BACKGROUND:Biologic agents are rapidly emerging as an effective therapy to treat autoimmune and other chronic diseases. The use of these agents is poorly characterized, resulting in a lack of guidance for dental practitioners. Case reports of oral adverse events have begun to emerge. However, their scope and frequency have not been summarized and analysed to date. The objective of this review was to characterize the literature on oral adverse effects associated with biological therapy when used for autoimmune and inflammatory disorders. METHODS:This review was developed in accordance with scoping review recommendations. Search strategies were developed and employed for six databases. Studies were selected using a systematic search process but with broad inclusion of study types given the paucity of information available. Reports of oral adverse events were analysed descriptively according to agent, mechanism of action, underlying disease, and oral adverse effect observed. RESULTS:Our search returned 2080 articles and 51 met our inclusion criteria, of which most were case reports. The most frequent adverse effects included angioedema, oral lichenoid lesions, osteonecrosis of the jaw, and oral infections. There were also cases of oral malignancies associated with use of biologic agents. Less common effects such as pigmentation were also described. CONCLUSIONS:Oral adverse events have been reported in patients on biologic therapy, albeit in small numbers to date. This limits the generalizability of these results, which should not be used to generate a clinical guideline as they are based primarily on case reports. However, this study presents the first review characterizing the adverse effects observed. Large multi-center studies will be necessary to further define the oral and dental complications caused by biologic agents.

The release of the National Institutes of Health report, Oral Health in America: Advances and Challenges, in 2022 identified a pressing concern about oral healthcare and that "the job is far from finished." The High Point University Workman School of Dental Medicine utilized this report as inspiration to facilitate the design of the Clinician-Advocate-Researcher-Entrepreneur Curriculum. The aspiration was to create a novel curriculum and experiential model to prepare learners for the future of dental medicine, including addressing these public oral healthcare needs. This article describes how we conducted this process in three steps: defining the curriculum philosophy, outcomes, and structure. We present this example for those interested in curriculum design and modifications. Our goal is to encourage educators to explore opportunities to enhance dental education as a critical component of the complex system that impacts oral healthcare broadly.

Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease characterized primarily by immune-mediated destruction of exocrine tissues, such as those of the salivary and lacrimal glands, resulting in the loss of saliva and tear production, respectively. This disease predominantly affects middle-aged women, often in an insidious manner with the accumulation of subtle changes in glandular function occurring over many years. Patients commonly suffer from pSS symptoms for years before receiving a diagnosis. Currently, there is no effective cure for pSS and treatment options and targeted therapy approaches are limited due to a lack of our overall understanding of the disease etiology and its underlying pathology. To better elucidate the underlying molecular nature of this disease, we have performed RNA-sequencing to generate a comprehensive global gene expression profile of minor salivary glands from an ethnically diverse cohort of patients with pSS. Gene expression analysis has identified a number of pathways and networks that are relevant in pSS pathogenesis. Moreover, our detailed integrative analysis has revealed a primary Sjögren’s syndrome molecular signature that may represent important players acting as potential drivers of this disease. Finally, we have established that the global transcriptomic changes in pSS are likely to be attributed not only to various immune cell types within the salivary gland but also epithelial cells which are likely playing a contributing role. Overall, our comprehensive studies provide a database-enriched framework and resource for the identification and examination of key pathways, mediators, and new biomarkers important in the pathogenesis of this disease with the long-term goals of facilitating earlier diagnosis of pSS and to mitigate or abrogate the progression of this debilitating disease.

Purpose The entrustable professional activity (EPA) framework is an assessment approach used to define the educational outcomes of a program by outlining discrete work tasks learners are expected to perform independently upon graduation. This study outlines the development and evaluation of an EPA framework for predoctoral dental education at the University of North Carolina Adams School of Dentistry. Methods The draft EPA framework was created in collaboration with a group of faculty members and included 15 statements that were mapped to relevant Commission on Dental Accreditation standards. The draft EPA framework was distributed to faculty via an electronic survey, requesting participants to evaluate whether the EPAs were well-defined; observable; measurable; expected of a general dentist; transferable to other practice settings; and required application of relevant knowledge, skills, and attitudes. In addition, participants were asked to identify the percentage of graduates who could perform these tasks independently and whether learners must be able to perform the list of EPAs upon graduation. Results Sixty-eight faculty members completed the survey (72% response rate); participants represented all divisions across the school and had extensive dental practice experiences. Overall, participants agreed the EPAs met the defined criteria and were considered important for graduates to be able to demonstrate. Feedback from faculty voiced support for the EPA framework and identified concerns regarding the implementation due to potential faculty calibration and time constraints. Conclusion Evidence from this study supports additional research to explore how the EPA framework can be further developed in predoctoral and postgraduate dental education programs.

Eric T. Stoopler, DMD, FDSRCS, FDSRCPS, is a member of Executive Committee and Board of Trustees, American Academy of Oral Medicine, and employed at the University of Pennsylvania. Thomas P. Sollecito, DMD, FDS RCSEd, is a vice-president of American Board of Oral Medicine; board of trustees, American Academy of Oral Medicine; and employed at the University of Pennsylvania. Scott S. De Rossi, DMD, MBA, and Martin S. Greenberg, DDS, FDS, RCSEd, have nothing to declare.

Burning mouth syndrome is a chronic condition characterized by an intraoral burning sensation in the absence of a local or systemic cause.

Burning mouth syndrome is a chronic condition characterized by an intraoral burning sensation in the absence of a local or systemic cause.

The University of North Carolina at Chapel Hill Adams School of Dentistry is developing a transformative curriculum that prepares students to enter contemporary practice. The Advocate, Clinician, and Thinker (ACT) framework will provide the basis for developing a resilient workforce capable of meeting emerging health care needs over the next 40 years.

The American Academy of Oral Medicine (AAOM) affirms that oral contact allergy (OCA) is an oral mucosal response that may be associated with materials and substances found in oral hygiene products, common food items, and topically applied agents. The AAOM also affirms that patients with suspected OCA should be referred to the appropriate dental and/or medical health care provider(s) for comprehensive evaluation and management of the condition. Replacement and/or substitution of dental materials should be considered only if (1) a reasonable temporal association has been established between the suspected triggering material and development of clinical signs and/or symptoms, (2) clinical examination supports an association between the suspected triggering material and objective clinical findings, and (3) diagnostic testing (e.g., dermatologic patch testing, skin-prick testing) confirms a hypersensitivity reaction to the suspected offending material. Originators: Dr. Eric T. Stoopler, DMD, FDS RCSEd, FDS RCSEng, Dr. Scott S. De Rossi, DMD.

To evaluate the incidence of second primary malignancies in patients diagnosed with head and neck cancers in the United States. The SEER registry was used to identify patients with primary head and neck cancers from 1973-2005. Patients’ data were retrieved using ICD-3-O topography codes for all head and neck sites (C00.0-C14.8) (C30.0-C32.9) (C44.2) (C69.0-C69.9) (C73.9). Individuals were stratified by age, race, sex, stage, surgery and radiation. Pooled overall survival (OS) and disease specific survival (DSS) were calculated using univariate Cox Proportional Hazards models. Overall and site-specific relative risks of second malignancies (SMs) were evaluated using standardized incidence ratios (SIRs) to determine the ratio of observed to the expected number of cases among the cohort population. P <0.05 was used to determine the required level of significance. For all ages, 190,468 patients were found to have 34266 second primary malignant tumors observed in this patient cohort. Among these cases, 111,469 individuals were male (58%), 161,325 were white (84%), 23,319 were 60-64 years (12.2%), and 96,883 received radiation therapy (50%). 5 year OS and DSS was 36% and 63%, respectively. Among this cohort, OS was improved in females (P<0.0005), non-white or African American race (P<0.0005), age 0-20 (P<0.001), localized stage (P<0.0003), surgical treatment (P<0.0002) and radiation treatment (P<0.0003). Evaluation of all sites identified that patients are at higher risk of second primary malignancies in all sites (SIR 1.56), The most significant risk was located in head and neck region; oral cavity and pharynx (SIR 8.68), tongue (SIR 11.2), floor of mouth (SIR 12.25), gum (SIR 13.7), oropharynx (SIR 10.27), hypopharynx (SIR 8.95), tonsil (SIR 6.92), pharynx (SIR 7.85), other oral cavity and pharynx (SIR 12.70) and trachea (SIR 11.64). Evaluation of the latency to development of second primary malignancies revealed this increased risk remained significant at multiple time frames from 6 months to greater than 60 months. On Multivariate Cox Proportional Hazards analysis, both age and surgery significantly reduced risk of SMs, (CI = 0.625-0.753, P<0.0005) and (CI = 0.762-0.812, P<0.001), respectively. This remained true on subgroup analysis performed on non-radiation and radiation groups were associated with less risk of SMs (CI = 0.576-0.689, P = 0.0004) and (CI = 0.514-0.630, P = 0.002), respectively. Head and neck cancer patients are at a significant risk for second primary malignancies, most notably in the head and neck region. Radiation therapy improves OS and does not increase risk of SMs, suggesting that elevated risk is attributable to factors other than radiation.

Normal tissue sparing strategies are becoming the standard for modern radiation therapy; without organ preservation the toxicity associated with external beam radiation therapy, such as xerostomia, adversely affects a patient’s long-term quality of life (QOL). Recently, clinicians have come to understand that there are significant changes to the head and neck (H&N) anatomic compartments induced by radiation therapy, despite efforts to spare normal structures. Herein, we propose an investigation of the anatomic and volume changes of the major salivary (parotid and submandibular) glands during treatment with concurrent chemoradiation. We further assess the volume changes of the deep and superficial parotid glands during our IMRT treatment. Our ultimate goal is to identify the timing at which radiation-induced changes to the salivary glands occur, the effects on saliva quality, and assess QOL, with the future goal to design an adaptive radiation therapy paradigm to maximize the quality of life of H&N patients. We retrospectively investigated 20 patients with recurrent or newly diagnosed squamous cell carcinoma of the H&N carcinoma treated with concurrent chemoradiation therapy. Assessed, were the volume and anatomic positions of the parotid and submandibular glands at the time of CT simulation, the 12th, 25th, and final fraction of image guided radiation therapy. We compared the total gland volumes, and then measured position translation to a bony reference (C2 dens). We utilized the embedded volume, distance, and dosing tools within the treatment planning software package. Cohort median age was 61 (3:1 male:female ratio). Fifteen patients were diagnosed with stage IVa H&N squamous cell carcinoma. There was a balance of left vs. right-sided disease. Patients received a minimum of 66 Gy, with a median dose of 70 Gy. Mean treatment package time was 44d; 85% of patients received concurrent chemotherapy. Median weight loss was 7.4%. CCRT vs. no chemotherapy resulted in a trend towards significant mean parotid gland volume loss (41.9 ± 19.4% vs. 35.2 ± 20.1%; P = 0.18). Volume loss was greatest by the first 12 fractions of treatment. For submandibular glands, our sample small sample size suggested a trend increased volume loss with CCRT. The glands exhibited a medial displacement of 5-8mm during the course of treatment. No differences in unstimulated/stimulated saliva output or pH were seen between the two groups. Our data suggests a connection with use of CCRT and salivary gland changes. Due to a small sample size, these differences were not statistically significant, however, we are increasing our study size in light of this important result. We wish to identify timing of gland changes, dose effect on saliva chemistry, and assess QOL to design an adaptive CCRT paradigm to maximize QOL.

e17522 Background: Without organ preservation techniques, the toxicity associated with external beam radiation therapy (e.g. xerostomia), adversely affects a patient’s quality of life (QOL). Complicating these changes are multi-modality treatments, particularly, the use of concurrent chemoradiotherapy (CCRT). Here, we compare the chemotherapy effect on the saliva chemistry, anatomic position and volume of the major salivary (parotid and submandibular) glands during CCRT. Methods: This is a pilot study of 10 patients diagnosed with H&N carcinoma treated at our institution from 2014-2015. Daily image-guided intensity modulated radiotherapy and platinum-based concurrent chemoradiotherapy was used. Assessed, were the volume and anatomic positions of the salivary glands at CT simulation and the 12th, 25th, and final fractions. We measured gland translation to a bony reference then, compared the gland volume at the above time points. The Mann-Whitney U test was used for the significance of chemotherapy and gland changes. Saliva was tested at the completion of treatment. Results: Average cohort age was 60, comprised of 7 males and 3 females. There were 6 stage IVA, 2 stage III, 1 stage II, and 1 recurrent, primarily oropharyngeal, squamous cell carcinoma diagnoses. For all glands, mean volume loss was 30% with a mean medial displacement of 6-7mm. Six of 10 patients received weekly or q3w chemotherapy. CCRT resulted in a non-significant mean gland volume loss of 33% (2.5 – 49%), compared to a mean of 25% (8 – 45%) with RT alone. Volume loss was greatest by the first 12 fractions of treatment. For submandibular glands, there was a trend of 36% greater volume loss with CCRT (p= 0.07). No differences in unstimulated/stimulated saliva output or pH was seen between the two groups. Conclusions: Our data suggests a connection with use of concurrent chemotherapy and salivary gland changes. Due to a small sample size, these differences were not statistically significant, however, we are increasing our study size in light of this important result. We wish to identify when gland changes occur, the effect on saliva chemistry, and assess QOL to design an adaptive CCRT paradigm to maximize QOL.