DIAGNOSTIC ANESTHESIA TESTING OF 264 PAINFULQUADRANTS IN IDIOPATHIC FACIAL PAIN PATIENTS.Bouquot J, Adams W, Spolnik K, Deardorf K. University ofTexas Dental Branch at Houston, Houston, TX; private prac-tice of endodontics, Indianapolis, IN.

Introduction: The diagnostic anesthesia test (DAT) was firstsuggested by Box in the 1950s, but it was not until 1995 that thehistopathology of the bone in a positive alveolar test site wasreported: McMahon et al found bone disease in 48 of 48 patientswith idiopathic facial pain (IFP). These authors concluded thatthis represented regional neural hypersensitivity or neuritis. Theirstudy has not yet been duplicated.

Purpose: To correlate, in a large IFP patient cohort, the siteof a positive DAT in the quadrant of pain, and to further correlatea positive DAT with microscopic evidence of bone or marrowdisease at that site.

Material and methods: Over a 13 year period, 117 IFPpatients (103 females, age range � 19-74 years; mean � 47.1years) without identifiable dental, periodontal or sinus diseaseunderwent DAT evaluation in 293 quadrants of pain. Cancellousbone biopsy was performed immediately beneath the DAT injec-tion site unless the patient refused surgery. Pearson chi squareanalysis was used to confirm associations; specificity and sensi-tivity calculations were attempted.

Results: Of 293 painful quadrants (58.5% maxillary), 90.1%(264/293) had a positive DAT. Histopathologic diagnoses of 231positive DAT sites in patients who allowed biopsy included:chronic ischemic bone disease (n � 127); chronic nonsuppurativeosteomyelitis (n � 93); acute osteomyelitis (n � 4); focal osteo-porotic marrow defect (n � 4); normal bone (n � 2); andinflamed odontogenic cyst (n � 1). Pearson chi square analysisshowed a strong correlation (p�.0001, df) between the site ofpain and a positive DAT, as well as between a positive DAT andmicroscopic evidence of marrow disease (p�.0001, df 1). Addi-tionally, 15 painful sites with a negative DAT were biopsied fromthis cohort: 12 showed marrow disease. Using these cases, sen-sitivity was 95.0% but specificity was only 60.0%.

Conclusion: A positive DAT appears to be strongly corre-lated with the quadrant of pain in IFP. Also, a positive DAT isstrongly correlated with underlying bone disease. While the DATseems to be a very sensitive test for marrow disease in IFPpatients, the high rate of false negative tests in the small numberof biopsied negative DAT sites makes sensitivity and specificityresults suspect. We presume the DAT works because local alve-olar nerves are hypersensitized, but our investigation did not andcould not determine the underlying mechanisms involved.

CHILDHOOD LEAD EXPOSURE AND DENTAL CARIES.Martin MD, Benton T, Leroux B, Woods JS, Bernardo MF,Soares H, Leitao J, DeRouen TA

Introduction: A small number of studies in the last fourdecades have examined the potential association between child-hood lead exposure and dental caries. Markers of lead exposurewhich have been evaluated have included food, water, blood andtooth enamel. These studies have produced inconsistent results,with some finding positive associations for all dental caries, andothers finding either no association, or association only withcaries in some deciduous teeth.

Objectives: To examine the association of caries with leadexposure in a population of schoolchildren.

Methods: In the current study, we examined 507 children

enrolled in the Casa Pia Study of the Health Effects of DentalAmalgam in Children, a randomized, prospective clinical trial toevaluate potential effects of mercury from dental amalgam onhealth. During enrollment into the study, baseline blood leadconcentrations, as well as complete baseline dental examinationswith radiographic confirmation of dental caries were obtained.

Results: The age range of subjects in our sample was 8.3 to12.4 years, with a mean of 10.1 years. There was no genderdifference in age, although there was a gender difference incaries, with boys having less decay in primary teeth (p�.01).Caucasian subjects had higher levels of decay than non-Cauca-sians (p�.06). The blood lead concentration in our sample rangedfrom 1.0 to 16.0 �g/dL, with a mean of 4.6 �g/dL. Aftercontrolling for age, gender, ethnicity and tooth brushing fre-quency, we found no significant association of blood lead withtotal caries, or with caries levels in either primary or permanentteeth alone. When comparing caries in only those subjects with�5ug/dL blood lead to those with �10ug/dL, we found nosignificant difference in caries levels.

Conclusions: We conclude that this study provides no evi-dence of a relationship between low level exposure to lead anddental caries. Funded by NIDCR Cooperative agreement:UO1DE11894.

CLINICAL OUTCOMES IN HIV–POSITIVE PATIENTSAFTER DENTOALVEOLAR SURGERY. Kishore Shetty,DDS, MS, MRCS,1,2 Janet Leigh, BDS, DMD.2,3 1MedicallyComplex Patient Clinic, University of Texas Health SciencesCenter. 2Department of General Dentistry, Louisiana StateUniversity Health Sciences Center. 3Department of Oral Di-agnosis, Medicine and Radiology, Louisiana State UniversityHealth Sciences Center.

Introduction: The purpose of this study was to perform apreliminary test of the hypothesis that patients infected with thehuman immunodeficiency virus (HIV) have an increased risk ofcomplications after oral surgery in comparison with HIV-nega-tive patients.

Methods: A retrospective cohort study records of HIV sero-positive individuals who underwent any dentoalveolar surgicalprocedures between 1999 and 2004 was matched with the recordsof HIV negative control patients. Demographic and clinical in-formation was entered into a database that included: indicationfor surgery, type of surgical procedure, emergent or electivesurgery, anesthetic type, pre-procedure antibiotics, CD4 count,viral load, white blood cell count, hematocrit, serum chemistryand liver functions tests. Peri-operative and post-operative eventswere recorded as complications if they occurred within 30 daysof surgery and if they were described in the record as a compli-cation or an unexpected event. Logistic regression analysis wasdone to determine the independent effects of HIV infection andother potential risk factors for surgical complications.

Results: The adjusted rates [(OR�3.12, p�0.02)] of infec-tious and hematological complications in major dentoalveolarprocedures were higher among the HIV positive patients thenamong the HIV negative individuals. Variables significantly as-sociated with complications were age (OR�1.68), ethnicity(OR�1.97), viral load (OR�2.33) and highly active antiretrovi-ral therapy OR�2.45).

Conclusions: HIV- seropositive status was found to be anindependent risk factor for complications of major oral surgicalprocedures. The most important risk factors for complication of

OOOOEVolume 102, Number 3 Abstracts 327

surgery in HIV positive individuals were high viral load andabsence of antiretroviral treatment.

A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CON-TROLLED, CLINICAL TRIAL OF CURCUMINOIDS INORAL LICHEN PLANUS. N. Chainani-WU,1 S. SilvermanJr,1 A. Reingold,2 A. Bostrom,3 C. McCulloch,3 F. Lozada-Nur,1 J. Weintraub.4 1Department of Orofacial Sciences, Uni-versity of California, San Francisco. 2Division of Epidemiol-ogy, School of Public Health, University of California,Berkeley. 3Department of Epidemiology and Biostatistics,University of California, San Francisco. 4Department of Pre-ventive and Restorative Dental Sciences, University of Cali-fornia, San Francisco.

Introduction: Lichen planus is a chronic, mucocutaneous,immunologic disease. It can affect the oral mucosa, causing whitechanges, red changes and ulcerations. Symptoms can range fromnone to severe. Curcuminoids are components of tumeric (cur-cuma longa) and have anti-inflammatory activity.

Objective: To study the efficacy of curcuminoids in thetreatment of oral lichen planus (OLP).

Methods: A randomized, double-blind, placebo-controlledtrial was conducted. 100 consecutive, eligible patients with OLPpresenting to the oral medicine clinic at the University of Cali-fornia, San Francisco, were to be enrolled. Measurement ofsymptoms and signs was done at baseline and at the end of thefirst, fourth and seventh week, using the Visual Analogue Scale,the Numeric Rating Scale (NRS), the Change in Symptoms Scaleand the Modified Oral Mucositis Index. Interim analyses were tobe conducted at completion of data collection for the first 30 andthen 60 subjects.

Results: The trial was conducted between February 2003 andSeptember 2004. The first interim analysis was conducted usingdata from the first 33 subjects. This analysis did not show asignificant difference between the placebo and control group. Thechanges in NRS values from baseline to seven weeks in theplacebo group and the curcuminoids group were -1.996 and-1.666 respectively, difference � -0.33 (95% CI : - 2.021, 1.360),2 sided p� 0.691). Conditional power calculations suggested thatthere was less than a 2% chance that the curcuminoids groupwould have a significantly better outcome compared with theplacebo group if the trial was to continue to completion. There-fore the study was ended early for futility.

Conclusion: Reaching a conclusion regarding efficacy ofcurcuminoids based on the results of this study is not possible asit was ended early for futility. However curcuminoids at this dosewere well-tolerated and the results suggest that for future studiesa larger sample size and possibly a higher dose and / or longerduration of curcuminoids should be considered.

Support by: NIH/ NIDCR T32 DE07204; General ClinicalResearch Center, UCSF (5 M01 RR-00079, U.S. PHS); MountZion Health Fund.

VALIDATION OF VISUAL ANALOGUE SCALE, NU-MERIC RATING SCALE, CHANGE IN SYMPTOMSSCALE, AND MODIFIED ORAL MUCOSITIS INDEX FORMEASUREMENT OF SYMPTOMS AND SIGNS OF ORALLICHEN PLANUS. N. Chainani-Wu,1 S. Silverman, Jr,1 A.Reingold,2 A. Bostrom,3 F. Lozada-nur,1 J. Weintraub.4 1De-partment of Orofacial Sciences, University of California, SanFrancisco; 2Division of Epidemiology, School of Public

Health, University of California, Berkeley; 3Department ofEpidemiology and Biostatistics, University of California, SanFrancisco; 4Department of Preventive and Restorative Den-tal Sciences, University of California, San Francisco.

Introduction: Evaluation of the severity and extent of thesigns and symptoms of oral lichen planus (OLP) is important forbaseline assessment as well as during follow-up to monitordisease progression and treatment responses.

Objective: To assess the validity of the visual analogue scale(VAS), the numeric rating scale(NRS), the change in symptomsscale (CSS) and the modified oral mucositis index (MOMI) inmeasuring the symptoms and signs of oral lichen planus.

Methods: Data from a randomized, double-blind, placebo-controlled clinical trial of curcuminoids in OLP was used. Anal-yses of criterion validity, construct validity and internal consis-tency were conducted.

Results: High positive statistically significant correlations(�0.9) were found between NRS and VAS scores, and betweenthe CSS score for a given visit and difference in NRS/VAS scoreat that visit and the previous visit. Correlations of NRS, VAS andCSS with clinical signs ranged from minimal to moderate posi-tive correlations. Correlation of NRS with clinical signs wasstronger than that of VAS with clinical signs. Presence of ery-thema and/or ulceration on the tongue at a follow-up visit wasassociated with greater reported oral discomfort as compared toabsence of clinical signs on the tongue, as measured by NRS[difference 1.00, 95% CI (0.06, 1.95), p�0.037] and VAS scores[difference 13.74, 95% CI (2.63, 24.84), p�0.015]. Mixed effectsmodels showed significant changes from baseline at first, secondand third follow-up in NRS (p�0.0001), VAS (p�0.0001), ery-thema (p�0.001), ulceration (p�0.02) and total clinical signsscore (p�0.0001). Moderate to high correlations were seen be-tween erythema and ulceration scores from the MOMI.

Conclusions: NRS, VAS, CSS and MOMI are valid scalesfor measurement of symptoms and signs of OLP. VAS, NRS andCSS show good concurrent validity. NRS appears to have higherconstruct validity than VAS, based on higher correlations withclinical signs. For clinical signs, erythema plus ulceration is abetter measure than ulceration alone. Sensitivity to change isgood for VAS, NRS and MOMI. Internal consistency of MOMIscale is good.

Support by: NIH/ NIDCR T32 DE07204; General ClinicalResearch Center, UCSF (5 M01 RR-00079, U.S. PHS); MountZion Health Fund.

DILEMMA IN MANAGEMENT OF BISPHOSPHONATE-RELATED OSTEONECROSIS OF THE JAW. Shin-Mey RoseYin Geist, DDS, MS, Sara C. Gordon, DDS, MSc, James R.Geist, DDS, MS. University of Detroit Mercy School of Den-tistry, Detroit, Michigan.

Background: Bisphosphonates have been related to osteone-crosis of the jaw (ONJ) since 2003. These drugs inhibit boneresorption and are used in the management of bone cancers andosteoporosis. Most ONJ cases have followed intravenous infu-sion of pamidronate (Aredia) or zoledronic acid (Zometa), butsome cases have been associated with oral alendronate (Fosa-max). Although a causal relationship has not been established,many patients have discontinued the medication and have beenadvised against invasive dental treatment. This poses problemsfor patients who require surgical dental care. Furthermore,

OOOOE328 Abstracts September 2006