Log file lp070198.html for
Chat room Dental_Study_Club
-- Log on lp070198.html started at Wed Jul 01 15:42:59 PDT 1998
aupton Welcome to the Lichen Planus Discussion. Tonight Dr. Nancy Burkhart and Dr. Terry Rees of Baylor College of Dentistry will be answering your questions. We'll be getting under way on the hour.
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Kathy I'm a little early. Basically just forgot about the chat and happened to see the message while checking my e-mail. Is anyone here yet?
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Kathy Is it too early for a question?
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aupton Kathy, welcome. Dr. Burkhart is here and will take your questions.
Kathy Are we open for questions yet?
Krish Good evening. I had previously contacted Dr. Burkhart about my longstanding trouble with Lichen planus.
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burkhart Kathy, how are you? What would you like to talk about?Type HERE
burkhart Krish, How are you?
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Kathy Good. To give you a little background; I'm 53 years old, diagnosed with OLP 20 years ago. It has been active for about a year with raw tongue. On and off Decadron. As of June 1, I was off all prednisone completely, tongue doing pretty well. My big problem now is when I am OFF the prednisone, my face and neck are getting very swollen. Any suggestions as to why?
Kathy I am having to take a 5 mg prednisone tablet just to keep my face down somewhat. My cheeks are red. Now for the past three days my feet and hands are starting to swell also. Still taking 5 mg of prednisone daily.
rodstrom Have you tried topical treatment with steroids
Kathy Decadron, .5 mg, 4 times a day. It did not help much, that's why I started the 5 mg tablet.
Krish I am fine! My doctor says that I have 90% OLP. Further tests are needed to confirm this. Are they necessary?
burkhart Rodstrom, what happened with the topical application?
burkhart Krish, do you mean a biopsy?
rees Type HERE Kathy, the symptoms you are describing do not really fit with discontinuance of prednisone. I think you should have your physician evaluate the situation. I do not think you should automatically gto back on the prednisone to mask these symptoms. Your physician needs to see you while they are present.
rodstrom In Sweden we try to avoid systemic treatment with steroids, I have noticed athat in Anerica it is more common with systenmic use
Krish Yes doctor. Further tests are needed to confirm 100%. Are further biopsies necessary?
Kathy I have an appointment Friday, just thought you might have an explanation.
Kathy Had to do something, my glasses would leave an imprint at my temples my face was so big.
Kathy The good news is my tongue is great; nice and pink and healthy looking!
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rees Rodstrom, we in America also usually prefer to treat LP with topical medication. In most instances that is all that is required but as you know, topicals won't control every lesion.
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Krish I am at present on topical steriods Triamcinolone. I am getting reasonably good results with it. should I continue with it?
Laur Type HERE Hello?
burkhart Krish, Here at the stomatology clinic, a biopsy is needed to rule out other mucosal diseases that may be similar to LP. The only way to know for sure is to look at it under the microscope. Otherwise, you may treated for a disease that may respond totally in a different way.
aupton Laur, welcome. There are two doctors here to take your questions about Lichen Planus.
burkhart Laur, Hello and welcome. Do you have a question?
Laur Thanks! I am having a problem getting the screen large enough to see what is being said...
Krish I have the biopsy report that says Lichenoid Mucositis. Marginal gingiva. Is this OLP
Laur got it..
burkhart bjr, Hello, do you have a question?
rodstrom Yes I know well about it, we do not always know if the patient has understood how to applicate a local steroid containing Orabase. In that way systemic treatment is more easy handling for the patient but with
rees Krish, that is an interesting report. In our pathology department that would suggest the possibility of an allergic reaction or a drug reaction. In other laboratories, however, it might simply mean that the lesion looks somewhat like LP but it may not be diagnostic. If you have other lesions another biopsy might help.
rodstrom I leave you now, will check up for next opportunity to discuss with you. To BurkhartŠ Nice poster about positive and negative factors among OLP patients. Good? bye from me and the
Krish Thanks Dr. Rees. My doctor also suggests using peridex twice a day. But that stings and it has 11.7% alcohol. I was told by Dr. Burkhart that alcohoal may aggravate OLP What is your opinion>
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rees Krish, I agree that peridex may be a bit strong for right now. In my opinion, if it burns, that means you should not use that material until your mouth improves. Peridex will not control lichen planus if used alone.
Laur Any new information out there since our last chat??
Krish My doctor gave me a couple of italian studies that says fluocinone with chlorhexine has given good results in the control of OLP. What do you think?
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burkhart Laur, I just attended an international meeting and there were some interesting items. A company in Europe is marketing some natural plant products that they claim have produced some good results. We are reviewing the list of products and there may be some possibilities for some cases. I also presented some information on the value of optimism and responses for lp.
rees Krish- topical corticosteroids are often helpful and chlorhexidine will help with plaque control but as far as we know it has no directly beneficial effect on LP. There is evidence , however, to show that effective plaque control is helpful for the condition and I encourage you to use the peridex as soon as it stops causing discomfort.
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Kathy I was disconnected. Are we atill on?
burkhart Kathy, Yes.
aupton It happens occassionally. We're still here.
Kathy Did anyone get my question about this being a hormone-related problem?
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rees While we are on the subject of oral hygiene let's discuss that a bit. Most people have trouble keeping their teeth and gums clean if they have LP of the gums. One should use a soft bristle tooth brush and a very bland toothpaste. An electric brush is probably too vigorous to use until the gums have healed.
aupton Kathy, Dr. B. is working on an answer for you.
Krish I use sulcus brush with a bland toothpaste. It is better. Previously I used Crest with tartar. That made the condition worse
Kathy While I'm waiting, the current discussion raises another question. Any information about using sea salt and baking soda to brush teeth? I tried it. My teeth felt really clean, but seemed to be more sensitive to cold. Any comments? This is using a soft bristle tooth brush.
rees Krish, you know exactly what I am talking about, the tarter control toothpastes are a bit too strong to use for the time being.
burkhart Kathy, many of the female patients appear to be in the 50 age group. Men tend to be in this age group also so I am not sure that you can say that this is a female disorder or that it is hormonally related. I have heard some researchers say that they believe that there is a connection. Anytime, that you are not feeling 100%, you are more likely to develop other problems.
rees Kathy, the combination of salt and baking soda has been found to be fairly abrasive to the gums and maybe the teeth. That may be why your teeth are sensitive. I'd use something more bland.
Krish I have an asthma problem and I use steriod sprays for controlling the asthma. Do these sprays cause OLP?
Kathy The reason I mentioned it is the fact I was diagnosed with OLP 20 years ago, but have not had any problems since started with the raging hormones. I use Biotene toothpaste, just tried the sea salt for about 5 days till I realized what it was doing.
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Kathy Have got to leave the chat room shortly. Any new News as to how to get rid of this problem?
rees Krish, it may well be that the steroid sprays will help OLP. The problem, however, is that they dry the mouth and may make the tissues a bit more likely to be affected by the OLP. They also predispose you to oral yeast infections which can make your mouth sore very much like LP does.
Krish Yes. Using topical steriods also may cause an yeast infection. How does one prevent this?
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burkhart Kathy, I believe that you need to find someone that you feel confident in seeing and be monitored closely. As Dr. Rees mentioned, a mild toothpaste is needed and try to avoid trigger mechanisms. If you are under stress , join a stress management class, excercise and stay up-beat.
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rees Krish, I'm not sure one can totally prevent yeast infections. If we use a strong topical steroid in the mouth we usually have the patient use a mouth rinse such as nystatin to try to prevent the yeast. We do that very often with our asthma patients who use the sprays. Another thing that can help is to rinse your mouth with water or baking soda mixed with water after you have used the spray. Sometimes that seems to help prevent the problem.
Kathy I have an appointment with Dr. Susan Zunt in about 3 weeks. My life has been very stressful for about the last month but should calm down by the end of August.
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burkhart Kathy, Do you record the periods of stress and the way that you feel at the time?
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Kathy Have to leave in about 5 minutes. Any great words of wisdom?
rees Kathy, I have a great deal of confidence in Susan Zunt as I'm sure you do. You are in good hands and together I think you can find a way to at least control your OLP.
Kathy I don't feel stress at all. If anyone asked, I would say I was a very low key, unemotional person. So, it is hard to record the periods of stress because I don't feel them.
Krish I always wash my mouth with water after the sparay. May be I should try mixing it with baking soda.
rees Krish, just put a teaspoonful of baking soda in a small glass of warm water. We have not done studies on it but a colleague of mine tells me it is much more effective than water alone as suggested by the spray manufacturer.
burkhart Kathy, this is not uncommon. Many of the patients with LP say that they are not stressed. This is because many times, they are unable to recognize true stress or negative past life events. I think that stress management often helps you to realize the stress associated with daily events.
Krish I have to go now. Can I contact Dr. Burkhart or Dr. Rees by email if I have any further questions? Thanks for all of your help.
Kathy Have got to run. Thanks for the discussion. I will check the site soon and read the rest of the transcript.
Kathy I'm on my way to choir practice -- that's my weekly group therapy!
burkhart Kathy, this is good. I believe that music is therapy.
rees Krish of course you can contact us by e-mail at any time. We'll try our best to be helpful.
Kathy Good music and good friends!
burkhart Kathy, this is true.
Krish My daughter is on me to take her for purchasing gifts. Thanks once again.
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Kathy Bye! Thanks again.
aupton Thanks for joining us, Kathy. Enjoy the choir!
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-- Log stopped at Wed Jul 01 16:45:00 PDT 1998
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