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December 2022

Greetings International Oral Lichen Planus Support Group! December 2022

Happy Holidays everyone! Another year has passed, and we have heard from so many of you over the past twelve months from areas throughout the world! Some of you have been recently diagnosed with oral lichen planus or in some cases, another type of skin disease. As you know, sometimes a diagnosis is difficult to obtain, and our main priority is to get that correct diagnosis for you and help you to navigate the dental/medical systems. Sometimes, we see that you may be dealing with several medical conditions at the same time. Since we are here throughout the year, please take advantage of our expertise and do feel free to contact us whenever you need advice or assistance. We are excellent listeners!

I have had an amazing journey this year since I was a part of the Oral Lichen Planus World Workshop through the American Academy of Oral Medicine. The group was comprised of dental specialists from many countries conducting research in treating oral lichen planus. Multiple papers have resulted from this research and a large portion of the research conducted, involved the concerns of patients who participated in focus groups and shared their own information about lichen planus. We presented some of the results at the annual AAOM meeting this past year in Memphis Tennessee. We had a lot of discussion and sharing of promising ideas for future research.

This year has truly been one of international focus since we had so many of you contact us from all over the world. The global network has become a smaller, but ever-connected one, with a focus on providing quality health care for everyone.

It has also been a sad year since my co-founder, Dr. Terry Rees, died and we all miss his dedication and advice. Along with Dr. Rees, Mr. Art Upton, our webmaster, also passed away. We miss Art and still benefit from his years of expertise. We continue to keep the support group active to provide the best information to our members. Thank you all for the kind words and your participation.

On January 24, 2023, we will host a webinar and our guest will be Dr. Miriam Grushka, from Canada.

The webinar will occur from 7:00-8:00 p.m. EST.

Miriam Grushka MSc, DDS, PhD

Certified Specialist (Ontario), Oral Medicine

Diplomate, American Board of Oral Medicine

Diplomate, American Board of Orofacial Pain

Visiting Lecturer, Tufts University, Department of Diagnostic Sciences- Oral and Maxillofacial Pathology

Brief Biography:
 Dr.  Miriam Grushka has received her DDS and a PhD in Oral biology from the University of Toronto and has engaged in the practice of Oral Medicine and Orofacial Pain for many years, treating patients with mucosal disease, including lichen planus, Burning Mouth pain, taste disturbance and other orofacial pains. She has previously been on the Faculty of Dentistry at Case Western Reserve in Cleveland and at the University of Illinois in Chicago.  She is Board certified by the American Boards of Oral Medicine and Orofacial Pain and she is also a Certified Specialist in Oral Medicine both in Canada and the United States.  She has published numerous scholarly articles and book chapters and has delivered numerous presentations on topics such as Burning Mouth Syndrome, Oral sensory phantoms, and the impact of mucosal disease.

Dr. Grushka currently maintains a private practice in Toronto limited to Oral Medicine and Orofacial pain and sees and treats many patients with oral lichen planus. 

If you are not able to make the webinar, it will be posted on the site within a few days. If you have questions and will not be there for the actual webinar, please send the questions to me at the address below.

Dr. Nancy W. Burkhart, Ed.D, M.Ed., BS, RDH, AAFAAOM

Department of Periodontics, Adjunct Professor

School of Dentistry, Texas A&M University

3302 Gaston Ave.

Dallas Texas 75246

nancy.burkhart@tamu.edu

https://dentistry.tamu.edu/olp/index.html

Again, happy holidays and the best to you and your family.

Nancy W. Burkhart

 

We still find that there may be a problem for patients in how they apply corticosteroids to treat oral lichen planus. See the instructions listed below.

Corticosteroids and Topical Medications: Are You Applying Them Correctly?

  • Your doctor has prescribed a topical corticosteroid gel, ointment, or cream for periodic application to your mouth sores. Please follow his/her instructions as written on the prescription box regarding how many times you should apply the medication daily. These medications are used to reduce inflammation and often used for skin conditions such as eczema and allergic reactions. Some commonly used medications are betamethasone and clobetasol. The box sometimes will say that the medication is for “external use only” since the most commonly used corticosteroids are used for “external skin lesions” most of the time. However, the safety of corticosteroids in the mouth is based on research and they are commonly prescribed as well for oral lesions/conditions. Follow the instructions in the use listed below.

  • It is important to make sure that one of these applications occurs just before bedtime in the evening. The medication probably stays in place longer at that time because saliva flow diminishes when you are asleep.

  • Do not eat or drink anything for at least 30-45 minutes after any application.

  • It will help if you gently blot the area with gauze. This also will help keep the medication in place longer.

  • When you apply the topical corticosteroid, try to avoid rubbing it in place using a back-and-forth motion, because that motion may rub the “skin” surface away. Instead, pat the medication into place. This means just “light, gentle pats.”

  •  Remember that more is not better. All you need to do is apply a thin coating of the medication. If you do this, it will stay in place better, last longer, and will be safer to use. The areas that are treated orally, are not as large as those skin areas so the amount of the medication is much less. Less of the medication is absorbed into the whole body over time. 
  • Wash your hands after application-especially if any contact with your fingers and hand area. Do not touch your eyes. 
  • Do not use any medication after the expiration date on the box/tube. 
  • When in doubt about your concerns/lesions, contact your healthcare provider for clarification.

How to apply topical corticosteroids in the mouth-The Stomatology Center, Texas A&M School of Dentistry, Dallas Texas, January 2022.

Tips for patients to reduce stain on your teeth (this is related to general stain from beverages and food, whether you are a patient with any oral mucosal disease or for anyone who wants to maintain a nice smile)

  • Use a straw when drinking juices or liquids that stain the teeth such as red juices, blueberry, and coffee-type drinks.
  • Add milk to tea/coffee to lessen the stain of the product.
  • Rinse with clear water after eating or drinking a highly pigmented drink such as coffee, tea, red wine or blueberries.
  • 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, ginger 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. One that is recommended for the individual patient by a dental professional.
  • Toothbrushes do not clean in between the teeth, so daily use of floss is optimal or interdental Proxabrush/or Soft-Picks.
  • Depending upon the condition of the oral tissue, one of the new water flossers may even work for some individuals. Discuss their use with your dental hygienist/dentist.

Burkhart NW. Reduction of tooth stains: Patient education is vital to preventing tooth stain. RDH April 2015 5: (4) http://www.rdhmag.com/articles/print/volume-35/issue-4/columns/reduction-of-tooth-stains.html July 2017