We are honored and grateful to have join us this evening as our special guests Dr. John Wright, Professor of Oral Pathology at Baylor; Dr. William Carpenter, Chairman of The Dept. of Pathology and Medicine, University of The Pacific; and Dr. Steven Sonis, Chief, Division of Oral Medicine, Oral and Maxillofacial Surgery and Dentistry, Brigham and Women's Hospital and Professor and Chair, Dept of Oral Medicine and Diagnostic Sciences, Harvard School of Dental Medicine.
If you have not completed our survey and wish to do so, please complete the survey on line or simply print it and mail it to my address. The demographic data gained from the survey will provide very useful information regarding lichen planus and treatment procedures.
We hope to provide you with some of the results very soon.
The comments from all of you who have contacted us have been extremely positive regarding the site. We here at the stomatology center hope to continue this service as long as we are meeting your needs.
aupton Greetings carb and fiftyplus, the doctors will join us in just a moment
fiftyplus thanks...
...........................Dianne joined............. :)
drburkhart Dr. Carpenter are you Carp?
aupton Welcome, dianne. The doctors will be joining us in a couple of minutes
............................BW left ............. :(
Carp Art, Carp is Dr. Carpenter.
aupton Thank you, doctor. Welcome aboard.
...........................BW joined............. :)
drburkhart Welcome everyone! The format this evening will be a little different. Please ask your questions and we will assign someone to answer.
fiftyplus First of all...anything new concerning OLP?
...........................catheryn joined............. :)
aupton Welcome, catheryn. We just got started.
catheryn Type HEREHi.
drburkhart Fiftyplus, would you be more specific? Are you confirmed through biopsy to have lichen planus
............................drwright left ............. :(
fiftyplus yes.
fiftyplus I guess that I mean...any breakthroughs?
...........................drwright joined............. :)
...........................DrS joined............. :)
fiftyplus ...anything that might be helpful to us as LP sufferers?
fiftyplus ...any new info?
drburkhart Fiftyplus, how are you currently being managed?
aupton For everyone's information, certain things will be on the transcript tommorrow which may have occurred prior to your joining us. I'll say more at the end.
fiftyplus Lidex ointment and avoidance of spicy, minty, and hot foods...
BW Type HERE this is Bill Wathen, at Baylor. I just want to jump in here and welcome everyone on behalf of the Center for Professional Development at Baylor college of Dentistry, the host for this chat room. Welcome also to our "visiting" doctors, Drs. Carpenter and Sonis.
fiftyplus welcome!
DrS Type HEREGood to be here
drburkhart Fiftyplus Dr. Wright will answer your question.
drburkhart Hello Dr. Sonis. Thank you for being with us. We will assign a question for you soon.
drburkhart Dianne, do you have any questions?
fiftyplus I am sorry to keep getting on...I do have a specific question about toothpaste...
............................Dianne left ............. :(
drburkhart Dr. Carpenter, What do you recommend for fiftyplus about toothpaste?
fiftyplus Why does the toothpaste for "Sensitive Teeth" say that you should only use this product for "...no longer than four weeks.."?
drwright fiftyplus Lidex is one of themost effective and safest steroid preparations for LP but I like the gel form better then the ointment or cream The gel rubs into mucosa a little better. If the lidex doesn't work for you, there are more potent steroids like diprolene or temovate that might provide more relief. All of these steroids promote yeast growth, so check with your doctor to see if your lack of response is due to yeast infectioon or a true lack of drug response
aupton For everyone, including fiftyplus, ask as many questions as you like. The doctors will attempt to get to them all.
fiftyplus I actually am using the gel....and it does "settle" things down a lttle for me...
...........................Dianne joined............. :)
fiftyplus I actually massage it into my cheeks...is this correct?
............................Dianne left ............. :(
...........................Dianne joined............. :)
............................Carp left ............. :(
drwright fiftyplus Can the Lidex relieve all your symptoms. I'm assuming you kknow that LP is not a curable condition. Treatment is aimed primarily at symptomatic relief and if you are achieving that then your treatment is successful.
...........................Mary joined............. :)
fiftyplus I know that LP is not a curable condition unfortunately...and yes, I am getting some relief with the Lidex.
drburkhart Mary, welcome! Please ask us any questions that you may have about LP.
Mary Hello and thanks..........think I will just watch for a minute
...........................Anne joined............. :)
...........................Carp joined............. :)
fiftyplus By the way, I did use a bleaching product on my teeth without exacerbating the LP.
drburkhart Dr. Sonis, what toothpaste do you recommend at Harvard?
fiftyplus I know that had come up before.
drburkhart Hello Anne. How are you? Do you have a question?
............................catheryn left ............. :(
Carp I am not aware of any direct effect of toothpaste ingredients causing LP. However, some of the flavoring agents may irritate in already exhisting case, especially if it is of the erosive type.
Dianne I have VLP for over 10 yrs. and Scar tissue built up in the outer area. I am concerned with the urethra closing up . Is this a possibility?
...........................sally joined............. :)
DrS biotene seems to be mild to tissues. i would stay away from any of the pyrophosphate containing (tarter control) toothpastes.
............................sally left ............. :(
drburkhart Dr. Sonis, Do you want to comment on Dianne's question.
fiftyplus Biotene doesn't make my mouth feel fresh...
............................BW left ............. :(
DrS fiftyplus - you could try one of the natural toothpastes like tom's of maine
aupton Tech note. If you get knocked off, it is line noise on the internet. The Log off button will become a Connect button and just log back on.
...........................Jean joined............. :)
fiftyplus As I stated earlier...I like the toothpaste that I am using now...it is for "Sensitive Teeth"...I am just concerned that it says to "..not use for longer than 4 weeks without consulting a dr."
DrS i think that dainne's question is best asked of her gyn doc.
Mary Have any of you heard of any success with Dexamethasone rinses or Clobetasol ointment? Those are my latest treatments.
drburkhart Hello Jean
Jean Hi
drburkhart Dr. Carpenter, would you answer Many?
Jean I had trouble getting in here.
Dianne my doctors do not know what to do with me.
Anne Type HERESo did I
drburkhart Jean, thanks for the info. Have you been trying from 4:00?
Jean No, just a few minutes.
drwright Fiftyplus I think it's more important to stay away form the tartar control toothpastes than to select the right hypoallergenic one. As long as you don't use tartar control. I woudl experiment to find one you like and see if it aggravates your LP. I think with trial and error you can find a better substitute.
aupton Welcome, Jean. I just answered your email.
Jean thanks.
Carp Mary, we find the greatest success with lidex in gel form or mixed with orabase
Carp however, other forms of steroids are also effective
Anne Is there any new research going on that seems promising?
Jean I haven't had any soreness with my LP until just the last 2 months. I keep getting like a blister that forms at the back of my mouth. It comes and goes quite often.
drburkhart Jean, Dr. Wright will answer you.
Jean And a spot on my tongue the does the same type thing.
drburkhart Anne, Dr. Sonis will answer you.
DrS re research. there is exciting research which is better defining the mechanism of action by which lp occurs. as the immunologic steps in lp are defined, opportunities arise for new types of therapy.
Anne Thanks
fiftyplus Any relationship with hormones and LP? It seems like so many of us are peri- or post-menopausal women...
Mary so are all you medical professionals convinced that this is an auto-immune phenonmenon
Jean Dr.S, I'm not sure what that means. Have they found new information?
DrS anne - the course of your disease is quite typical for lichen planus - it comes and goes. the trick is to treat it when it first becomes symptomatic to minimize the time during which you have active lesions.
drwright Jean Thats a fairly typical pattern. We recommend treating a new area as soon as you have a feeling that you are getting a new outbreak. This is when the underlying cellular reaction is just starting and early treatment is usually effective to alleviate it. Unfortunately, successful treatment of one outbreak doesn't affect subsequent outbreaks.
Jean Does LP act sort of like canker sores?
Jean Drwright, what do you suggest treating it with? Anything you use is by prescription only, isn't it?
drwright Jean LP might feel like a canker sore but they are completely different conditions. Most patients with canker sores seem to outgrow their outbreaks with time.
Dianne are there any cases of lp clearing up copletely?
Anne Is there a danger of using the lidex gel for many years?
drburkhart Dr. Sonis, do you want to answer Dianne?
Jean Is it basicly related to stress? I have had an unusual amount of stress since the end of Aug.
drwright Jean There are topical steroids available overthe counter but these are usually not potent enough to do much good. The most effective steroids available are only be prescription which you can get from your MD or dentist. Most of my patients I start on Lidex gel. This is fairly effective and has few side effects.
drburkhart Dr. Carpenter, do you want to answer Anne's question.
DrS mary and jean - i think there is pretty good evidence to indicate that immune cells are the major drivers of lp. the reason that steroids are helpful in treating the condition is that they decrease the activity of the immune cells beneath the mucosa in your mouth. other immunosuppressive agents are being or have been used as well such as cyclosporine. in addition it is possible that the substances released by the immune cells are the mediators of tissue damage and
drwright Diane
drburkhart Jean, we find that many of the patients who contact us are under much stress. Stress has profound effects on the body and the immune system.
Carp Anne, Lidex gel is a fairly potent steroid that needs to be used for asymptomatic outbreaks of LP. However, these applications usually will affect the cure over a short time until a recurrance. At that point new applications are required. This kind of irregular usage is safe over long time periods with very little systemic effect from a topical application.
DrS diane - there certainly are cases of lichen planus either resolving completely or decreasing in severity or frequency. there are medications which have been associated with lichen planus or with tissue reactions which resemble lichen planus. sometimes if we can identify one of these in a patient with lp we can has the patient's doc to consider switching to an equally effective alternative.
drwright Diane There are cases of "spontaneous remission" in some patients. Because we don't kknow the cause for sure, we also don't understand why some patients experience complete remission. I don't know however how to predict which patients will resolve and which won't. Many patients never resolve and must be treated for years.
Jean I like fresh tomatoes from the garden. I noticed this year with the first (and only) tomato I ate, the blister at the back of my mouth immediately appeared, and was very painful.
Mary would someone comment on the topical use of Clobetasol.................
drwright Mary
drburkhart Mary, Dr. Wright will answer
drburkhart Jean, we hear this from patients frequently. Have you been tested for any allergic reactions?
Jean no
............................fiftyplus left ............. :(
Dianne I am told this disease is rare. How rare is it?
drburkhart Jean, do you react to anything else?
...........................fiftyplus joined............. :)
drburkhart Dr. Sonis, would you answer Dianne?
Jean My oral surgeon has only prescribed one kind of medicine. Can't remember the name, but didn't help much. Since I hadn't had any pain associated with the LP, just never used anything.
DrS jean - it may be that the tomato, which is quite acidic, exacerbated the sensitivity which you felt from your palatal lesion, rather than act as a cause. if you were truly allergic to the tomato, i would have expected a more generalized response in your mouth , rather than a localized lesion.
drwright Mary Topical clobetasol is one of the most potent steroids available. I have had very good response with its use. There are two downsides however, We are not sure about the long term safety with its use like we know for Lidex. Also, all of the steroid preparations can occasionally cause secondary candidosis (yeast infection) and the clobetasol is a lot worse at this than lidex. I f your steroid causes a secondary candidosis, I'ts hard for the patient to know w
Jean I haven't noticed a reaction to anything else in particular, but do notice now and then when I'm eating something the blisters will appear.
Jean Maybe salt????
DrS diane - lp is actually quite common. the estimated frequency is about 1% adults.
............................aupton left ............. :(
Mary I do use Biotene toothpaste .........is there an OTC mouthmouth that would not be painful that someone could recommend?
...........................aupton joined............. :)
DrS biotene also makes a mouthrinse
Jean I've used Biotene toothpaste, didn't seem to make any difference.
............................fiftyplus left ............. :(
............................Anne left ............. :(
...........................fiftyplus joined............. :)
DrS jean - i wouldn't expect biotene to make things appreciably better, just not worse.
Mary I have been seen by a dentist, dentist/MD, internist, and dermatologist. Who is REALLY the best health professional to treat LP?
Mary Oh yes. and homeopathic doctor........................
drwright Jean We don't usually use biotene products to treat the lp, its used to not aggravate it
drburkhart Anyone may answer Mary.
Jean ok
fiftyplus My question may hve gotten lost in the shuffle...but I am still wondering why my toothpaste states"do not use this product longer than four weeks unless recommended by a dentist or physician.."?????
DrS mary - depends on the expertise of the individual you're seeing. certainly dentists or dermatologists with expertise in the area would be appropriate.
fiftyplus The ingredients are: potassium nitrate, sodium monofluorophosphate
Mary the problem is no body wants it....................
drburkhart Dr. Carpenter may answer fiftyplus.
drwright Mary Depends on where your lp is. I believe that oral lp is best managed by someone on the dental side with experience in the diagnosis and treatment of oral lesions.
............................Carp left ............. :(
Jean Mary, nobody wants it............ what's that mean?
...........................Carp joined............. :)
Carp Mary, if you skin involvement with lp a dermatologist is recommended. If your oral mucosa is involved, the specialty area that most commonly treats these is an oral pathologist with a clinical practice or an oral medicine specialist
Mary thank you all...................if any of you LP sufferers would like to chat further about this and commiserate......my email is eastmanm@aol.com
Carp These specialties may be difficult to locate except at a dental school. Periodontists are also often proficient at treating these matters.
drburkhart Mary, sometimes the problem involves the fact that these problems are not easily solved and the resolution takes time. It is important to find someone knowledgeable in oral diseases and work with them.
Jean Mary, I may write you. Just so you know, My email is jeamarmar@aol.com.
Mary I knowDr. burkhart. Iwas being a tad facetious.
Jean Would it help to call around locally and just ask each doctor's office if they are very familiar with LP?
Carp fiftyplus, the reason that the manufacturers recommend that you see a dentist after failure of their products to work in four weeks, is that they should have cured the hypersensitivity by that time. If not, they may be another reason and futher diagnostic work up is recommended.
............................Mary left ............. :(
fiftyplus ok...but in my situation...I can jusst continue to use it, right?
............................Dianne left ............. :(
drburkhart We have some good articles on certain topics related to lichen planus. If you would like more information please contact us.
Carp I am not sure what your situation is exactly. I would recommend further evaluation by your dentist for this permission.
DrS jean - if you live near or in a city with a dental school, i'd start there. as the others have suggested, a local periodontist, general dentist or oral surgeon may be a helpful source for referral info.
fiftyplus My situation is that I have been positively diagnosed with OLP through a biopsy performed by an oral surgeon.
drwright Jean Most general dentists don't have a lot of experience with LP. If you are close to a dental school, I would recommend calling them and see if they run a clinic for mucosal problems. Most do. If you don't have access to a dental school, see if there are oral surgeons, dermatologists, oral pathologists or oral medicine clinicians in your area,
Jean With my last pap test, I asked the Dr. if there was a chance I could have vaginal LP. He just told me I probably had a yeast infection. Would he be accurate in saying that, or should he have done a biopsy?
drburkhart Jean, The stomatology center is available to help you find someone close by that has an interest in oral lichen planus. Just email us at the web site.
Carp fiftyplus, What is the reason for your use of a desentitizing toothpaste?
Jean No, I'm not close to a dental school, but I have been seeing an oral surgeon.
............................aupton left ............. :(
fiftyplus I guess that the mint was mild enough in it to allow me to brush my teeth without tremendous discomfort.
...........................aupton joined............. :)
Jean They have already looked to see if I'm near anyone like that. The closest place is probably 3 or 4 hours away.
drburkhart Jean, where are you?
drwright Jean The symptoms for vaginal yeast infection and lp can be very similar. If yeast meds don't work, then it may not be a yeast infection and biopsy might be considered.
Carp Desensitizing toothpaste are meant to be used for hypersensitive teeth for a short period of time. If this is not the case, a toothpaste that minimally causes a painful response in your oral mucosa would be recommended.
DrS yeast infections are pretty easily diagnosed by scraping of the tissue and then looking under a microscope or by culture. alternatively, if your doc treated for a fungal infection, the lesions should have disappeared. if they did, the diagnosis was probably correct. if not, then biopsy
fiftyplus ok...thank you...
Jean Fort Wayne, IN. I think the closest place was Chicago.
aupton Folks, we have about 10 minutes before the doctors have to leave. Please start wrapping up.
...........................dianne joined............. :)
Jean Do you happen to know the symptoms of vaginal LP?
...........................Dianne joined............. :)
...........................toby joined............. :)
drwright Jean there are dental schools at Illinois U and I know that IU in Indianapolis runs an oral medicine clinic where they treat lp.
drburkhart Jean, we have some very good articles that we can send you. Dr. Eisen, 1994/95, wrote a very good article on the subject. Email me and I will send you a copy.
Jean I don't get to Indianapolis very often.
Carp Symptoms of vaginal lp are pain and discomfort
Jean ok, I'd like to read them.
drburkhart Toby, welcome. Do you have some questions?
Jean Carp, not itching?
Carp itching may also be manifested. I would recommend a gyn appointment for definitve diagnosis.
Jean ok, thanks.
toby I'd like to just waatch for a few minutes then I'll join in
aupton Last call for questions, Folks. About 5 minutes to go. The log will be posted tommorrow on the web site.
toby Sorry I'm so late in arriving. I had the time figured incorrectly. I'll communicate next time or by Email, thanks.
fiftyplus Dr. Burkhart...any results from the questionaires?
drburkhart Many females who have completed our survey are complaining of discomfort, pain and burning related to vaginal problems. If you have not completed our survey, please do. The information will provide good demographic information on lichen planus.
Jean I completed the survey several months ago. Should I do it again?
drburkhart We will try to do some tabulation soon and hope to share this with all of you.
fiftyplus Great...look forward to it. Thank you doctors!
aupton On behalf of Center for Professional Development, I'd like to thank all our guests. Keep watching the website for schedules of future chats on LP. Exchange any farwells now, if you would, and we'll see you next time.
DrS your're welcome
drburkhart Jean, no, please do not send more than one form. Thanks
Carp thanks for being included.
Jean Ok. Farewell.... and thanks.
drwright Steve and Carp thanks
DrS my pleasure
drburkhart Dr. Wright, Dr. Sonis and Dr. Carpenter, thank you for all the good information that you provided for us this afternoon.
Dianne bye
............................drwright left ............. :(
............................fiftyplus left ............. :(
...........................drwright joined............. :)
............................drwright left ............. :(
............................Dianne left ............. :(
drburkhart Thank you all for being here and please contact us with any follow up questions.
............................drburkhart left ............. :(
............................toby left ............. :(
............................DrS left ............. :(
............................Jean left ............. :(
............................dianne left ............. :(
aupton Dr. Carpenter, you can just click your 'Log off' button. Thank you! Hope it went well for you. -- art
............................aupton left ............. :(
............................Carp left ............. :(
-- Log stopped at Tue Oct 19 15:00:17 PDT 1999