Log file lichen221 for
Chat room Dental_Study_Club
-- Log on lichen221 started at Sat Feb 21 08:24:52 PST 1998
aupton GREETINGS, VISITORS! aupton is the sysop, and the Doctors are ready to take your questions.
Burkhart Welcome to the chat room! Do you have any questions that we may answer for you today?
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Burkhart FACTS ABOUT LICHEN PLANUS
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Burkhart 1. It is a disease of unknown cause but it may sometimes represent an allergic reaction.
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Burkhart 2. It affects about 1%-2% of the general population.
Burkhart 3. It occurs in women more often than men.
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Burkhart 4. It occurs more often in individuals past the age of 50.
Burkhart 5. It can occur on the skin or genitalia and in the oral cavity.
Burkhart Boots, do you have a question for us?
boots Dr. Burkhart are there different types of treatment available for LP?
Burkhart Yes, it would depend on your particular situation.
boots By particular situation do you mean a biopsy is necessary.
Burkhart A biopsy is needed for diagnosis, but the treatment would depend on the severity of the disease.
Burkhart Other factors, would be the location and your own state of health.
boots Could you tell me something about the different types of treatment available.
Rees Boots, in most circumstances
once the diagnosis is established in the oral cavity the first type of
treatment used is a relatively strong topical corticosteroid. In other
circumstances one might receive injections of steroids into the lesions
or even systemic steroids. On other occasions things like synthetic
vitamin A may be beneficial.
boots What is synthetic vitamin A
Burkhart 6. In the mouth it can occur in 6 different forms ranging from lacy-white streaks, to white plaques, to eroded ulcers.
Burkhart 7. The white lesions of lichen planus are usually painless.
Burkhart 8. The eroded lesions usually burn and can be quite sore.
boots Does it also occur in the throat or nasal cavity, or sinus?
Rees Synthetic vitamin A is
represented by a family of drugs called retinoids. They can be taken as
a pill or applied as a topical agent. There are some side effects to
each but the newer drugs such as this do have fewer side effects. The
trouble with retinoids is that lichen planus lesions tend to return as
soon as one stops treatment
Burkhart 9. The gums are often affected causing the surface of the gum tissue to peel off and leaving the gum tissue red and raw.
Rees Boots, we see it in the throat
sometimes and in theory it can affect the nasal cavity although we have
not seen that at our Center. As far as is known it does not affect the
sinuses.
boots How about the tongue?
Rees The tongue is a relatively
common site for lichen planus. The inside of the cheeks are affected
most often however, and the gums are also a relatively common site.
boots I probably should have a
biopsy done. Can you tell me more about this procedure. My outbreaks
come and go, without rhyme or reason as far as I can tell. It seems to
me that scheduling a biopsy may be a problem.
Burkhart 10. Sometimes it appears
to represent a reaction to medications, some filling materials, dental
hygiene products, chewing gum, candy or other substances that touch
mouth tissues.
Burkhart 11. Stress may play a role in outbreak of the sores.
Rees Boots, you do need to have a
lesion present when the biopsy is scheduled and you are correct in that
sometimes the condition tends to come and go. There may be a reason,
however. For example it may be occurring as a result of contact with a
specific type of toothpaste or it may occur more often during periods
of stress.
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boots Well, I went to my dentist
with my last severe outbreak. He gave me a prescription that contained
an anitbiotic, an antihistamine (that tasted like Benadryl) and a
steriod. I had wonderful results with the medication. I also stopped
using Listerine and tarter control toothpaste. Also with good results.
I've had ulcers since I was a teen and no one ever was able to give me
any recommendations. I tried to keep my mouth clean but I was using the
wrong products.
Burkhart Boots, we are trying to
decide on a schedule for a regularly scheduled chat room. What times
during the week would be good for you? Is the week day better for most
people?
boots I can participate almost any time.
Burkhart 12. Lichen planus may come and go but it often can remain present for years if not treated.
Rees Boots, the biopsy procedure is
relatively simple. The dentist or physician gets you numb and takes a
small bit of soft tissue. He probalby will need to place a suture or
two. In regard to your comments about the mouth rinse, it sounds as
though that is working quite well for you. In addition, you and your
dentist have played detective and found some of the things that may be
causing your mouth sores. Avoiding those may be the best treatment
possible.
boots About stress, do some of your patients take medicaitons such as prozac?
boots I thought an oral surgeon was needed for a biopsy. Also are biopsies (sp?) done on the tongue?
Rees Boots, prozac is an
antidepressant and probably not predictably helpful in controlling
lichen planus. That has not been studied. There are many ways to cope
with stress and medications to do so are probably pretty low on the
list of things to do in managing lichen planus.
Burkhart Boots, do you believe that stress is a major factor in relation to your situation?
Rees Oral surgeons do perform
biopsies but so do some general dentists and various other specalists.
Yes biopsies are often performed on the tongue since that is a
relatively frequent site for lichen planus and other types of lesions.
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boots I'm really not sure. I think
stress could be a factor. I don't know that I can say it is major. I do
have a child with cystic fibrosis, which is an ongoing challenge. I've
had to relocate for employment reasons in the past and perhaps in the
future. However, I think of myself as "laid back". Although my blood
pressure does go up as high as 130 over 90 when I'm nervous (I know
that's not a bad number).
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Burkhart Boots, have you found ways
to combat the stress through exercise or other events such as a hobby,
meditation, or lifestyle changes?
boots I don't like the idea of a
tongue biopsy. The ulcers I get on my tongue are so painful. Generally,
I am unable to eat, drink or speak. This tongue outbreak is relatively
new (last 5 years). In the past I almost exclusively got ulcers on the
insides of my cheeks. This last outbreak affected the roof of my mouth,
soft palate and throat.
boots I an enrolling in a yoga
class in March. I studied and practiced self hypnosis in college
although I don't any longer. I hate to exercise unless I participate in
a sport. But I'm not as young (age 45) to play sports as I used to. I
don't have a hobby.
Rees Boots, biopsies of the tongue
are not really so bad. However, one doesn't biopsy an actual ulcer
because the skin surface is missing in an ulcerated area and it won't
help the pathologist make the diagnosis. Usually another site can be
selected in a case such as yours since you get lesions in varous
tissues. From what you said earlier it is my impression that you are
controlling the outbreaks. If you develop ongoing lesions though, we
would be happy to discuss our
Burkhart Yoga is great for
relaxation and also for muscle tone. If this is your first class, you
will be really pleased with how the concepts will help in stressful
situations.
boots It seems you all believe stress is the key.
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Burkhart Boots, many lichen planus
patients report that the lesions are far more erosive during times of
stress. We are not suggesting that stress causes lichen planus because
we have no research to substantiate this fact. However, most
individuals find that if they become sick, it usually at a time when
the body is not responding as effectively to environmental factors.
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Rees From my perspective stress
management is often important in coping with chronic conditions such as
lichen planus. It may also play a role as a causative factor but many
other factors do as well. Most of us are under stress in todays world
but most of us do not delevelop lichen planus.
aupton This is the sysop, folks. We've got about 5 minutes to go.
boots I've been looking into
different books on subjects such as yoga. The difficulty is in trying
to decide which one. I found there are variations of yoga. Also, I do
know I need to exercise. I have a treadmill and a skier. Both boring.
I've looked in weight bearing or anaerobic exercise. It's so very
confusing. Then there is the dilemma of cost. I just read your last
note, I agree that stress doesn't cause most people to develop LP.
boots Thanks for your responses. I'll ask my dentist about a biopsy or email Dr. Burkhart.
boots Do you know of alternative
therapies that are successful? Like zinc lozenges for a cold or St.
John's Wort for depression. That type of thing?
Burkhart Boots, thank you for
participating. If you have any additonal questions, please contact us
through the address and we will be happy to get literature to you .
boots thank you.
Rees Althenative therapies have not
been studied. Unfortunately sometimes strong clains are made for them
without adequate study. We will all have to wait a while to know how
they may relate to lichen planus.
boots thank you.
Rees Thanks for your questions, we are signing off now.
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-- Log stopped at Sat Feb 21 09:36:08 PST 1998
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