Log file 101498 for
Chat room Dental_Study_Club

-- Log on 101498 started at Wed Oct 14 16:51:46 PDT 1998
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Burkhart Welcome to the discussion group tonight. We have made the time a little later to allow for time differences. Please feel free to write to us and ask any questions that you may have concerning lichen planus. We often receive comments, suggestions and follow-up questions concerning the discussion sessions. Please feel free to contact us at any time. ThanksType HERE
Burkhart Hello girlie, Do you have some questions for us?
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Burkhart Hello Cindy
girlie Type HEREIf a person has oral lichen planus...what are the chances that they will also eventually get vaginal lichen planus?
Burkhart Girlie, we are composing an answer.
Rees Girlie, there is a recent study which found a fqir number of women who had oral lichen planus also hqd viginal. The study recommended that one should request such and exam if oral LP is diagnosed. We have also had one individual on our e-mail line who recently did this and the presence of LP was confirmed.
girlie I know you are all from the dental school...can you answer questions concerning vaginal lp?
cindy Type HEREhi, I have been diagnosed w/LP I have it in my mouth,genital area and possibly my scalp. I itch all the time, my mouth hurts you know the complaints I'm sure. I tried prednisone for a 40 day period, it cleared up and I got fat!!! After discontinuing the prednisone it came back. Tried Griziofulvin, no response to that. Now it is really flared up. I have a topical paste for the mouth Elecon cream for other areas and take 2 Atarax so I can sleep without scratch
Rees Not really except in general terms. It has the same features as found in the mouth.
girlie ok --thanks...that is interesting that cindy mentioned the scalp..I have been to a dermatologist about itchy scalp..He called it psoriasis!
Burkhart Cindy, how long have you been suffering with all this?
girlie I wonder if it is really LP?
girlie I am treating it with Locoid.
Rees Cindy , it is interesting that we have two follks on line who may have a similar problem. What kind of topical paste are you using and is it helping the mouth lesions?
Burkhart Cindy and Girlie, the only way to know for sure, is to have a biopsy.
girlie of the scalp?
girlie I have been positively diagnosed with oral LP through a biopsy.
Burkhart Girlie, have you been able to identify any trigger mechanisms such as diet, environmental or stress related factors?
cindy About 9 mos. It started with a severe reaction which the doc thought was allergic. Very itchy wrists and I also had dermatografism at that time I mentioned a sore mouth but no connection was made until I saw the dentist who freaked and sent me to the perio who did a biopsy and so on....
girlie Cindy, you might want to try Lidex gel..
girlie not really...
Rees Girlie, it is a little uncommon to have LP of the scalp and pshoriasis is quite common there so yes a biopsy would help but your dermatologist is probabily able to diagnosis psoriasis based on it's apperarance.
cindy I have Lidex lotion for my scalp. I was diagnosed by biopsy both oral and genital OUCH
Burkhart Girle, do you keep a record of events? What other oral products do you use?
girlie I wonder about that diagnosis...most doctors seem to know soooo little about LP!
girlie Just Lidex gel at the present time...
girlie No, I really don't keep a record...
Burkhart Girlie, did you have the biopsy read by an oral pathologist?
girlie yes!
Rees Girlie, then a biopsy should be done. Psoriasis has very definite features on biopsy.
girlie ok...thanks
girlie Would the treatment be any different with LP or psoriasis?
Burkhart Girlie, was the diagnosis oral lichen planus or features of?
girlie Lichen planus...
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Rees Girlie, yes a different set of medications are used for psoriasis.
girlie with mild dysplasia
girlie Cindy, are you a stressful individual?
Burkhart Girlie, I would feel comfortable with the diagnosis from an oral pathologist but since you mention the dysplasia, you were probably told that the area should be monitored frequently and that any changes should be evaluated immediately.
Rees Girlie, if you have mild dysplasia if is not uncommon in any area of inflammation. However, it does mean thay you should have a follow-up biopsy in a few months if the lesions persist.
cindy Do any drugs cause lp? I take tetracycline for acne, synthroid for multinodular nontoxic goiter and zoloft for management of PMS. I seem to notice an increase in symptoms in the week before my period. Maybe hormones are a factor? Grabbing at straws. By the way, my Mom also has lp but only oral.
girlie They come and go...this was a couple of years ago...sometimes I am fine...other times it flares up.
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cindy Girlie, I am a pretty laid back person, I sew for a living(quilts) 2 kids and ride horses for pleasure. I don't feel like a stressed person but who knows
Rees Cindy, yes drugs can cause a so-called lichenoid reaction. There are about 40 which have been identified so far but non of those you listed. However, in theory any drug can cause the reaction in some individual. You should relate your symptoms to when you started taking those meds.
Burkhart Cindy, we have received a few comments through email in the last few weeks about the hereditary factors in oral lichen planus. We plan to have a survey on the net very soon and hope to look at some of these demographics.
girlie No one in my family (that I know of) has LP.
cindy I have been on all these meds for quite some time. The synthroid for 20 yrs. the others for 3 or 4 yrs.
girlie Cindy, how did you know that you had vaginal LP? biopsy?
Burkhart Cindy, have you noticed that the LP becomes more apparent when you have increased activity?
girlie I have heard that temovate is good for that..
Rees Cindy, we have a few other patients who associate onset of lesions with hormonal imbalance, however, to date there is no real evidence to confirm this. Perhaps the survey will help answer that question.
Rees Girlie, temovate is one of several topical steriods which seems quite effective in controlling LP
girlie vaginal lp, right?
Burkhart Girle and Cindy, what type of toothpaste do you use?
Rees Girlie, yes.
girlie None---baking soda only..
cindy The vaginal lp was diagnosed by biopsy after I read on the net about lp. I had a pos. dig. for the oral and never thought that the itching and burning of the genitals could have anything to do with the mouth!!! I am pretty active in general so I don't know if it gets worse or not. I am not one to sit still for long ang seem to be busy most of the time.
cindy I use Crest multi care
girlie Doesn't it burn you?
Burkhart Girlie, here at the stomatology center, the patients are asked to stop using the baking soda and we recommend the biotene toothpaste . The paste does not have the usual additives found in regualr paste.
girlie Biotene is the brand name?
cindy Yes it does burn. Do you get a clean feeling mouth with baking soda alone?
Rees Girlie, if you are talking about the Multi-care it burns me and I don't have LP
girlie : )
girlie Well, there is nothing like a nice minty taste--but yes--with lots of flossing and regular cleanings at the dentist...I seem to do ok.
cindy Where do you get the Biotene?
Burkhart Yes, the product may be found in most pharmacy locations
girlie thank you...I will look into it...
girlie Is the baking soda possibly harming me more than helping?
Rees Girlie, you bring up an important point. Good oral hygiene seems to help LP although sometimes if not done carefully it can make things worse instead of better.
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Burkhart Girlie, most of the patients seen here cannot use baking soda. We have not heard anything positive.
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girlie Why can't they use it?
girlie My oral surgeon recommended it...
cindy My dermatologist has mentioned Methotrexate, Cyclosporin and Interferon as possible treatment if the symptoms are to bad. The dentist is concerned about loss of gum tissue. The treatments mentioned by the doc seem like the side effectsmight be worse than the lp unless it would cure or put the lp into remissin.
girlie Cindy--I want to ask you again--Has your doctor not mentioned Lidex gel?
Burkhart Cindy, does it ever go into remission?
Rees Girlie, we don't know for sure but many patients with LP get erosive lesions on their gums with baking soda. It could even be that the baking soda doesn't offer enough protection from the effects of toothbrushing
girlie Interesting...my dentist has commented how healthy my gums have been lately...I wonder if it is from the Lidex gel;?
Rees Cindy, all of those meds have been used for LP but reports are mixed at best and yes they do have side effects.
cindy Girlie I have Lidex for my scalp, the paste for my mouth is Kenalog, Orabase and Benadryl mixed by the phamacist.
Burkhart Girlie, most patients do respond nicely with lidex.
girlie Cindy, you might want to try it--gel-not ointment.
girlie I had a mixture of Benadryl etc. and it didn't do anything..
Rees Girlie, if your mouth is helathy and your LP is under control don't change a thing. Yes, however, the lidex often helps.
girlie I wouldn't exactly say that it is under control...it still can flare up occasionally pretty badly!!!!!
Burkhart Girlie, you are correct in that what works for one patient may not be appropriate for some one else.
cindy Girlie I will ask the doc for it. I'll try anything. I sometime itch all over my body and the doc says I may also have it in my nose. I get lesions and itching there too. I also notice a mild sore throat when my other symptoms are really bad
Rees Girlie, those are the times when something stronger such as lidex may do better than kenalog.
Burkhart Girlie, do you have any signs/symptoms of the oral lichen planus before you can actually see the ulcerations?
girlie My mouth almost always burns when I eat something minty, spicy or hot!
girlie Mint toothpaste could bring tears to my eyes..
cindy Me too. I can't even chew gum at times, and forget about spicy foods.
Burkhart Girlie, do you see the appearance of LP right after eating certain foods?
girlie Fun, huh?
Rees Girlie, then you need to be careful with toothpastes. But as I understand what you said you are doing ok with the baking soda aren't you?
girlie Forget Mexican food!!
girlie Yes, but I will try the Biotene..
girlie Does it have a flavor?
girlie No, I don't see the appearance of LP after eating certain foods...
Rees Girlie, your burning discomfort with spices and Mexican food suggests that your oral lesions are not yet fully controlled. One of the first comments patients often make is being delighted to be able to eat such foods again.
girlie Hmmm.
Burkhart Girlie, biotene does not have a flavor, but this is essential since many patients are sensitive to the additional additives. I will say that it does not taste bad and has a pleasing taste-not minty.
girlie I have never been without that discomfort...even without any visible signs of LP in my mouth..
girlie It is a matter of degree..
Burkhart Girlie, on a scale of 1 to 10, what is the discomfort like when you can see no lesions in your mouth?
girlie 4?
Rees Girlie, then there is the possibility that you do have an allergic reaction or an irritant reaction to some components of those kinds of foods. An allergist can often help to sore those things out.
cindy I am also always uncomfortable sometimes it's mild but other times like now it hurts if I press on the outside of my cheek! How can you get it under control WITHOUT the use of oral streoids? That was the only time it actually went away.
girlie Thank you...I am allergic to penicillin...originally, the oral pathologist thought that I had a cinnamon reaction because i was using cinammon flavored floss..
Burkhart Girlie, there are many cinnamon products in mexican food, dr. Pepper, mints, candy, some oral products, etc. The oral pathologist was correct in being concerned. We see many patients with this problem.
Rees Cindy, for some patients the the topical steriods are often necessary. The goal then becomes to reach a point where you only have to use them occasionally when you have a flare. The lidex is safe to use for a long time if necessary provided there are no medical contraindications.
girlie That is interesting...once I was diagnosed with LP it was never mentioned again and I switched to plain floss..
cindy I guess I wasn't clear. By oral steroids I meant Prednisone by mouth. I should say systemic as opposed to oral when speaking with dentists I guess
Rees Girlie, just for the record a cinnamon allergic reaction can often look like LP even on the biopsy but there are now some known features which an oral pathologist can identify to implicate cinnamon if that is a factor.
girlie Hmmm....I haven't been back to him for years...Maybe I should get in touch with him again...Have you heard of him...Brad Rodu from Birmingham, Al.?
Rees Cindy, you are right, I was thinking that you used a topical steroid in the mouth. They are our main drugs of use for LP and they have the advantage of not causing the usual side effects of prednisone.
girlie Or Radu maybe?
Burkhart Girlie, yes many patients do not recognize the hidden food additives. In fact, many cola products have cinnamon. If you email us, we can give you a list of foods that contain cinnamon. Dr. Rees is correct in telling you that the oral pathologist can tell you if he has a concern about this factor.
cindy Time to put the kids to bed. Thanks to everyone for the info. What a frustrating condition.!!!!!!
Rees Cindy, thank you. This has been an interesting discussion for us and I hope for you.
aupton Thanks for joining us, Cindy. I'll have a transcript of this session on the web site in the morning. -- art
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Rees Girlie, I don't know you doctor. Is he an oral pathologist, a dentist or a physician?
Burkhart Yes, we have enjoyed this and just commented on what good information we have tonight. The other group members who cannot be here will be able to read the transcripts. Thank you for attending and if you have additional comments, please email us directly. Thank yoy.
girlie Oral pathologist..
Rees Good. Then I think it is time to see him again.
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-- Log stopped at Wed Oct 14 17:53:33 PDT 1998
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