Log file 032499.html for
Chat room Dental_Study_Club
-- Log on 032499.html started at Wed Mar 24 13:44:04 PST 1999
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aupton cb welcome. Drs Burkhart and possibly Dr. Rivera will be online in a moment. Get your questions ready
CB Type HERE Thanks
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dots how long have you had this study
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DrBurkhart Welcome to the discussion group this afternoon. Today we will be joined by Dr. Rivera who is a faculty member in our stomatology department. Dr. Rivera has been with Baylor for a nember of years. Dr. Rees has a commitment this afternoon and may be with us a little later. With us also this afternoon is Dr. Celeste Abraham who is a fellow in our stomatology department. Many of us just attended the International Association of Research meeting in Vancouver this past we
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DrBurkhart has been great!
aupton Welcome, dots and Iola. The doctors are 'listening' ... for your questions about Lichen Planus.
DrBurkhart What questions do you have for us? We will try to answer your questions or get back to you with the appropiate information when we can.
lola How can you tell if you have lp or canker sores?
DrBurkhart Iola, have you been told that you have lichen planus?
CB I have heard mixed feelings wrt to OLP and stress. What does the majority of LP experts feel about this?
dots What special attention should a person with oral linchen planus take?
lola no,but i have had tingling and soreness that look like ulcers
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aupton CB, your question will be answered in just a moment.
DrBurkhart Lola, there is no way to know without seeing someone clinically and being evaluated.
lola i have an appt. soon.
dots My LP diagnosed by Tufts Dental School Dr. Jeffrey Freedman, Periodontology Concord, MA. A biopsy was done 6-1/2 years ago and its about the same.
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DrBurkhart CB, I think that most people will agree that most anything becomes accentuated with stress. Most people are not ready to make a statement that stress causes lichen planus. Stress does however have a profound effect on the immune system in general. What do you think?
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lola can toothpaste with tarter control irritate your mouth?
DrRees Dots, have you been under treatment for the past six years? Have you had an additional biopsy?
CB What type of coping mechanisms have people with painful OLP been using. It is hard to live with this condition on a daily basis and aside from steroids or other tx, are there any ways in particular that people cope with this -food? exercise? etc. Do these ways help?
aupton To all visitors, if your question is not answered immediately, be patient. The it takes a few moments for the doctors to process and send your answer. Thanks
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DrRees Lola, yes tarter control toothpaste can be irritating especially if you already have a sore mouth. As q general rule, anything that burns, don't use.
lola Thanks.
CB Dr. Burkhart- I am a very emotional and anxious person definately a type A inside with a type B inside. Basically I bottle everything up and have had a lot of stress related things come and go . It is hard for me to really know if this OLP is exacerbated by stress like other things in my past or whether it is a disease that just happened. Do people with OLP have a tendency toward perfection and an anxious disposition?
CB DrBurkhart-I mean a type A inside-type B outside
dots Dr. Rees I have only been under the care of my regular dentist (who knew immediately that it was LP. I don't go to a Dr. Freedman because I don't know if it is also important for him to see me other than my regular dentist. It never really goes away completely and under stree becomes very raw. Should a person like me be doing anythings else but doing for regular checks up and having them cleaned as best they can.
DrBurkhart CB, This is a good questionl, so happy that you aksed. Yes, I feel strongly that there are measures that you can take to combat stress in general. It is well documented that exercise plays a major role in stress reduction and general health. Also, reduction in activities that are stressful to you will make a difference; although, this is sometimes just not possible such as job situations. Yes, coping mechanisms do seem to matter and these are getting more attention i
DrRees Lola, just for your info, the flavoring agent in many toothpastes can be irritating and in one other ingredient, sodium lauryl sulfate may irritate.
CB Lola-where is your LP? Is it painful? What do you take?
dots My question is to the Doctors, have you seen many people with OLP and later have developed Vaginal Linchen planus
DrRees Dots. In our view you should probably be receiving some type of treatment even for mild lichen planus, primarily because it has the potential to become more severe as long as it is present. You are probably a good candidate for a topical corticosteroid.
DrBurkhart CB, your characteristics that are described are often noted and we have some research that has been conducted on this subject. I would be happy to send you some articles. Yes, I have spoken and interviewed many patients with lichen planus and I am always amazed at how calm most appear in spite of severe and tragic cirmumstances that they may have encountered in the past.
CB Dots-since you have had this for 6 years, has it been the same for all that time? Have you experienced the same pain? Are there times that you feel better?
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CB DrBurkhart-Information would be great my email is barrys@maxinter.net
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DrRees Dots, yes there is a growing amount of evidence indicating that vaginal and oral lichen planus may occur at the same time. We don't know if the presence of OLP will lead to vaginal lesions but we do believe that any female with oral lichen planus should have a gyn exam.
CB To the Docs-have any of you performed laser on OLP of the tongue? What was the outcome generally?
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dots At about the first year the OLP was so painful I sometimes had trouble eating. But am use to it for the most part and manage around it. The one lucky thing you can not see my gums.
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DrBurkhart CB, Additionally, coping skills may be learned. In past research, we have found that optimism also plays a role in the self-evaluation of improvement in patients with oral lichen planus
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DrRees CB, we have used laser ablation occasionally on these lesions but we are not particularly impressed with our results because the lesions tend to come back.
DrBurkhart CB, What measures are you taking to cope with some of these problems related to anxiety?
CB dots-I know what you mean about getting used to it. It is hard to know if you are improving or just adjusting
DrRivera CB, therebare other treatments available for OLP that work well and do not involve laser or surgery.
DrAbraham CB and dots- do you have any allergies to any medications or any particular food allergies?
dots Does OLP turn into gum canser? I don't know what I'm supose to be doing for it?
CB Dr Burkhart- I exercise -run . Although I just had a baby in Feb. I am getting back into things slowly. The OLP has defiba=nately been bad lately and throughout the pregnancy which I attribute to hormones since I hear that mostly menopausal women get OLP. I am wating for life with two small children to get tolerable again before I can get into a routine.
DrAbraham CB and dots- have you used any particular home remedies to ease the discomfort of your LP lesions?
DrRivera Dots, treatment with corticosteroids will bring most patients to an acceptable level of confort if not resolution.
aupton technical note for everybody: if you get knocked off line it is due to line noise. Just click the LOG OFF/CONNECT button at the top. That will take you back to the login page. Click the OK, CONNECT and you will be back.
DrRees Dots, that is a question about which there is a lot of controversy. In our view, to avoid concerns about possible malignant changes you should be receiving some type of treatment. We also often suggest to our patients that they be re-biopsied from time to time if the lesions persist.
CB Dr.Abraham-I have been put on "magic mouthwash" but found out I was pregnant back in May of 98. Now I am trying it again. I have been using it for two days after clearing it with a Dr. regarding nursing and topicla steroids.
CB To the Docs-What are your feelings on magic mouthwash? Has it been effective? What is the active ingredients(s)
dots Dr. Abraham, no I don't have any allergies but last year I was tested for ashma but I don't think I have ashma even though I caught a lot. They are going to do a bronchoscopy in two weeks to see if there is LP in my lungs.
DrAbraham CB- there are many forms/types of the "magic mouthwashes" and it would be up to the dicretion of your physician as to which mouthwash/particular ingredients in a mouthwash that he or she would request that you use.
DrBurkhart CB, It is truly difficult with young children and anyone who has ever been there, done that, can relate. I know that when my children were very young and I was home full-time, I found an exercise facility and was able to go there twice a week (really looked forward it!) Also, just getting our to take a walk takes you out of same environment and is even better if you can do this alone - have time to think.
DrBurkhart CB, also there are tapes that are available for yoga and relaxation. A good stress management class is a good resource.
DrRees CB, magic mouthwash may contain a variety of substances, some are soothing to the tissues but most contain a mild topical corticosteriod. The trouble is that mouthwashes lose there effectiveness within minutes after you have used them. There are other ways to apply topical sterioids which are far more effective.
CB Dr Abraham- I do not have allergies in particular but I tend to react to environmental things -hair spray, perfumes. tobacco etc. from time to time. It is minor. I also have a lot of red eye problems. An opthamologist attributed this to allergies to the environment at one time.
DrAbraham dots-how long have you had your cough?
dots Dr. Abraham, I have had it about two years.
DrAbraham dots-do you believe your cough to be related to environmental allergens( i.e. pollens, grasses, molds, etc.); is it seasonal in nature?
CB Dr.Burkhart-Thanks, transitioning form work to full time home for 12 weeks is a shock to the system and I am hoping that when I resume my "old life" at least for 40 hours a week, it will put things in perspective and help me focus less on this and all that is wrong in the world. You know what I mean?
dots Dr.Abraham I don't know the cough is enviornmental but I do know if I'm having a lively conversation or under pressure at work or just excited I cough more.
DrBurkhart Yes, it is sometimes very depressing to see the news everyday. In some ways, you are distanced from the events when focused on other activities.
aupton Folks, for everyone's information, there is a great deal of information on our web site about LP, as well as all the transcripts for all the past sessions online. I'll be giving the information on that specifically toward the end of the session today.
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DrBurkhart CB, Let me say that if you plan to return to work, you may encounter additional stress with the added duties so the better the plan you have for this, the less stressful this will be. Perhaps your work place has some facilities or classes.
dots Doctors: Have you seen many people OLP that has gone away at some point in time?
CB To the Docs- What is the most effective tx that you would recommend for OLP on the surface of the tongue. It is reticular/plaque type and stings and burns. It is not ,from what I have seen in photos , erosive -no bleeding or peeling but it doe s burn or sting. One cannot really see it unless I drank tea or ingested a colored food which stains my tongue differentially (ie, the LP patches do not stain, the rest of the tongue does.-I hope this is clear. Basically, wh
DrRivera Dots, many times the lesions do not go away comletely but they resolve to a point where the patients are able to function without pain.
DrRees Dots, we find that we can make the lesions go away about half of the time. They tend to recur, however, so most patients should be prepared to start treatment again but when the lesions are mild. About 15-20% of patients will have spontaneous remission.
CB Dr Burkhart- thanks for the suggestions
DrBurkhart Dots and CB, if you have not answered our survey on the home page, please do.
CB Docs-Am I correct in assuming you have not found the "magic mouthwash " approach effective with your patients?
dots Doctors: Just for your records of stress, actually my OLP appeared 4 weeks after my husband had a terrible accident and my daughter going off to college had a servere case of MOMO. The VLP came after a family tradgety which I have been in treatment for two years.
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DrRees CB, we treat Lp on the tongue just as we do other areas. However, the plaque-like form is less likely to respond to topical steroids. There are some other somewhat experimental treatment methods for plaque LP bu t I would rather discuss those with your physician or dentist.
DrRivera CB, there are no magic mouthwashes, however conventional treatments seem to work well.
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dots CB: I find rincing with Listerine stings my mouth but almost instantly feels better and because my brushing isn;t what it should be it kills germs also.
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DrBurkhart Dots, we hear this all the time. There is evidence that the immune system is altered when a subject is stressed. For my dissertation, I spent hours talking to patients with lichen planus and I was always amazed the multiple traumas within a span of a few years. Oftentimes, the lichen planus occurred after the person was in a care-giver role and the demands were great.
CB To the Docs- Have any of you heard of a Dr Denis Lynch? University of Tenn at memphis? Any thoughts on him? he seems to know a lot about this . I spoke with him regarding my case and he seemed reassuring that it is manageable.
DrRees Dots and CB, just for your info, we think that Listerine is too irritating for use in patients with OLP. It is an effective anti=bacterial agent but remember that it has a high alcohol content and it will irritate sore areas.
DrAbraham to both dots and cb- are you using topical steroids to manage your oral lesions of LP?
DrBurkhart CB, Yes, I know him-great person and very informed! You are in good hands.
DrRees CB, I know Dr Lynch quite well. He is extremely knowledgeable about these types of diseases and if you live close enough to Memphis I would recommend that you contact him and arrange an appointment.
CB DrBurkhart and dots- My OLP happened two years after multiple events in my life-marriage death of parent ,new home, a sever bout of chicken pox, new job , new baby. All these things happened in two year period
dots I don't know what a topical sterioid is. Do you use it in your mouth? I have been on Hydrocortisone supository for VLP
CB DrRees- I am actually going to get in touch with Dr, Mike Seigle at University of Maryland. Dr Lynch recommended him. I live in Maryland
DrBurkhart CB, all of this in addition to the way you have described yourself may be part of the way that your body is handled this stress. The one item that I notice most about individuals who are in high stress situations resulting in negative health problems is that oftentimes they do not even realize that they are stressed. So you are ahead in the game. Sometimes you need to feel what your body is like when it is stress-free to know the difference.
DrRees CB, I also know hiim and have just referred a patient to him. He is excellent and I believe he can help you.
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DrRees CB- Dr Siegal that is.
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CB To Docs_ have you encountered patients with OLP who have complained of "Chronic Fatigue Syndrome"?
DrBurkhart CB, Just as Dr. Rees has suggested, Dr. Siegal is excellent and highly recommended.
DrAbraham dots- do you use any other medications for any other medical conditions in addition to the hydrocortisone?
dots Do you know a person in the Boston area that I could contact for Oral Linchen Planus?
DrRees Dots, the hydrocortisone that you are using is a topical steroid. There are a variety of others, some of which are stronger in case you don't respond to the hydrocortisone. Any time you use a topical steroid be it vaginally or orally there is a potential for a yeast infection which may complicate treatment a bit. We often use an antifungal along with the topical steroid
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dots Dr. Abrahma, yes I am on Prempro. I have been on replacement for almost 10 years. I am 56 years old.
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CB Docs-Is it unusual to be in your early thirties with OLP? Dont most people get this later?
DrBurkhart Dots, we do have a contact in that area. If you would contact me through email, I will suggest a facility for you to call.
aupton Last call for questions and answers, folks. The doctors will be signing off in about 5 minutes.
DrRees dots, yes Dr Steven Sonis is an expert in these kinds of problems. He is at the Women's Hospital in Boston. I don't know if he sees private patients but I am sure he can recommend someone to you.
aupton Don't forget there is a great deal of LP info published and updated on our Web site at http://www.tambcd.edu/lichen
aupton Transcripts for today's session, as well as all past sessions online, can be found at http://www.tambcd.edu/DentalCE/chat/logs/
DrRees CB, our average patient is 56 years of age but we have seen in in children as young as 12.
DrBurkhart CB, It is a little younger than we normally see, there are certainly cases reported. The usual age is in the 50 range for women and sometimes may be younger for men. Again, there are reported cases of children with lichen.
DrBurkhart If you have any additional questions or suggestions, please contact us by email. We want to hear your suggestions and comments. If you have suggestions that will improve our discussions or our page, please let us know. Thank you.
CB Docs- How confirming is a biopsy for OLP? Is it really pathologically apparent
aupton Thanks, everyone, for getting together. Please exchange any last bits of information you have before logging off. And keep watching the Web site for the date of next month's LP chat.
DrRees CB, yes but it helps to have special immunofluorescent tests of the biopsy material as well.
DrRivera CB, a biopsy that also test for immunofluorescence in addition to regualr histology can be diagnostic.
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dots Thank you very much. I've never had anyone to talk to before that knew what this OLP is. This was my first time on the web
DrRees Thanks folks, we appreciate your participation. I hope we haven't confused you too much.
CB Docs-thanks
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DrRivera Good Bye
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-- Log stopped at Wed Mar 24 15:00:41 PST 1999
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