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CR0432 Oral manifestations of areca nut habits: selected cases
ORAL MEDICINE e380 Abstracts extractable nuclear antigens, antinuclear antibodies, double stranded DNA, and rheumatoid factor autoantibodies. Recent salivary gland ultrasonography has confirmed a normal echotexture of the major salivary glands. A labial gland biopsy is planned as so far the diagnosis of Sjögren is unlikely. Conclusions: This case highlights the diagnostic dilemma when assessing patients with xerostomia as 1 component of a complex connective tissue disease presentation. By the Modified American European Diagnostic criteria, the Sjögren diagnosis cannot be sustained, even with a positive lip gland biopsy. However, following the newly proposed SICCA Collaboration criteria, the diagnosis is still doubtful without the lip biopsy contribution, unless ultrasonography is permitted as an alternative. The results of further investigations will be presented in the context of the diagnostic criteria for Sjögren syndrome, highlighting the current controversies in its diagnosis.
CR0421 TWO SURGICAL TREATMENTS FOR THE MANAGEMENT OF KERATOCYSTIC ODONTOGENIC TUMORS Rebeca Vasconcelos, E.L. Queiroz, S. CorbyNunes, P.M. Corby, B.L. Schmidt, Bluestone Center for Clinical Research, NYU College of Dentistry, New York, NY, USA Background: The keratocystic odontogenic tumor (KCOT) is a benign odontogenic neoplasm that has destructive and infiltrative behavior and a high recurrence rate. The KCOT can occur as part of nevoid basal cell carcinoma syndrome (NBCCS) with high prevalence or as a sporadic case. A wide spectrum of surgical treatment has been reported for the KCOT, with no optimal outcomes. The treatment modalities include enucleation alone or with peripheral osteotomy, resection, treatment with adjuvant substances (Carnoy solution or cryotherapy), marsupialization, and decompression. Summary: In this poster we report 2 different surgical treatments for KCOT: (1) a modified decompression technique and (2) enucleation with cryosurgery and a simultaneous bone graft. Conclusions: The techniques presented in these case reports have been reported to be associated with a lower recurrence rate. However, given the clinical behavior of KCOTs and the welldocumented high recurrence rate, long-term follow-up with clinical examination and plain radiographs is required.
CR0432 ORAL MANIFESTATIONS OF ARECA NUT HABITS: SELECTED CASES Nirav H. Parekh, Sonal Shah, Dharti Patel, Alexander Ross Kerr, Department of Oral Maxillofacial Pathology and Radiology, New York University College of Dentistry, New York, NY, USA Background: Areca nut chewing with or without tobacco is widespread in people of South Asian countries. Areca nut alkaloids are addictive, and habitual use of areca nut can adversely affect oral health. There is a growing immigrant population from countries like India, Pakistan, and Bangladesh, and these immigrants bring these habits to the United States. Currently, there are few restrictions on the sale and distribution of areca nut products. To help educate oral health care providers, we will present a series of clinical cases from South Asian immigrants in New York City to show the different habits and oral manifestations of areca nut use. Summary: The cases compare and contrast 2 different habits, namely the chewing of paan or betel quid (where the user rolls up the ingredients in a betel leaf) and guthka (where the user
OOOO May 2014 opens a single-use industrially manufactured sachet containing the ingredients). The oral manifestations include severe dental attrition, extrinsic staining, betel chewer’s mucosa lichenoid reactions, and potentially malignant oral disorders including oral submucous fibrosis epithelial dysplasia and oral squamous cell carcinoma. Conclusions: An understanding of these habits and their oral manifestations can facilitate better patient care management of such patients, including the early detection of potentially malignant oral disorders.
OI0269 TREATMENT OF ORAL LICHEN PLANUS WITH 0.1% TACROLIMUS IN ORAGARD-B Siddharth Gupta, Nitasha Gupta, Department of Oral Medicine and Radiology, I.T.S. Dental College, Hospital and Research Centre, Greater Noida, India Objectives: The purpose of the study is to investigate the efficacy and safety of 0.1% tacrolimus powder in Oragard-B for the treatment of patients with symptomatic oral lichen planus (OLP). Methods: A nonrandomized, unblinded study was conducted in 20 patients with symptomatic oral lichen planus. Patients were provided with 20 g containers of study medication, and instructed to apply 3 times daily until the resolution of the lesions. Clinical assessment was performed every 15 days. Tissue changes from pretreatment values and posttreatment values were compared using Wilcoxon signed rank test; a value of P < .001 indicated a significant change. Results: The patients responded well to topical tacrolimus. Eleven patients had complete resolution of lesions, and all 20 patients had significant improvement in their symptoms. There were significant improvements comparing pretreatment status with posttreatment changes (P < .001). Conclusions: Topical tacrolimus in Oragard-B is effective in the treatment of patients with symptomatic oral lichen planus.
OI0442 LOW-COST ORAL SPLINT IN THE BRAZILIAN PUBLIC HEALTH SERVICE Paulo Pimentel, Jr., Laira Machado de Braganca Soares, Department of Dentistry, Niterói, Rio de Janeiro, Brazil Objectives: The mechanisms of action of oral splints are still controversial. Nevertheless, their use in the management of temporomandibular disorders (TMDs) is known to help relieve pain and to protect tooth wear associated with bruxism. The use of articulators, the need for occlusal adjustments, and the laboratory steps to fabricate acrylic splints are associated with costs that are too high for splints to be used in the Public Health Service (PHS). The aim of this study was to evaluate the use of acetate oral splints in patients referred to the PHS Orofacial Pain and TMD Center in Rio de Janeiro, Brazil. Methods: The patients referred to the OFP/TMD Center were assessed according to the American Academy of Orofacial Pain criteria. They were educated to recognize and avoid oral parafunctional habits, to understand sleep hygiene and methods for reducing anxiety, and to perform therapeutic exercises and were provided directions on the use of analgesics and adjunctive drugs. When needed, the oral splints were made of acetate. Casts of the lower or upper arches were made, the splint was pressed in a vacuum press device using an acetate plate, and it was then fitted to the patient. Additional occlusal build-up with self-curing acrylic was performed only when
CR0421 TWO SURGICAL TREATMENTS FOR THE MANAGEMENT OF KERATOCYSTIC ODONTOGENIC TUMORS Rebeca Vasconcelos, E.L. Queiroz, S. CorbyNunes, P.M. Corby, B.L. Schmidt, Bluestone Center for Clinical Research, NYU College of Dentistry, New York, NY, USA Background: The keratocystic odontogenic tumor (KCOT) is a benign odontogenic neoplasm that has destructive and infiltrative behavior and a high recurrence rate. The KCOT can occur as part of nevoid basal cell carcinoma syndrome (NBCCS) with high prevalence or as a sporadic case. A wide spectrum of surgical treatment has been reported for the KCOT, with no optimal outcomes. The treatment modalities include enucleation alone or with peripheral osteotomy, resection, treatment with adjuvant substances (Carnoy solution or cryotherapy), marsupialization, and decompression. Summary: In this poster we report 2 different surgical treatments for KCOT: (1) a modified decompression technique and (2) enucleation with cryosurgery and a simultaneous bone graft. Conclusions: The techniques presented in these case reports have been reported to be associated with a lower recurrence rate. However, given the clinical behavior of KCOTs and the welldocumented high recurrence rate, long-term follow-up with clinical examination and plain radiographs is required.
CR0432 ORAL MANIFESTATIONS OF ARECA NUT HABITS: SELECTED CASES Nirav H. Parekh, Sonal Shah, Dharti Patel, Alexander Ross Kerr, Department of Oral Maxillofacial Pathology and Radiology, New York University College of Dentistry, New York, NY, USA Background: Areca nut chewing with or without tobacco is widespread in people of South Asian countries. Areca nut alkaloids are addictive, and habitual use of areca nut can adversely affect oral health. There is a growing immigrant population from countries like India, Pakistan, and Bangladesh, and these immigrants bring these habits to the United States. Currently, there are few restrictions on the sale and distribution of areca nut products. To help educate oral health care providers, we will present a series of clinical cases from South Asian immigrants in New York City to show the different habits and oral manifestations of areca nut use. Summary: The cases compare and contrast 2 different habits, namely the chewing of paan or betel quid (where the user rolls up the ingredients in a betel leaf) and guthka (where the user
OOOO May 2014 opens a single-use industrially manufactured sachet containing the ingredients). The oral manifestations include severe dental attrition, extrinsic staining, betel chewer’s mucosa lichenoid reactions, and potentially malignant oral disorders including oral submucous fibrosis epithelial dysplasia and oral squamous cell carcinoma. Conclusions: An understanding of these habits and their oral manifestations can facilitate better patient care management of such patients, including the early detection of potentially malignant oral disorders.
OI0269 TREATMENT OF ORAL LICHEN PLANUS WITH 0.1% TACROLIMUS IN ORAGARD-B Siddharth Gupta, Nitasha Gupta, Department of Oral Medicine and Radiology, I.T.S. Dental College, Hospital and Research Centre, Greater Noida, India Objectives: The purpose of the study is to investigate the efficacy and safety of 0.1% tacrolimus powder in Oragard-B for the treatment of patients with symptomatic oral lichen planus (OLP). Methods: A nonrandomized, unblinded study was conducted in 20 patients with symptomatic oral lichen planus. Patients were provided with 20 g containers of study medication, and instructed to apply 3 times daily until the resolution of the lesions. Clinical assessment was performed every 15 days. Tissue changes from pretreatment values and posttreatment values were compared using Wilcoxon signed rank test; a value of P < .001 indicated a significant change. Results: The patients responded well to topical tacrolimus. Eleven patients had complete resolution of lesions, and all 20 patients had significant improvement in their symptoms. There were significant improvements comparing pretreatment status with posttreatment changes (P < .001). Conclusions: Topical tacrolimus in Oragard-B is effective in the treatment of patients with symptomatic oral lichen planus.
OI0442 LOW-COST ORAL SPLINT IN THE BRAZILIAN PUBLIC HEALTH SERVICE Paulo Pimentel, Jr., Laira Machado de Braganca Soares, Department of Dentistry, Niterói, Rio de Janeiro, Brazil Objectives: The mechanisms of action of oral splints are still controversial. Nevertheless, their use in the management of temporomandibular disorders (TMDs) is known to help relieve pain and to protect tooth wear associated with bruxism. The use of articulators, the need for occlusal adjustments, and the laboratory steps to fabricate acrylic splints are associated with costs that are too high for splints to be used in the Public Health Service (PHS). The aim of this study was to evaluate the use of acetate oral splints in patients referred to the PHS Orofacial Pain and TMD Center in Rio de Janeiro, Brazil. Methods: The patients referred to the OFP/TMD Center were assessed according to the American Academy of Orofacial Pain criteria. They were educated to recognize and avoid oral parafunctional habits, to understand sleep hygiene and methods for reducing anxiety, and to perform therapeutic exercises and were provided directions on the use of analgesics and adjunctive drugs. When needed, the oral splints were made of acetate. Casts of the lower or upper arches were made, the splint was pressed in a vacuum press device using an acetate plate, and it was then fitted to the patient. Additional occlusal build-up with self-curing acrylic was performed only when