Contributing Writer 
Lichen Planus
What is lichen planus? Lichen planus is a skin disease that frequently affects the mucous membranes inside the mouth.
What causes lichen planus? No one knows what causes lichen planus. It is not an infection. You didn't catch it from someone, nor can you give it to someone else. It is not inherited. It was not passed down from your parents, nor can you pas it on to your own children. Lichen planus is one of a group of inflammatory diseases that affect skin and mucous membranes. It is the inflammation in lichen planus which causes all of the problems associated with the disease.
Who gets lichen planus? Lichen planus is twice as common in women as men and usually begins around the time of menopause. It can begin, however, in young adults as well as senior citizens.
What does lichen planus look like? Lichen planus has many different forms. The most common type has white streaks and patches on the cheeks, tongue, or gums. Another type has blisters and ulcers. A third form simply has extensive reddening of the oral tissues. Often more than one form is present.
How o I know if I have lichen planus? One of the problems with lichen planus is that it can resemble a number of other conditions and vice versa. These conditions range from canker sores to cancer. The only way to tell for sure whether or not a patient has lichen planus is to do a biopsy and examine the tissue with a microscope.
What is involved in a biopsy? A biopsy involves the removal of a small piece of tissue from your mouth. This is usually done in the office rather than the hospital. First, a small amount of anesthetic us used to numb the area. The specimen removed is usually so small that a stitch is often not even required. Most patients do not require any pain medication following this type of biopsy, although some prefer to take two non-aspirin tablets before going to bed.
What will happen to the biopsy specimen? The biopsy specimen will be processed and made into slides which can be looked at under the microscope. Depending on the particular situation, one or more stains are used to demonstrate the specific types of cells and changes present which would indicate that a patient has lichen planus or some other disease. Once the diagnosis is made, an appropriate type of treatment can be started.
How is lichen planus treated? Because lichen planus has many different forms, it is treated in many different ways. In many cases, if a patient's lichen planus does not have any symptoms associated with it, nothing is done other than to monitor the disease periodically, usually twice a year. Lichen planus is an inflammatory disease; therefore, those cases that are symptomatic are usually treated with anti-inflammatory medication. Other medications may also be used to treat the discomfort associated with the disease.
What sorts of anti-inflammatory medications are used to treat lichen planus? The most common medications used to treat lichen planus are steroids. Most of the time these are applied topically to minimize the incidence of side effects from the medication. These topical medications are applied either as a gel to be massaged into the lesions or a rinse to be swished in the mouth. Occasionally, individual lesions that do not respond to topical medication are injected with steroids. In severe cases, high doses of steroids are given in liquid or pill form. Lichen planus frequently affects only the gums and interferes with a patient's ability to brush and floss. In such cases, appliances are made to hold medication next to the gums. These appliances are usually worn at night. Not only does this method of treating lichen planus of the gums work well, it also makes it easier for patients to brush and floss as they would like to do. Because lichen planus has so many forms and patients respond differently to various medications, the treatment has to be individualized in each case.
Does lichen planus cause gum disease? Lichen planus does not cause gum disease directly; however, if lichen planus prevents you from practicing good oral hygiene because it makes your gums sore, you will get gum disease because you don't brush and floss. Oral hygiene is extremely important in managing lichen planus; therefore, it is necessary that you make an extra effort to do everything your dentist and dental hygienist tell you to do in this regard.
How long will I have lichen planus? Lichen planus is a chronic disease; therefore, you will have it the rest of your life. It is not curable; however, it is certainly treatable. There are a variety of ways to make patients comfortable that are both safe and effective.
Will lichen planus ever turn into anything else? There is some evidence that patients with lichen planus have a slightly higher than normal risk of developing oral cancer. This risk is extremely small, however, and certainly much less than the risk associated with tobacco use and alcohol abuse. Nevertheless, it is important that you be reexamined on a regular basis to ensure that there are not any significant problems developing which you are not aware of.
More free Dental Practice Management Free goodies:
Dr. O's Dental Consultant Management Downloads
Dr. O's Dental Office Sample Letters
Dr. O's Dental Insurance and Coding Documents
DENTAL PATIENT INSTRUCTIONS: INFECTIONS
An infection (abscess) of a tooth or the gums can start out small, but can quickly become quite severe, even requiring hospitalization, if not attended to properly.
Be sure to follow these instructions faithfully. The success of fighting the infection is dependant largely on how closely you follow them. If you have any questions or problems, call your dentist.
- If antibiotics are prescribed, start taking them immediately. Take them exactly as it says on the label. Finish all the pills even if you feel better before they are gone.
- If pain medication is prescribed, take it as you need it. Don't exceed the dose on the label. Taking with food or milk will help reduce upset stomach. Avoid driving or operating heavy machinery when taking pain prescriptions.
- Avoid pain medications with aspirin. Nuprin or Advil are good alternatives.
- Use warm saltwater "holds". Mix 1 teaspoon salt in a glass of warm water. Take a mouthful and pouch it in your cheek over the infection area until the water cools; repeat until the water is gone. Doing this every hour helps pull the infection towards the surface of the gums so it can drain. Doing this at the same time as using the cold packs outside of mouth enhances the effect.
- Use cold packs on face over the infected area. Place on face for 15-20 minutes, then leave off for 15-20 minutes.
- DO NOT use heating pads on outside of face. This can cause the infection to worsen and spread further.
- Maintain a good, balanced diet, and get plenty of rest. Your body needs extra energy when fighting infections. You may need to eat softer foods.
- Avoid smoking until the infection has subsided. If you must smoke, keep it to an absolute minimum.
Even when following these instructions, it may take at least 24 hours for the infection and discomfort to stop increasing. If you don't get significant improvement within 48 hours, or if it continues to get worse after 24 hours, call your dentist.
More free Dental Practice Management Free goodies:
Dr. O's Dental Consultant Management Downloads
Dr. O's Dental Office Sample Letters
Dr. O's Dental Insurance and Coding Documents
Dry Mouth
(Xerostomia)
Causes of Dry Mouth:
- Certain prescription drugs
- Certain over-the-counter medications
- Tobacco
- Mouth breathing
- Anxiety
- Depression
- Alcohol
- Caffeine
- Spicy or salty foods
- Breathing unusually dry, cold,dusty, or dirty air
- Stress
- Vitamin deficiencies
- Simply not drinking enough water
- Radiation and chemotherapy
- Arthritis
- Diabetes
- Menopause
- Sjogren's Syndrome
- Lupus
- Parkinson’s disease
What drugs and medications can cause dry mouth?
- High blood pressure medicines
- Antidepressants
- Tranquilizers
- Antihistamines
- Anti-Parkinson agents
- Antipsychotics
- Decongestants
- Narcotic pain relievers
- Chemotherapy
- Antidiarrheals
- Bronchodilators
What problems might develop because of dry mouth?
- Rapid development of tooth decay
- Sore tissues
- Worsening periodontal disease
- Sore spots and ulcers under dentures
- Difficulty wearing dentures
- Mouth sores in non-denture wearers
- Breath doesn’t feel as fresh
- Difficulty chewing and swallowing normal foods
- Difficulty tasting normal foods
- Difficulty speaking
- Burning sensation in the mouth
- Dry or painful tongue
How can I avoid destruction from rapid tooth decay?
- Avoid hidden sugars, such as cough drops, lemon drops, hard candy, breath mints, chewing gum, soda pop, etc. People with dry mouths can get literally dozens of cavities in a matter of a few months.
- Use a prescription fluoride preparation. These get more fluoride to the teeth than regular fluoride toothpaste. They are available as a mouthrinse, brush-on gel, or a gel applied in a custom-made mouth tray. Ask your dentist for prescriptions, or construction of a custom fluoride tray. Prevident and Gel-Kam are examples.
- Maintain superior oral hygiene habits: brush at least twice a day for two minutes per brushing, floss every day, and have your teeth cleaned/checked twice a year.
What will help relieve my dry mouth?
- Increase water intake throughout the day, and take frequent small sips
- Add moisture to the air with a humidifier.
- Protect lips with a balm.
- In cold weather keep mouth and nose covered with a scarf when outdoors.
- Don’t use tobacco or alcohol.
- Avoid strong toothpastes.
- Avoid mouthwashes containing alcohol.
- Use only toothpastes and mouthwashes that don’t contain sodium laurel sulfate.
- Avoid spicy and salty foods, and products containing cinnamon, peppermint, or wintergreen.
- Take a daily multi-vitamin.
- Use oral products that contains Xylitol.
- Be sure your doctors and pharmacist are aware of all the medications you are taking.
- Ask your doctor if your medications can be adjusted or changed.
- Use a saliva substitute or mouth moisturizers.
- Use sugarless hard candies to stimulate saliva flow.
