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Dental Panoramic Radiographic Evaluation in Bisphosphonate-Associated Osteonecrosis of the Jaws
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Abstracts
diagnosed with multiple myeloma. A secondary objective is to determine the optimal site for detection of amyloid in the oral cavity. Methods: Eleven subjects have been enrolled as part of this ongoing study of amyloid in MM patients. Inclusion criteria are: (1) subjects with an initial diagnosis of multiple myeloma with no more than six months of initial therapy, (2) subjects have not yet received a peripheral stem cell transplant, and (3) subjects have not been previously diagnosed with amyloidosis. Each subject completed a tongue biopsy and a minor salivary gland biopsy. The oral specimens were evaluated histologically to determine presence of amyloid via Congo red staining. A fine needle aspiration of the subject’s subcutaneous abdominal fat was completed to determine presence of amyloid via Congo red analysis. Cohen’s kappa statistic and McNemar’s test are used to analyze the data. Results: To date, nine patients have completed the research protocol. Two subjects demonstrated amyloid deposition in the minor salivary glands only. Neither of these subjects demonstrated systemic amyloidosis after 6 month follow – up. Amyloid has not been detected in subcutaneous abdominal fat or tongue specimens of any subject to date. Conclusion: The initial results of this study suggest that the minor salivary glands may be the optimal site to detect amyloid in patients with MM. Funding: Supported by a Senior Research Grant from the Multiple Myeloma Research Foundation
DENTAL PANORAMIC RADIOGRAPHIC EVALUATION IN BISPHOSPHONATE-ASSOCIATED OSTEONECROSIS OF THE JAWS Nathaniel Treister(1,2,4), Erica Hyunji Bae(3), Niall Sheehy(2), Bernard Friedland(4), Mark Lerman(1,4), SookBin Woo(1,2,4) (1)Brigham and Women’s Hospital, (2)DanaFarber Cancer Institute, (3)Beth Israel Deaconess Medical Center, (4)Harvard School of Dental Medicine, Boston, MA Objectives: Several studies have reported radiographic findings of bisphosphonate-associated osteonecrosis of the jaw (BONJ), however the relationship between clinical and radiographic signs is unclear. The objective of this study was to determine the extent to which clinical and radiographic features of BONJ are correlated. Methods: The records of 39 patients diagnosed with BONJ and examined by panoramic radiography were retrospectively evaluated. Diagnosis and staging was based on the AAOMS guidelines with only the initial visit and radiograph included for analyses. The arches were divided into sextants (n ⫽ 234) and images were evaluated by two radiologists for the following signs: sclerosis, surface irregularity, sockets, fragmentation and lysis. The radiologists were blinded to clinical details and differences were resolved by consensus. The McNemar, KruskallWallis and equivalency tests were performed to analyze the association between clinical and radiographic signs and BONJ severity. Those with history of previous tooth extraction were subanalyzed. Results: 62/234 sextants were abnormal by clinical criteria and 61/234 sextants demonstrated at least one radiographic abnormality. McNemar’s and equivalency tests showed agreement
OOOOE September 2008 between clinical and radiographic detection in 41sextants. The data showed equivalency between BONJ diagnosis and both sclerosis and surface irregularity; extraction data further demonstrated equivalency for persistent sockets. The correlation between number of clinical sites and any radiographic finding was statistically significant in the maxilla (p⬍ 0.001) but not the mandible (p ⫽ 0.178). The total number of radiographic signs per patient increased with BONJ stage (p⫽0.12). Conclusions: Focal panoramic radiographic findings of sclerosis, surface irregularity and persistent sockets correlate with clinical sites of BONJ. Severity of BONJ, as measured by stage, did not correlate with radiographic signs. Panoramic radiographs, which are less expensive and expose patients to far less radiation than computed tomography, may be a useful and reliable tool to detect early changes of BONJ or to confirm a clinical diagnosis.
ENVIRONMENTAL TRIGGERS IN RECURRENT APHTHOUS STOMATITIS Baccaglini L, Theriaque DW, Brantly ML, Shuster JJ. University of Florida and General Clinical Research Center (GCRC), Gainesville, FL Objectives: Recurrent Aphthous Stomatitis (RAS) is characterized by painful intraoral ulcers of unknown etiology. We conducted an exploratory study to identify the most commonly reported environmental triggers. Methods: We analyzed preliminary data from an exploratory case series study nested within a larger case-control epidemiologic study. Following IRB approval, participants aged 13 years and older were recruited by advertisements throughout the University of Florida over a 3-month period (June-September 2007). Cases with a lifetime history of idiopathic RAS completed a standardized questionnaire that included the close-ended question: “What do you think is/are the possible cause(s) of your canker sores? (we are interested in your specific case, not what you may have heard from others)”. Participants marked yes/no for each possible answer that included possible triggers and neutral responses: bad teeth, bad gums, acidic foods, too much sugar, diet, stress, lack of sleep, accidental bite/trauma, allergy, other reason or no apparent reason. Descriptive statistics (median, range and %) were performed using SAS v9.1. Results: Fifty cases were recruited, with 94% completing the study. Participants were 44.7% female, 8.5% Hispanic, 66.0% White, 25.5% Asian, 8.5% other race, aged 19-66 (median age 22 years). The 3 most common answers, with 45/47 cases reporting at least one of them, were: no apparent reason (87.0%), stress (57.4%) and lack of sleep (44.7%). The remaining 2 cases reported acidic foods/diet and too much sugar as the main trigger. The least common answers were bad teeth (8.5%), allergies (8.5%) and other specific reasons (13.0%), e.g. playing the saxophone, indigestion/excessive internal heat, low blood, braces (n⫽1/each), or being sick (n⫽2). Conclusions: Stress and lack of sleep were commonly reported triggers among RAS patients. More in-depth studies are needed on the role of sleep disturbances in RAS onset and their relationship to stress. Funding: NIH grants R03DE016356, U24DE016509 and M01RR00082.
Abstracts
diagnosed with multiple myeloma. A secondary objective is to determine the optimal site for detection of amyloid in the oral cavity. Methods: Eleven subjects have been enrolled as part of this ongoing study of amyloid in MM patients. Inclusion criteria are: (1) subjects with an initial diagnosis of multiple myeloma with no more than six months of initial therapy, (2) subjects have not yet received a peripheral stem cell transplant, and (3) subjects have not been previously diagnosed with amyloidosis. Each subject completed a tongue biopsy and a minor salivary gland biopsy. The oral specimens were evaluated histologically to determine presence of amyloid via Congo red staining. A fine needle aspiration of the subject’s subcutaneous abdominal fat was completed to determine presence of amyloid via Congo red analysis. Cohen’s kappa statistic and McNemar’s test are used to analyze the data. Results: To date, nine patients have completed the research protocol. Two subjects demonstrated amyloid deposition in the minor salivary glands only. Neither of these subjects demonstrated systemic amyloidosis after 6 month follow – up. Amyloid has not been detected in subcutaneous abdominal fat or tongue specimens of any subject to date. Conclusion: The initial results of this study suggest that the minor salivary glands may be the optimal site to detect amyloid in patients with MM. Funding: Supported by a Senior Research Grant from the Multiple Myeloma Research Foundation
DENTAL PANORAMIC RADIOGRAPHIC EVALUATION IN BISPHOSPHONATE-ASSOCIATED OSTEONECROSIS OF THE JAWS Nathaniel Treister(1,2,4), Erica Hyunji Bae(3), Niall Sheehy(2), Bernard Friedland(4), Mark Lerman(1,4), SookBin Woo(1,2,4) (1)Brigham and Women’s Hospital, (2)DanaFarber Cancer Institute, (3)Beth Israel Deaconess Medical Center, (4)Harvard School of Dental Medicine, Boston, MA Objectives: Several studies have reported radiographic findings of bisphosphonate-associated osteonecrosis of the jaw (BONJ), however the relationship between clinical and radiographic signs is unclear. The objective of this study was to determine the extent to which clinical and radiographic features of BONJ are correlated. Methods: The records of 39 patients diagnosed with BONJ and examined by panoramic radiography were retrospectively evaluated. Diagnosis and staging was based on the AAOMS guidelines with only the initial visit and radiograph included for analyses. The arches were divided into sextants (n ⫽ 234) and images were evaluated by two radiologists for the following signs: sclerosis, surface irregularity, sockets, fragmentation and lysis. The radiologists were blinded to clinical details and differences were resolved by consensus. The McNemar, KruskallWallis and equivalency tests were performed to analyze the association between clinical and radiographic signs and BONJ severity. Those with history of previous tooth extraction were subanalyzed. Results: 62/234 sextants were abnormal by clinical criteria and 61/234 sextants demonstrated at least one radiographic abnormality. McNemar’s and equivalency tests showed agreement
OOOOE September 2008 between clinical and radiographic detection in 41sextants. The data showed equivalency between BONJ diagnosis and both sclerosis and surface irregularity; extraction data further demonstrated equivalency for persistent sockets. The correlation between number of clinical sites and any radiographic finding was statistically significant in the maxilla (p⬍ 0.001) but not the mandible (p ⫽ 0.178). The total number of radiographic signs per patient increased with BONJ stage (p⫽0.12). Conclusions: Focal panoramic radiographic findings of sclerosis, surface irregularity and persistent sockets correlate with clinical sites of BONJ. Severity of BONJ, as measured by stage, did not correlate with radiographic signs. Panoramic radiographs, which are less expensive and expose patients to far less radiation than computed tomography, may be a useful and reliable tool to detect early changes of BONJ or to confirm a clinical diagnosis.
ENVIRONMENTAL TRIGGERS IN RECURRENT APHTHOUS STOMATITIS Baccaglini L, Theriaque DW, Brantly ML, Shuster JJ. University of Florida and General Clinical Research Center (GCRC), Gainesville, FL Objectives: Recurrent Aphthous Stomatitis (RAS) is characterized by painful intraoral ulcers of unknown etiology. We conducted an exploratory study to identify the most commonly reported environmental triggers. Methods: We analyzed preliminary data from an exploratory case series study nested within a larger case-control epidemiologic study. Following IRB approval, participants aged 13 years and older were recruited by advertisements throughout the University of Florida over a 3-month period (June-September 2007). Cases with a lifetime history of idiopathic RAS completed a standardized questionnaire that included the close-ended question: “What do you think is/are the possible cause(s) of your canker sores? (we are interested in your specific case, not what you may have heard from others)”. Participants marked yes/no for each possible answer that included possible triggers and neutral responses: bad teeth, bad gums, acidic foods, too much sugar, diet, stress, lack of sleep, accidental bite/trauma, allergy, other reason or no apparent reason. Descriptive statistics (median, range and %) were performed using SAS v9.1. Results: Fifty cases were recruited, with 94% completing the study. Participants were 44.7% female, 8.5% Hispanic, 66.0% White, 25.5% Asian, 8.5% other race, aged 19-66 (median age 22 years). The 3 most common answers, with 45/47 cases reporting at least one of them, were: no apparent reason (87.0%), stress (57.4%) and lack of sleep (44.7%). The remaining 2 cases reported acidic foods/diet and too much sugar as the main trigger. The least common answers were bad teeth (8.5%), allergies (8.5%) and other specific reasons (13.0%), e.g. playing the saxophone, indigestion/excessive internal heat, low blood, braces (n⫽1/each), or being sick (n⫽2). Conclusions: Stress and lack of sleep were commonly reported triggers among RAS patients. More in-depth studies are needed on the role of sleep disturbances in RAS onset and their relationship to stress. Funding: NIH grants R03DE016356, U24DE016509 and M01RR00082.