A Few Interesting Articles

I'd like to discuss today is an interesting article that I found about the triggers of oral lichen planus flares and the potential role of trigger avoidance in disease management. And this is by Chen et al from North Carolina at Chapel Hill and the objective of this survey that he did and this questionnaire of 51 patients was to take people that had biopsy proven lichen planus and asked them a series of questions. And 94 percent of the participants identified at least one trigger of their biopsy proven oral lichen planus flare ups. Approximately half of the participants reported at least one trigger that overlapped with known triggers of Oral Allergy Syndrome and 63 percent identified at least one trigger that overlapped with known triggers of oral contact dermatitis. Emotional stress was the most common reported at approximately 77 percent. Regarding avoidance, 75 percent of the study participants reported avoiding their known triggers in daily life.

Just as a side note, this seems like common sense to me, if you noticed that a certain trigger causes mouth sores and pain it would seem natural to try to avoid that. 89 percent reported improvement with symptoms when they avoid triggers and 70 percent reported a decrease in the frequency of flare ups. I guess the bottom line for this article for me was that there are apparently triggers of oral lichen planus flare ups. And in the list of potential flare up items they had things such as raw citrus fruits, raw non-citrus fruits, melons, cooked, canned or preserved fruits, raw vegetables, vinegar based foods or dressings, spices such as parsley, fennel, caraway and coriander. Nuts, mustard, mint flavor, cinnamon, spicy foods, crunchy foods, toothpaste, mouthwash, alcohol. Trauma from dental procedures, metal from dental procedures or fillings, lip chewing. Emotional stress such as anxiety and depression. Smoking or tobacco use. Illness. Temperature change, medications and they also had a category for other.

So I read these off so that you could get a feel for what kind of triggers were actually identified. The most common was stress and anxiety. Spicy foods was high. Raw citrus fruits, mouthwash, toothpaste, dental procedures, crunchy foods, vinegar based foods, systemic illness, alcohol, medications, temperature change were among the highest and that was in a decreasing order. The very bottom was melons, cooked or canned fruits, oral habits, raw vegetables and then cinnamon.

The second article that I'd like to discuss is by Widar et al out of Sweden and the title of the article is The Incidence and Risk Factors Predisposing Plate Removal Following Orthognathic Surgery. So the aim of the study was to investigate the incidence and reasons for titanium fixation plate removal following jaw surgery and to identify risk factors predisposing removal and explore if discomfort was reduced post-operative. So again this was taking the medical records of 404 consecutive cases that were retrospectively reviewed. Now all these patients received a questionnaire and a total of 323 patients actually answered the questionnaire thus forming the sample group. Of all the responding patients 15 percent had plates removed and 92 percent of these patients experienced relief from discomfort after removal of the plates.

Infection was the most common reason for plate removal, approximately 10 percent of the time. And smoking increases your likelihood of removal by 2.7 times, almost three times. And surgery performed in the mandible also had an increased odds ratio or hazards ratio of 2.4 times increasing the need for plate removal. For each plate added in the mandible the risk of removal increased by a third or approximately 34 percent. So in conclusion. Smoking, mandibular osteotomies and additional number of plates in the mandible resulted in a higher incidence of plate removal. Most patients experience relief from discomfort after plate removal. I think this is a really important to know when we are doing orthognathic surgery or if you see someone in your practice that has plates and to try to give us an idea of when people are more likely to need their plates removed after jaw surgery. What I tell people is that if they need their plates removed we can do that well after the osteotomies have healed which is typically nine plus months later. We're not too keen on removing the plates  and screws sooner than that unless there's a clear indication such as infection. Fortunately infection is fairly rare in my experience with my patients with these plates.

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