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October 2017 - Articles Archive

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Rees' Pieces

The phases of therapy for oral lichen planus

by Dr. Terry Rees

Oral lichen planus is one of a group of diseases that may affect the skin, mouth and other mucous membranes of the body.

Since many of these diseases may cause similar oral lesions, a correct diagnosis and proper management approach must be carefully determined.

This 3 or 4 part discussion will attempt to clarify the philosophy of practice that we adhere to in our Stomatology Center at Texas AM College of Dentistry in Dallas Texas. This may be of some importance since in our chat sessions we often allude to the way we manage oral lichen planus and it won't necessarily coincide with the management concepts of your own health care provider.

Several previous authors have described various phases of therapy in treatment of mucocutaneous diseases and, in our practice, we have adopted their concepts with a little modification. We believe that diagnosis and management can be divided into 4 phases as follows:

  1. Diagnostic phase ( Essential to successful management.)
  2. Control Phase ( Therapy to reduce or eliminate the signs and symptoms of the disease)
  3. Consolidation Phase ( A period in which we gradually reduce or eliminate therapy to determine what level if any of ongoing treatment may be required as the lesions improve)
  4. Maintenance Phase (Long term control of the disease, if necessary to maintain an acceptable state of health and comfort).

As always, our goal is to eliminate the disease if possible but we believe that since we don't know what causes most oral lichen planus, even former sufferers with complete elimination of their signs and symptoms should be followed periodically for many years.

Diagnostic Phase

  • Past history
  • Clinical appearance
  • Biopsy, when needed (microscopic evaluation often and direct immunoflourescence occasionally)
  • Yeast culture or exfoliative cytology (Similar to Pap smear)
  • Occasional use of some ancillary tools

We believe the biopsy examination of diseased tissue is the gold standard for accurate diagnosis of oral soft tissue lesions. Usually this requires microscopic examination and occasionally something called direct immunofluorescence is also used to look for diagnostic features of some of the mucocutaneous diseases.

Direct immunoflourescence requires some special transport media for the biopsied tissue which will be provided free to the doctor upon request. We also want to know if the patient has lesions elsewhere on the body and whether or not these have been previously diagnosed.

A classic example is lichen planus of the genitalia which often occurs in concert with oral lichen. This is more common in women although it also may occur in men. We believe that any woman diagnosed with oral lichen planus should have an OBGYN exam as well to identify or rule this out.

Yeast (Candida) cultures are important to us because a sore mouth is often more susceptible to oral yeast than a healthy mouth. This can also cause lesions similar to those of lichen planus and if one is not as responsive to therapy as expected it may be due to a secondary yeast infection.

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Lichen Lady

Tips: Mucosal disease patient tips for reducing stain on teeth

by Dr. Nancy Burkhart

  • Use a straw when drinking juices or liquids that stain the teeth.
  • Add milk to tea/coffee to lessen the stain of the product.
  • Rinse with clear water after eating or drinking a highly-pigmented food or drink.
  • Eat raw, crunchy type vegetables throughout the day.
  • Some teas may stain more than others, changing to a less staining type such as white tea can decrease the stain.
  • Hard cheeses may add a protective element to the teeth in fighting stains.
  • Drinking hot water with lemon or flavors added to hot water such as fennel seeds, coriander, and cumin (placed in a tea ball) can provide some of the same calming sensations as tea.
  • The patient who drinks tea throughout the day might consider drinking tea followed by warm water with lemon for the next cup or perhaps a light herbal tea.
  • Chewing gum with xylitol may diminish the stain by stimulating saliva to cleanse the mouth.
  • Using a tongue cleaner to remove the residue on the tongue and in the papillae. The stain is continually bathing the teeth when left in the tongue papillae. Using a tongue cleaner several times a day is optimal.
  • Specific instruction in brushing and flossing for the individual patient is necessary and may include an electric toothbrush as well as a manual brush along with an appropriate type of toothpaste that is recommended for the individual patient.
  • NOTE: mucosal disease patients may find that a soft manual brush will often be better for them than the electric toothbrushes. Lesions on the tongue may be too sensitive for an electric toothbrush and the manual will be gentle yet enable removal of film on the tongue. This applies to gingival lesions as well.
  • Toothbrushes do not clean in between the teeth, so daily use of floss is optimal and/or the interproximal brushes. We like the GUM interproximal brushes.
Burkhart NW. Reduction of tooth stains: Patient education is vital to preventing tooth stain. RDH April 2015 5: (4)