| .............. Log on sep2002 started at Tue Sep 17 06:22:25 PDT 2002 ........... | |
| aupton | Greetings all. Hold your questions until Dr. Burkhart opens the session |
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| .............. Log on sep2002 started at Tue Sep 17 07:13:51 PDT 2002 ........... | |
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| DrRees | Molly, Sure, I will be glad to provide the info. |
| arkthrift | When my mouth is burning and I have nothing else to use, yougart is good. Hold it in your mouth and let it work. I use a lot of asodophillis and it seems to help. I had a very high yeast count in my body and i think there is a correlation to olp with this. Is there any study on that? |
| DrBurkhart | D. I missed the beginning of your question, concerned about what? |
| D | If I have no pain do I have to be concerned about OLP |
| Molly | Is your number provided on the website? Thank you. |
| drcarpenter | [arkthrift]I am not aware of any correlation with yeast count and OLP |
| DrRees | D, One of the endpoints of treatment is absence of pain. If you still have lesions you should work out a maintenance visit routine with your dentist or physician. |
| arkthrift | thanks |
| Roz | I think you are not getting my questions. Again-if I use oral prednisone how much & how long? |
| arkthrift | what is an endpoint? |
| DrRees | Molly, I don' t think so but contact our e-mail address and we will give it to you. |
| Lomby | are you posting a medication possible cause list on your site |
| DrBurkhart | D, anyone with LP should be checked on a regular basis. We suggest photos initially and with follow ups. Read our new guidelines. If you think that the tissue appears different, go back and have it checked. |
| frank | arkthrit said yogurt; I use alpoe vera gel. I have no pain. Is this OK? |
| DrBurkhart | D, that is even if it is not time for you to be checked. |
| DrRees | arkthrift. That is the point at which it is not desirable to increase dosage of a medication or switch to a stronger one. |
| JT | My OLP started from a sore caused by a new denture...is there a large percentage of OLP that start that way? |
| D | Dr. Reese my periodentist just discovered the LP and sent me for a biopsy to an oral surgeon. So I thought I was at the beginning not the endpoint? |
| tzucuskie | Is there a specific neutral fluoride brand that you particularly like? Have you noted any particular adverse reaction in LP patients to fluoride or are they generally well-tolerated? |
| DrRees | Roz, We try to limit use of oral prednisone to 2-3 weeks at a time. That should be enough to get things under control if oral prednisone is going to work for you. |
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| bluetrout | Have to go now. Will read rest later. Thanks, all! |
| DrBurkhart | JT, if you have LP, any trauma may be just enough to set the disorder into motion. That is why we recommend less trauma with routine cleaning appointments. |
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| DrRees | D,ok you are right. You have a mild form of the condition perhaps or you are just lucky enough to be able to tolerate pain well. Discuss your best course of action with your periodontist. |
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| arkthrift | i find the oral prednisone hard to spread in my mouth and then i feel like my mouth is really yucky. any tricks to doing the spreading? |
| Lomby | what is a periodontist? |
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| DrBurkhart | Hello Copenhagen, are you one of our guests? |
| Molly | I did not know what olp looked like until my dr explained it was the white streaks. I was using cortisone cream all over my mouth it hurt so bad. Do all the patients know what this looks like? I think that is very important as it was in my case. |
| DrRees | JT, On rare occasions we have seen a lichenoid reaction to dentures. Dentures are far more likely to cause other problems, however, and these should be checked. |
| arkthrift | jt is your bite off? |
| Copenhagen | We are the group of invited drs. (Anne Marie Pedersen, Lis Andersen Torpet, Palle Holmstrup and Jesper Reibel) |
| DrRees | Lomby, A periodontist is a dental specialist who treats gum diseases |
| Lomby | Does Nexium cause OLP |
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| arkthrift | Lomby I got olp after being treated for refulx. |
| sjco3 | Has there been any known Lichenoid reaction to Claritin, Celebrex or Valtrex |
| Wendy | Hello Copenhagen Drs.! |
| DrRees | Molly- You are right, when your mouth is sore there is usually no way for you to know why. See your dentist |
| DrBurkhart | Welcome: Copenhagen. We have many people on line. Let me begin by asking you what your normal protocol is for treating LP. |
| Rosalie | I think all oral application meds are hard to apply. But I found that if I bite down on a clean paper towel just before applying at bedtime, it helps. Also using the finger to apply it rather than a qtip works better for me. Just dab - don't rug. |
| JT | What type of Lichenoid reaction to dentures...alergic type or just irritation that causes epasodes of LP to service?? |
| Lomby | does nexium cause an increase in lesions |
| DrRees | sjco3-Not yet! In theory any drug can cause a lichenoid reaction in someone. |
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| pete | Dr Burkhart I have had OLP for over 2 years, about two months ago I noticed a small lump under my chin which my dr said was just a swollen salivarry gland, it hasn't gone away or changed in two months, what do you suggest I do about this? |
| KathaB2 | Hi! I've found something that works for my OLP...can I share this? |
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| bobw | Are there any alternative remedies or treaments such as foods or herbs? |
| DrBurkhart | Pete, I suggest that you ask for a biopsy right away. |
| DrRees | JT, The cases I have seen have been allergic. However, most denture reactions are due to irritation from the materials in the denture. That usually goes away in a jew days. |
| Rosalie | KathaB2, please share. That's what this is all about. |
| JT | Please let KathaB2 share her "something that works for OLP!" |
| Copenhagen | Improved oral hygiene with individual professional assistance to ensure the less traumatic but sufficient cleaning procedures. If candidal infection is identified antimycotic treatment may be added. If sore lesions are persisting topical steroid will be prescribed. |
| DrRees | Copenhagen, We have been asked about contact lichenoid oral reactions. what are your feelings about that? |
| KathaB2 | I've been using "Plaquenil", or Hydroxychloroquine sulfate tablets since last Feb. and it's almost all gone! |
| arkthrift | pete have you tried using goldenseal and echenesia to see if you have a low grade infection that needs to be cleared up? I had glands that did the same thing about 2 years into the lichen. |
| DrRees | bobw-Not that we are aware of but one should avoid those foods and beverages that cause discomfort |
| DrBurkhart | Dr. Pedersen, would you comment on any genetic component of LP and also any indication of a viral involvement |
| pete | Dr Burkhart, is there any way to examine the lump without biopsy first? should I see my dermatologist, or my primary? |
| tzucuskie | Dr. Rees, is there a specific neutral fluoride brand that you particularly like, or are these types of fluoride generally well-tolerated? |
| DrBurkhart | Pete, do you have someone in oral medicine, oral pathology or oral surgery that you are seeing? |
| Copenhagen | Lesions that are localized to the contact area usually are due to contact allergy to mercury or other dental materials. If widespread lesions are present they may improve after replacement of amalgam fillings with other materials. |
| DrRees | tzucuskie, Probably any are ok. we usually use Prevident which is a prescription item. |
| pete | No, I was diagnosed by an oral pathologist two years ago, but I haven't seen him since |
| Molly | Now that I am seeing all of this on dental work, I realize that this is when my olp became so much worse. I had bridges done in my mouth and it has been chronic since. Should I have the bridges removed?I believe that my bite is off some also. Another thing, I have had to have root canals (4) in the past two years. Coincidence? |
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| DrRees | Molly, do not go to the expense of having your bridtges removed unless it can be confirmed that they are the cause of your reaction. You can be allergy tested for dental materials |
| drcarpenter | [lomby] I have not seen any lichenoid reactions with nexium |
| DrBurkhart | Everyone, the group from Copenhagen is Dr. Anne Pedersen, Dr. Palle Homstrup, Dr.Torpet and Dr. Reibel |
| Copenhagen | Virus has never been shown to be an etiologic agent in oral lichen planus. There is no firm evidence of a genetic predisposition either. |
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| Wendy | What is the most accurate form of testing for dental material allergies? |
| DrBurkhart | Did I leave anyone out? |
| KathaB2 | The "Plaquenil" is an anti-malarial medicine. I found the medicine on the internet, reading transcripts that doctors were sending each other about OLP. |
| DrRees | Wendy, the technique we use is called patch testing. It should only be done by a physician and it is not foolproof. However it is often very helpful. |
| DrBurkhart | Pete, please contact me after the session so we can advise you more on this. Any lesion, bump or growth that does not go away witin a couple of weeks needs to be evaulated. |
| arkthrift | with all the trouble I have had in the last 5 years with medical proceedures I have gone to an herbal and have been doining a liver cleanse along with herbal suppliments. |
| Molly | Dr's, what are your thoughts on this plaquenil? |
| KathaB2 | I have had no lesions since February, and the spots on my arms have gone away, and the white surfaces in my mouth are 90% gone, too |
| DrRees | KathaB2-Please be sure that someone is monitoring you for any adverse effects of the Plaquenil. It seems to work quite well for some people but there is a potential for side effects. |
| Lomby | any known side effects from plaquenil? |
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| KathaB2 | I read in the same transcripts that one ought to have their eyes checked and I've done that. My opt. said there has been no change at all. |
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| JT | Would it be alright for KathaB2 to share what she has been using? |
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| DrRees | Lomby, yes there is a fairly long lest included some problems with blood cells on rare occasions. |
| Lomby | sounds like glacoma patients would react to plaquenil? |
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| DrBurkhart | Copenhagen, we have a question from a doctor in Africa who contacted us wanting to ask the group if there is any association with elevated platelet counts and OLP? |
| pete | Dr. Burkhart, do you want me to e-mail or call, I also have instant messaging, I would like to get to the bottom of this asap |
| DrRees | Copenhagen, what are your thoughts on how often someone with established lichen planus should be seen by their dentist? |
| Copenhagen | In our opinion patch testing is of little value since the correlation between clinical reactions in the oral mucosa and the result of patch tests of the skin is limited. |
| DrBurkhart | Dr. Homstrup, how often do you recommend that patients be seen for cleaning appointments |
| JT | My platelet counts have been normal and I have OLP |
| KathaB2 | I quote from the transcripts: "Eye problems are rare with Plaquenil at 400mg/d or less, and I suggtest opth. exam every 6 mo" |
| Lomby | I was wondering if one has a thyroid (goiter) condtion under control with synthroid does both this and olp indicate a problem with the immune system and if so anything can be done to up the immune system? |
| DrRees | Copenhagen, How do you test for contact allergies? |
| Wendy | Is there a blood test available for testing allergies to dental compounds? |
| DrBurkhart | Pete, my email is nburkhart@tambcd.edu |
| Copenhagen | Cleaning appointments will depend on the single patients ability to clean his/her teeth. Thus an individual approach is necessary. |
| DrRees | Wendy, there is a blood test but it may be even less accurate than some patch tests. |
| Copenhagen | Contact allergies are tested by dermatologists in Denmark. |
| drcarpenter | [lomby] Usually hypothyroidism is not an immune system problem neither is OLP |
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| Molly | I have found that when I have a vaginal infection and have been given medication the olp clears up for a time? Any accuracy to this? |
| DrRees | Copenhagen, here in the US also. But how do they do the tests? |
| DrBurkhart | Copenhagen, are you seeing an increase in Hepatitis C in relation to LP? |
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| DrRees | Molly, that probably means that you may have a mild yeast infection in the mouth if it is vaginal yeast being treated. |
| frank | dermatologists in NYC refuse to opine anything about lesions in the mouth |
| Molly | How is that treated? |
| Copenhagen | The test includes application of various components from dental restorative materials on the skin. Subsequently the skin reaction is read by the specialist as positive or negative. |
| DrRees | Molly, there are a variety of topical medications that can be used and one or two systemic ones. We usually start with the topicals. |
| JT | I thought OLP WAS in the ammune system catigory...isn't it white blood cell reaction? |
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| Rosalie | Thanks, Dr. Burkhart, for doing this.....you're a honey!! Just the group therapy here is a big help. |
| pete | Dr Carpenter, if the etiology of olp is not immune related then what is it, my dr's have said it is likely immune. |
| Copenhagen | We are not seeing increased Hepatitis C in relation to LP in Denmark. |
| DrRees | Copenhagen, That is what I mean by a patch test. |
| KathaB2 | Here is the website where I found the info last Feb: look on p.2, Dr. J.S.Sidhu: http/dermatology.cdlib.org/rxderm-archives/lichen-planus-oral |
| aupton | Folks, we will be going a few moments overtime for our guests. If you need to sign off, check the web tommorrow for the transcripts |
| arkthrift | after I had the mercury fillings removed I started keilating myself with cilantro/burdock solution and using a merc specific that helps carry off the mercury that is throughout the body. (I had one tooth that was cracked and the filling was leaking. I did not discover the crack until part of my tooth fell off one day. There was no pain.) I was told to do the keilation for a year after the removal of the fillings. It has been about 6 months and my mouth is much bett |
| JT | Dr. Carpenter, I have been told the same as peter...immune related |
| DrBurkhart | Copenhagen, what is currently being conducted in research related to LP at your facility? |
| Molly | Thank to all of the dr's. |
| aupton | KathaB2 and others. Please do not list web addresses or emails in the session. There will be time at the end of the session to exchange emails. Thanks |
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| arkthrift | Sorry I pushed enter before the question. Has anyone else done this? |
| Wendy | My thanks extended as well, you have been very helpful! |
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| KathaB2 | Before everyone signs off, I just want to recommend again, the PLAQUAENIL! |
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| DrRees | JT, I am not sure what you are asking but the cells in the tissue biopsy of old are lymphocytes that are in fact blood cells. the question about immunity has to do with why these cells gather and what their effect is. To me this is still unresolved. |
| arkthrift | do you need a perscription for the plaquaenil? |
| KathaB2 | sorry...PLAQUENIL |
| JT | Thank you all! |
| DrBurkhart | Everyone, we are going overtime here. Please stay on if you still have comments or want to listen. |
| drcarpenter | [pete] OLP is not an immune deficiency problem that would respond to an enhancement of the immune system but it is a immunologically mediated local reaction with certain types of lymphocytes |
| aupton | Katha leave the recommendations to the doctors. |
| Copenhagen | In Copenhagen we follow a large group of LP patients by regular clinical examinations. Especially patients with sore lesions. Furthermore, we are for the time being preparing for a study on the influence of certain types of medicine on the manifestations of oral LP. |
| pete | dr carpenter, so in layman's terms what does that mean? |
| JT | I thought it was an over active immune system problem |
| KathaB2 | But if it works for me, why don't the doctors have any interest in it? |
| Lomby | does it or does it not have something to do with the immune system? |
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| DrRees | arkthrift- yes you need a prescription. |
| JT | The mouth is reacting 'as if' there were an infection |
| Patrice | Patrice |
| DrBurkhart | Copenhagen, what type of medications are your testing? Corticosteroids? |
| DrRees | KathaB2-It is sort of a last resort because of potential side effects. There are usually other ways to treat the condition although we have had some success with plaquenil as well. |
| DrBurkhart | Patrice, do you have a question? |
| JT | That was a question.....The mouth reacts "as if" it were fighting an infection????? |
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| KathaB2 | Dr.Rees, what side effects??? |
| DrBurkhart | Dr. Homstrup, what is your procedure for cleaning appointments for LP patients-do you suggest as little trauma as possible with non-abrasive products? |
| DrRees | Lomby, and JT-the immune system is involved in almost everything. However, OLP may ultimately turn out to represent an allergic condition. Most of the time right now we are not able to find what the person is allergic too but there are numberous occasions in which we can. |
| JT | If it's possible, it would be a nice thing to have these sessions more often. |
| Copenhagen | We are not testing therapeutic approaches but etiological approaches of medication intake. As an example some medications may cause manifestations in the oral mucosa indistinguishable from OLP. |
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| arkthrift | I started having my teeth cleaned every three months about 2 years into the olp and it has helped greatly, they go down deep! |
| ollie | Speaking of last resorts...I took a stwo week course of Prednisone two months ago. It seemed to knock it out, tal least in the short term. The spots on the hand are still there, tho. |
| Copenhagen | The procedure for cleaning appointments is a little trauma as possible to the gingiva and the oral mucosa. |
| DrBurkhart | Arkthrift, Dr. Holmstup who is online has researched this connection and found this to be true. |
| Lomby | to Copenhagen..I agreee since I was doubled up on Vasotec and had cardizem diatek and clondine added my mouth is in complete agony |
| DrRees | ollie, good, we would want to follow up possibly with topical steroids to try to keep things under control now that you are better. |
| JT | Thank you DrRees Now where do I begin to find out what, after 58 years I have maybe become allergic too!? |
| aupton | Nancy, will you be calling the end time? |
| frank | frank : "Little Trauma" my quarterly periodontal maintenance causes a lot of trauma. are there recommendations to limit this? |
| Wendy | Does an oral biopsy mean a part of the lump taken or a part of the olp white aspects? Would removal of part of lump cause spread if cancerous? |
| arkthrift | has anyone done a study on the use of oral steriods and the eventual developement of olp? |
| DrRees | JT- I don't think you have had olp for 58 years so look for the things that coincide timing wise with the onset of your lesions. |
| KathaB2 | Dr. Rees, both my dentist and my ENT doctor are amazed at the way the plaquenil has helped my OLP, and LP, too. What are the side effects you mentioned??? |
| Copenhagen | Removal of subgingival plaque and calculus is important for LP to improve why some trauma is impossible to avoid. |
| DrRees | Everyone, I have to close out and go to the clinic. Thanks to all for you participation and Palle we really appreciate you folks in Copenhagen being willing to join us. Goodby |
| JT | A partial that did fit correctly and kept irritating for 8 months of ajustments! It started in one of the irritated areas...has sence spread to cheeks, tounge ..very typical case, they say! |
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| aupton | Folks, the session will be over in about 5 minutes |
| DrBurkhart | JT, keep a diary and list everything that causes you problems. |
| Copenhagen | Best wishes Terry, from Copenhagen. |
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| JT | Your right DrRees...only have had it 9 months. Thank you DrBurkhart |
| arkthrift | My husband started going to dr greg craig in Cerritos, Ca. he works with lazars. Instead of scraping he cleans right down to the roots with a lazar. My husaband had a lot of shifting teeth and was loosing his gums. The lazar corrected that |
| DrBurkhart | Copenhagen, how often do you recall patients with LP who are erosive? |
| Wendy | Thanks again to all Drs. |
| Lomby | yes, thank you all drs |
| aupton | Thank you, to all our guests! The room will be open for about 5 minutes after we call for final sign off in case anyone wishes to share email address. Transcripts will be posted by tommorrow on the web site. |
| arkthrift | thanks for having this on line |
| JT | The OLP is always their...it just isn't always flaired up. I know the things that flair it up but NOT what actually keeps it in my mouth. |
| DrBurkhart | Everyone, if your questions were not answered, please contact us after the session for a personal response. Also keep checking the materials on the site. |
| Copenhagen | We usually see erosive LP every third month, however it depends on individual factors like symptoms, location, oral hygiene etc. |
| arkthrift | I was told initially that olp should go away in 3 years but it has not. Does it ever go away completely? |
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| frank | could someone posta list of periodontists in NYC who use laser?. sounds good! |
| Copenhagen | Usually skin lesions dissapears after 3-12 months, however, oral LP may persist for many years. |
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| DrBurkhart | Arkthrift, some patients report complete remission while others have a constant problem. There is no way to know. |
| JT | Thank you to all for sharing...and Dr Burkhart, thank you for your referral of Dr. Sonis! Also would have missed this if you hadn't reminded me it was (AM and not tonight!!) |
| aupton | 3 minutes to go, everyone. Please tie up loose ends now. |
| DrBurkhart | JT, Dr. Sonis is great and we are happy that you are doing well. |
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| DrBurkhart | Everyone, we do have a list of practitioners who know about OLP, so contact us if you need help. |
| DrBurkhart | Barry, we are about to sign off so contact me after the session and read the transcipts which will be posted soon. |
| aupton | Our thanks to all our special guests for Copenhagen, and to Dr. Carpenter from California, and to all the rest of you from around the world! Keep checking the web site for new information and for the next online chat with Doctors from Baylor College of Dentistry. PLEASE SIGN OFF NOW. Thank you. |
| DrBurkhart | Copenhagen, thank you for joing us today and we will post the transcipts later. |
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| DrBurkhart | Thank you all for participating. Have a great day! |
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