Vol. 97 No. 4 April 2004
Editor: Martin S. Greenberg
Abstracts of the 58th Annual Meeting of the American Academy of Oral Medicine
CHARACTERIZATION OF PANORAMIC RADIOGRAPHIC FEATURES OF MAXILLO-MANDIBULAR FIBROUS DYSPLASIA IN MCCUNE-ALBRIGHT SYNDROME. S. O. Akintoye, L. L. Otis, J. C. Atkinson, J. Brahim, H. Kushner, P. G. Robey, M. T. Collins, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, University of Maryland School of Dentistry, Baltimore, National Institutes of Health, Bethesda, Md, and Biomedical Computer Institute, Philadelphia, Pa. Background. Fibrous dysplasia (FD) is a rare skeletal disease often associated with McCune-Albright Syndrome (MAS); a triad of FD, cafe´-au-lait skin hyperpigmentation and endocrinopathies. It is caused by activating postzygotic GNAS1 gene mutations. Multiple bones may be affected including maxilla and mandible. Also, endocrinopathies in MAS can further influence bone metabolism. Objective. This cross-sectional study was designed to characterize FD panoramic radiographic patterns and to evaluate the effects of age and endocrinopathies on radiographic characteristics of maxillomandibular FD. Study design. Panoramic radiographs of 43 consecutive MAS patients with craniofacial FD were evaluated and analyzed for FD involvement. Endocrine and renal functions also were evaluated clinically, biochemically, and radiographically. Associations between radiographic patterns and age, endocrinopathies, or renal phosphate wasting were analyzed using Fisher’s exact test. Results. Characteristic radiographic patterns observed were: ground glass (granular/condensed trabeculae), radiolucent (lytic), mixed radiolucent/radio-opaque (mixed density), or radio-opaque (sclerotic). Masking or displacement of the maxillary sinus (range 77.8%-86.4%) and mandibular canal (range 55.6%-75.0%) were prevalent in FD sites. Sixty-three percent of the MAS patients had multiple dysregulated endocrine/metabolic functions; the most common were hyperthyroidism, precocious puberty, and renal phosphate wasting. There were no statistically significant associations between radiographic patterns and age, endocrinopathies, or renal phosphate wasting. Conclusions. The maxillo-mandibular FD image in panoramic radiographs is a spectrum of 4 different patterns. MAS should be considered in patients with facial asymmetry associated with any of these radiographic patterns and should be promptly referred for further radiographic tests and endocrine evaluation.
ORAL CHRONIC GRAFT-VERSUS-HOST DISEASE IN ADULT PATIENTS FOLLOWING HEMATOPOIETIC STEM CELL TRANSPLANTATION. M. Al-Mohaya, S. Woo, Harvard University School of Dental Medicine, Boston, Mass. Background. Human allogenic hematopoietic stem cell transplantation (HSCT) has been used with increased frequency in the
treatment of severe combined immunodeficiency syndromes, hematological malignancies, severe aplastic anemia, and other bone marrow failure syndromes. One of the most common complications after HSCT is chronic graft-versus-host disease (cGVHD), which is associated with involvement of multiple organ system including the oral mucosa and salivary glands. Objective. This is a retrospective study of patients who were referred for the evaluation of cGVHD. Study design. The records of patients who had undergone HSCT and were referred for the evaluation of mouth sores at the oral medicine practice at the Brigham and Women’s Hospital, Boston, between February 2001 and October 2003 were reviewed. Subjective and objective findings were recorded. Descriptive statistics were used to analyze the data. Results. Forty-nine patients were examined. There were 25 male (51%) and 24 female (49%), with ages ranging from 21 to 61 years (mean age 44 years). Patients underwent HSCT for 8 different hematological conditions, the 2 most common being chronic myelogenous leukemia (24.5%) and myelodysplastic syndrome (16.3%). The mean duration from transplantation was 20.5 months. A total of 39 patients (79.6%) presented with oral lesions. Others (20%) presented with either hyposalivation or teeth decalcification. Thirty-six of the 39 (92.3%) presented with oral GVHD, one had Traumatic ulcerative granuloma, one presented with perioral dermatitis and one had extensive oral ulcerations that was culture positive for HSV-1. Fifty-one percent (25/ 49) had a history of any cGVHD, with 19 out of those 25 presenting with clinical evidence of oral cGVHD. Therefore, 47.2% of those who exhibited oral cGVHD did not have clinical evidence of GVHD of other organ systems. Out of 36 oral cGVHD, 36% were reticular, 5% were erythematous only, and 8.3% were solely ulcerative, while the remaining 50% exhibited combined clinical presentation (reticular, ulcerative, and erythematous). Candidiasis was diagnosed in 5 (10.2%). Thirty-two patients (65.3%) suffered from variable degrees of hyposalivation. Conclusions. cGVHD of the oral mucosa is common after HSCT. Typically, these present as lichenoid oral mucosal lesions and hyposalivation. Patients are also prone to develop opportunistic infections such as herpetic stomatitis and candidiasis.
ASSOCIATION BETWEEN HERPES SIMPLEX VIRUS TYPE 1 AND HELICOBACTER PYLORI. L. Baccaglini, V. J. Schoenbach, C. L. Poole, R. G. McKaig, J. Ibrahimd, R. S. Baric, C. Wiesen, University of Texas Health Science Center, San Antonio, and University of North Carolina, Chapel Hill. Objective. Studies of co- or superinfections provide information about populations at risk and mode of transmission of the organisms studied. Some investigators have hypothesized an association between herpes simplex virus type 1 (HSV-1) and H. Pylori (HPP). Thus, the objective of this investigation was to determine whether or not HPP prevalence is greater among HSV-1 seropositive individuals.
Study design. This study analyzed data from Phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III), a nationwide cross-sectional study conducted during 1988-94 by the National Center for Health Statistics of the Centers for Disease Control. Results of antibody tests against the 2 organisms were available for 1,227 participants aged 12-19 years. Generalized estimating equations (GEE) were used to estimate prevalence ratios for seropositivity for HPP antibody in relation to seropositivity for HSV-1 antibody, controlling for age, gender, race/ethnicity, poverty income ratio, frequency of dental appointments, history of orthodontic treatment, place of birth, alcohol or tobacco history, education, household size, and urban-rural residence. Results. Among 1,090 respondents with data on all variables, the crude overall prevalence ratio (PR) and 95% confidence interval for HPP seropositivity comparing HSV+ to HSVÿ individuals was 2.20 (1.69-2.85). In large urban households PR was twice that in small rural households, after adjustment for race/ethnicity and poverty level (2.27 vs. 1.15, respectively). Conclusions. HSV-1 seropositivity is associated with a higher HPP seroprevalence. However, the strength of this association varies in different subpopulations, suggesting that external environmental factors rather than biological reasons may be primarily responsible for the association between these 2 organisms. This research was funded by NIH/NIDCR grant # 5T32DE07191.
RADIOISOTOPE SCINTIGRAPHY OF 117 IDIOPATHIC FACIAL PAIN PATIENTS AND 32 CONTROLS. J. Bouquot, W. Adams, K. Spolnik, K. Deardorf, Maxillofacial Center, Morgantown, WV, and Indianapolis, Ind. Background. It has been suggested that technetium-99m MDP (Tc-99) bone scans might identify that proportion of radiographically negative chronic idiopathic facial pain (IFP) associated with ischemic or low-grade inflammatory marrow disease. A recent NIH study of 20 patients showed 79% with positive scans in the quadrant of pain, but no biopsies were performed. Objective. The objective of this study was to correlate a positive Tc-99 scan with the quadrant of pain in a large patient cohort and to correlate the positive hot spots with microscopic evidence of bone/ marrow disease. Study design. 117 IFP patients (103 females) without identifiable dental, periodontal, or sinus disease underwent Tc-99 bone scans; 32 patients without facial pain who had Tc-99 scans for extraoral problems were used as controls. Marrow and bone within hot spots in a quadrant of pain were surgically explored and biopsied. Pearson chi-square analysis was used to confirm associations, and accuracy, sensitivity, and specificity were determined. Results. In 117 IFP patients, 62.1% (293/468) of alveolar quadrants were painful, not necessarily chronologically synchronous. Of the painful quadrants (55.3% were maxillary), 79.2% (232/293) had positive Tc-99 scans (P\.0001; accuracy = 82.3%; sensitivity = 91.3%; specificity = 71.5%) compared to 12.6% (22/175) for nonpainful quadrants. Of biopsied hot spots, 98.5% (200/203) showed marrow disease, as did 95.1% (39/41) of Tc-99 negative painful sites. Among the controls, 6.3% (8/128) of the quadrants had positive scans. Conclusions. A positive Tc-99 scan is strongly correlated with the quadrant of pain in IFP, and almost all positive scan sites show microscopic evidence of marrow disease. The Tc-99 is a very sensitive test for marrow disease in IFP patients but lacks specificity. Therefore, a negative scan should not be accepted as evidence of no disease. Because of risks, the test should be used only after other imaging technologies have proven negative. Funded in part by the Foundation for Maxillofacial Research, Morgantown, WV.
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY April 2004 HYPERBARIC OXYGEN FOR RADIATION-INDUCED XEROSTOMIA. S S. DeRossi, E. Huang, K Hardy, J. Clark, P. Gimotty, A. Chalian, S. Thom, University of Pennsylvania Medical Center, Philadelphia. Objective. HBO2 is currently used to treat the sequelae of radiation injury such as ORN of the mandible and laryngeal STRN, but it also has the potential to be used as a novel treatment for radiationinduced xerostomia. Study design. We studied a group of patients who were currently receiving HBO2 for conditions that were independent of their xerostomia (e.g., ORN of the mandible, soft tissue radionecrosis of the neck or larynx, ORN prophylaxis prior to dental extractions). The patients agreed to have their xerostomia evaluated using both objective and subjective measurements, including saliva collections and QOL questionnaires. The primary measure of efficacy was the patient’s subjective perception of oral dryness using the 100-mm visual analog scale (VAS) as described by Johnson et al1. Using the left anchor as a negative response and the right anchor as a positive response, patients made a mark on the VAS and their measurement (in mm) prior to HBO2 was subtracted from their measurement post-HBO2 to determine clinical response. We also obtained measurements at the initial time of consultation in 9 patients that were subtracted from their pre-HBO2 measurement (mean 32.3 days, range 6-69 days) to determine the natural variability of their xerostomia without treatment to be ÿ1 mm (SD 6.4, 95% CI ÿ15 to +14). A total of 23 patients were enrolled in the study, but only 17 completed the entire protocol. Results. When looking at all 17 patients in the study, the mean improvement in patents’ subjective perception of oral dryness after completing all HBO2 sessions was 19.9 mm (SD 22.4, P\.0007). Based on the control measurements, changes greater than 15 mm were considered to be clinically significant. Therefore, in a population of 17 patients who had not received HBO2, one would expect only 5% (\ 1 patient) would have such a change in oral dryness purely by chance. After completing all HBO2 sessions (n = 17; mean 34 sessions, range 30-60 sessions), 9 of 17 (52.9%, 95% CI 27.7% to 78.1%) had improved oral dryness greater than 15 mm, clearly showing that HBO2 had some measurable effect on xerostomia that was not attributable to chance. A separate question assessed whether patients felt their dry mouth was ‘‘worse, no change, or better’’ compared to at the beginning of the study. Of the 9 patients who had $ 15 mm of change on the VAS, 8 (88.9%) reported that they felt better and 1 reported that he felt worse. Out of the 8 patients who had \15 mm of change, only 2 (25%) reported that they felt better and 6 (75%) reported no change. This demonstrates that the assessment of oral dryness correlated highly with patients’ perception of improvement. All patients received 120 minutes of 100% oxygen at a pressure of 2.0 atmospheres absolute, but because the study patients were getting HBO2 for pre-existing conditions, their lengths of treatment varied depending on their underlying condition. Some patients had a long delay between initial consultation and starting HBO2 while others started immediately. Some patients required dental extractions (13/17), while others did not. Some patients had a long delay between completing preoperative HBO2 and resumption of postoperative HBO2 (range 1-40 days), while others had their surgery scheduled immediately after completing preoperative HBO2. In an attempt to factor out the effects of dental extractions, we added an interim data collection in 13 of 17 patients after 20 sessions (i.e., the standard length of preoperative HBO2), prior to dental extractions. Conclusions. Our analysis showed that 5 of 13 (38.4%) patients had an increase greater than 15 mm after only 20 HBO2 sessions (n = 13, mean 20 sessions). A larger proportion of patients had a response to HBO2 after completing all sessions than after only 20 sessions. Unfortunately, we could not separate the effects of additional HBO2 sessions from the additional length of time between preoperative sessions and postoperative sessions. The fact that patients received