Current advances in the etiology of chronic diffuse sclerosing osteomyelitis of the mandible

Oral Abstract SessionIII: Nerve Repair and Infection patients), single, surgical extraction (1 l), multiple, nonsurgical extractions (43), multiple extractions, at least one surgical extraction (17). Thirteen patients (8.7%) had post-extraction complications (dry socket (ll), persistent pain (12) or bleeding (l), local (3) or space (1) infections, delayed wound healing (7), other (1). The uncontrolled post-extraction complication rates for HIV+ patients was 30% and for HIV-patients was 3.9% (p = .OOl). After controlling for confounding, HIV positivity was still statistically associated with an increased risk for post-extraction complications (p = .002). To date, studies of post-surgical complications as they relate to HIV infection have consisted of descriptive case series. This is the first analytic study assessing the risk of HIV status and post-surgical complications. To assess the risk, we utilized a dental extraction model. These preliminary results support the hypothesis that HIV+ patients are at an increased risk for postextraction complications. The complications, however, were minor and readily managed on an out-patient basis. Given these findings, with careful post-operative follow-up, out-patient management for dental extraction in HIV+ patients is feasible. It should be noted, however, that this cohort was composed of primarily asymptomatic HIV+ patients (67.4%). For a more complete assessment of the surgical risk of HIV+ patients, future studies should include a greater proportion of AIDS patients in the sample cohort. References Ferguson, C.M.: Surgical complications of human ‘immunodeficiency virusinfection. Am Surg 54:4,1988 Scannell, K.A.: Surgery and human immunodeficiency virus disease. J Acquir Immune Defic Syndr 2:43,1989 Funded by BRSG-RR5305

Current Advancesin the Etio&y of Chronic Di!e SclerosingOsteomyelitisof the Mandible Robert E. Marx, DDS, Henry Ford Hosp., Div. of OMS, 2799 W. Grand Blvd., Detroit, MI 48202 (Carlson, E.R.) Chronic diffuse sclerosing osteomyelitis has been considered a disease of unknown etiology for which the following causes have been suggested: immunologic reaction to bacterial toxins, hyperactive immunologic response, infection, and, most recently tendoperiostitis.’ While infection has been suspected as an etiologic factor, the results of most previous studies do not support an infectious etiology for this disease.’ The present, ongoing study reports results from 18 cases of this variant of osteomyelitis. All cases were 82

accompanied by constant high grade pain, a diffuse sclerosis of the mandible, slight expansion, and elevation of the erythrocyte sedimentation rate during exacerbations. Suppuration and sinus tracts are not present in any of the cases and white blood cell counts were normal. Surgery consisted of exploration with lateral decortication of the affected mandible, deep bone biopsies, with aerobic and anaerobic cultures. In particular, bone specimens were used for all cultures, rather than swab specimens. At surgery, the bone specimens were immediately placed in glass tubes and transported to the microbiology laboratory within 15 minutes so as to optimize the chances for accurate anaerobic culture results. In our microbiology laboratory these specimens were immediately minced in a Sage 3500 tissue grinder with thioglycolate broth. Anaerobic specimens were placed in thioglycolate broth, CDC-ANA, CDC-DEA, and CDC-KV with CO, enriched environments in gas pack pouches. Results of all cultures showed heavy Actinomyces species or closely related species and most also showed concomitant Eikenella corrodens: these results are the first which identify specific pathogens associated with this disease. We believe that the use of bone specimens, their rapid transport (less than 15 minutes), and immediate specific processing by the microbiologist lead to a yielding and reliable anaerobic culture, which has now identified the correct etiology of a confusing disease with a previously unknown cause. Failure to properly treat patients with chronic diffuse sclerosing osteomyelitis has in the past, and may continue to stem from lack of suspicion for these infectious etiologic agents. References van Merkesteyn, J.P.R., Groat, R.M., Bras, J., et al: Diffuse sclerosing osteomyelitis of the mandible: A new concept of its etiology. Oral Surg Oral Med Oral Pathol70:414-419,199O van Merkesteyn, J.P.R., Groat, R.M., Bras, J., et al: Diffuse sclerosing osteomyelitis of the mandible: Clinical radiographic and histologic findings in seventy-seven patients. J Oral Maxillofac Surg 46:825-880,1988

Reguhztionof MHC Chss I hkpressionin Cy&~vh Infected Human En&h&d Cellsand Fibroblasts Mark E. Wohlford, DDS, 305 W. 12th Ave., College of Dentistry, Columbus, OH 43210 (Alambi, N., Sedmak, D.D.) Major Histocompatibility Complex (MHC) antigens serve as recognition molecules for the T-cells of the immune system. T-cells recognize foreign antigens in the context of these surface proteins. Class I MHC antigens AAOMS

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1991