
JFT I don't understand why, if so many get OLP when having dental work done or from irritation from Denture that, that doesn't seem to be looked at more closely. Or has it?

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wray Betsy, There is unlikely to be a nickel problem with amalgam but nickel is in other dental metals. LP shows what's called a Koebner phenomenon which means it occurs at areas of irritation and this might be the connection with the temporary crown

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Ruthy Type hereButtom line...What is the best treatment to date?
DrRees Dona-Long acting steroid injections may work but they are associated with the same side effects as long term systemic steroids.
Dona Thanks Dr. Rees.
Dona Dont know what happened.. Ha.
vic does this stuff last FOREVER???
cbt What are the steroid side effects?
DrRees JFT-There are a number of reports in the literature regarding this. Certainly it is important to understand that most OLP does not appear to be caused by reactions to dental materials.
Barry Opinion onf Deximethosone as an oral rinse 3-4 times per day
aupton EVERYONE PLEASE NOTE: The doctors online now are drburkhart, (DR) wray, and DrRees. Thanks for sharing your personal experience. But, please let them be the ones to make recommedations based upon their education and extensive clinical experience. The discussion is not str. Thanks.

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drburkhart Vic, some people have OLP for a short time while others have an ongoing problem. There is no way to predict the length. With any chronic irritation, it is important to keep it under control and in a non-erosive state.
DrRees cbt- weight gain, high blood pressure, elevated blood sugar, osteoporosis, stomach ulcers and on and on. Usually however, these things can be avoided by careful monitoring.
Mary My dentist prescribed high doses of Vit c and iron supplements. Any views on this?
JFT So, if I had OLP (in my system/in my blood/whatever) the irritation from the denture caused the OLP to activate...I'm 58...would this mean I have had this all my life and it just never surfaced before?
wray Mary, there is no evidence that vit C or iron has any benifit.
drburkhart For those of you who asked about stress, you may want to read "The Okinawa Program" which is on the reading list with suggestions about stress, disease and lifesyle changes.

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belle my dentist recommended Brewer's yeast - will it help
aupton THERE ARE 5 MINUTES LEFT. PLEASE FINISH YOUR CURRENT STRINGS NOW. THERE WILL BEA BRIEF TIME AFTER THE DOCTORS SIGN OFF FOR SHARING EMAILS.
elsie my mother is 90 and has had this for 4 yrs now and has is evrewhere
DrRees Barru-Dexamethasone rinses have been reported to work for many patients. We have not had good luck with them however, probably because they don't stay in the mouth very long. They are especially good though if one has lesions all over the mouth. Secondary yeast infection is a possibility.
elsie she has started Plaq and has used it for a month only, what else can she possibly do, she cannot hardly eat anything?
wray Barru, also there is systemic absorption also from steroid mouthwashes
JFT I would like to learn more about the Koebner phenone (sp)
Mary Is geographical tongue any connecttion to lp
drburkhart If anyone has follow up questions for Dr. Wray , Dr. Rees or me, please contact me after the session.
JFT Thank you, as always I have learned more than I knew before the chat. You do great work here!
vic ditto
DrRees To all, These sessions move so quickly that I am sure some questions went unanswered. We apoligize for that.

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Ruthy hydrocort/tetracyc/diph? any value
gljamer Is sleep apnea, which I have, anyway related to olp and would wearing the mask increase risk of outbreaks?
elsie i need any help bad
wray Brewer's yeast would not be helpful. Candida can aggravate LP especially if steroids are being used. Peridex or natural yogurt would be better the yeast.
Dona Enjoyed the learning ..Thanks.
DrRees Mary-There does not appear to be a connection between olp and geographic tongue.
Mary Thank you for your help!
drburkhart gljamer, we have not heard this before-interesting. contact us later for more information.
Ruthy Thanks much for this opportunity
wray There is no connection with sleep apnoea and LP
happy thanks, it was an great session
elsie how can I continue after the time is up?
lola Type herelola-thank you
DrRees Ruthy-Contact us through Dr. Burkhart. There is simply no way to answer your question without a lot of additonal infomration about you.
drburkhart Everyone, keep us posted about your progress or problems through email. Thank you Dr. Wray.
aupton THANKS TO ALL. THE DOCTORS WILL BE SIGNING OFF NOW. PLEASE SEE THE WEB SITE FOR UPDATES. I'LL LEAVE THE ROOM OPEN FOR ABOUT ANOTHER 5 MINUTES. THANKS FOR JOINING US!!

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DrRees David-Thank you so much for paraticpating. Your input was most valuable and I hope you enjoyed it. We would love to have you join us again.
wray JFT your tongue is probably now scarred rather than just LP so it won't improve
DrRees Nancy, Thanks for all your hard work and so long.
elsie can anyone please help my 90 yr old mother

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wray Thanks for the invitation
JFT Thanks...I don't care as long as I can find out WHAT causes it and it doesn't act up
drburkhart Elsie, please contact me by email and I will talk to you nburkhart@tambcd.edu

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aupton EVERYONE PLEASE SIGN OFF NOW. THE ROOM WILL BE CLOSING IN JUST A MOMENT. THANK YOU FOR YOUR PARTICIPATION!!

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