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Volume 116, Number 3

glandular uid secretions. However, the pathogenic roles of antiM3R autoantibodies in the context of gland tissue destruction
and/or salivary hyposecretion remain unclear. Based on that, it
was hypothesized that anti-M3R monoclonal autoantibody could
induce salivary hyposecretion, as well as gland tissue destruction,
in normal BALB/c strain mice with no genetically predisposing
autoimmune condition.
Methods: Generation of mAb: BALB/c mice were immunized with synthetic M3R peptide. Hybridoma cells were generated that produced IgG class mAb that reacts to M3R.
Effect of anti-M3R IgG in vivo: BALB/c mice received
adoptive transfer of anti-M3R mAb or control phosphate buffered
saline (PBS) injection on day-0. LPS (1 mg/ml/mouse) was
injected to both groups on day-7. Saliva ow was monitored by
using a chemical saliva inducer, pilocarpine. On day-28, mice
were sacriced, and the salivary glands were isolated for histological evaluation using H&E staining. Immunohistochemical
stains AQP5 and TUNEL were done.
Results: An IgG2a class mAb specic to M3R was developed. The anti-M3R- mAb was detected in the serum of mice. On
day-28, the mouse group that had received anti-M3R mAb
showed signicantly lower levels of saliva secretion, in addition
to an abnormal histological expression pattern of AQP5 in salivary glands. Furthermore there was no lymphocyte inltration in
the glands of mice that received anti-M3R mAb.
Conclusions: These ndings have, for the rst time,
demonstrated that auto-anti-M3R IgG mAb can cause salivary
hypo-production, without tissue destruction, in normal syngeneic
mice with no predisposing autoimmune condition. Therefore,
these results suggest that the pathogenic causes of saliva hyposecretion and glandular tissue destruction are mediated by
different mechanisms; this study brings new insight into the
pathogenesis of SjS.
Funding Source(s): Partially supported by NIH grant DE18499

DOES BACTEREMIA INDUCED BY DENTAL PROCEDURES CAUSE CENTRAL LINE INFECTIONS? S Usmani,
L Choquette, R Bona, R Feinn, RV Lalla, University of
Connecticut, Farmington, CT
Objectives: To determine the contribution of bacteremia
induced by dental procedures to infections associated with central
venous catheters (CVCs) in patients with cancer.
Methods: Twenty-six cancer patients, with a CVC (port or
PICC line), received a dental cleaning (scaling and polishing),
without antibiotic prophylaxis. Periodontal status was assessed
prior to the procedure using the Periodontal Screening and
Recording (PSR) score. Blood samples for cultures were drawn
via the CVC before start of the procedure (baseline), 20 minutes
into the procedure, and 30 minutes and 24 hours after procedure.
Patients were followed for six months to detect evidence of
delayed infection.
Results: One subject with a positive blood culture at baseline was excluded from analyses. Baseline blood cultures were
negative in twenty-ve subjects. Nine of the twenty-ve subjects
(36%) had a positive blood culture 20 minutes into the procedure.
These nine subjects had a signicantly higher mean PSR score
(3.22) compared to the other sixteen subjects (2.56; p0.035). All
nine positive blood cultures were associated with at least one
microorganism typically found in the mouth. However, these
expected episodes of bacteremia did not persist, with no positive
blood cultures (0/25) at 30 minutes and 24 hours after procedure

ABSTRACTS
Abstracts e197
(p0.002 for comparison to 20 minutes into procedure). One
subject developed a port infection and bacteremia 4.5 months
after the procedure. This infection was associated with Staphylococcus aureus, which is found predominantly on the skin.
Furthermore, this subjects blood cultures during and after the
dental procedure were negative.
Conclusions: Patients with poor periodontal status are more
likely to experience a bacteremia following an invasive dental
procedure. Even in these patients, such occurrences of bacteremia
are transient in nature. These short-lived episodes of bacteremia
are highly unlikely to cause infections associated with CVCs in
patients with cancer. Therefore, routine antibiotic prophylaxis for
this reason is not warranted.
Funding Source(s): Neag Comprehensive Cancer Center at
the University of Connecticut Health Center

SUCCESSFUL MANAGEMENT OF PEMPHIGUS VULGARIS (PV): A PROSPECTIVE STUDY M Schifter, DA

Fulcher, MW Lin, S Kelly, S Ojaimi, J Vu, SC Yeoh, Westmead Hospital, Westmead Australia
Objectives: Twenty PV patients were prospectively evaluated as to the optimal treatment needed to induce clinical
remission.
Methods: Assessment was by clinical observation and use
of the PDA Index. The regimens included initial systemic corticosteroids alone, azathioprine or mycophenolate, as steroidsparing agents, or rituximab. Analysis was also undertaken of the
value of serological disease markers (ICSA, dsg-1 and dsg-3
titres), adverse reactions experienced by our patients and a cost
analysis. Due to the small sample size, meaningful statistical
analysis was limited.
Results: n 20 patients. Average age was 48 (range 22-48
years) comprising 11 women and 9 men, who predominantly, had
oral involvement on their presentation. Patients were followed on
average for 44 months (range 3-142 months). Eleven of 15
patients failed azathioprine therapy as their initial steroid-sparing
agent (statistically signicant). Sixteen patients (including 11 who
had failed azathioprine) were given mycophenolate, of which 8
proceeded to receive rituximab infusions and achieve remission
and were off all immune-suppressive agents, but 6 required repeat
infusions.
Conclusions: Azathioprine was of negligible value as
a steroid-sparing agent for our PV patients, mycophenolate was
modestly effective, rituximab was effective, but repeat infusions
were required. The ICSA titre was not a useful predictor of clinical
activity, whereas the dsg-3 titre was promising. In 14 patients,
serious adverse reactions occurred from their corticosteroid use. To
date, all patients treated with rituximab have had no serious adverse
complications. The annual cost per patient was respectively,
AUD$54 for prednisolone, $60 for azathioprine, $4 928 for
mycophenolate and $17 352 for rituximab if 3.85 g infusion was
used, but clinical remission was also achieved with infusions of
only 1.62 g, at an annual cost of only $7 301. The role of an oral
medicine specialist in providing clinical guidance in the diagnosis
and assessment of treatment response was essential.

POST EXTRACTION WOUND HEALING IN PATIENTS

WITH TYPE 2 DIABETES KS Fernandes, CM Kokron, M
Glick, M Gallottini, School of Dentistry of University of So
Paulo, So Paulo, Brazil
Objectives: Diabetes is recognized as an independent risk
factor for postoperative infections. Thus, maintaining perioperative

ORAL MEDICINE
e198 Abstracts
glucose control has become the standard of care. However, there
are scarce data on the appropriate glucose control during minor
dental surgery. Despite the paucity of studies investigating the risk
of postsurgical oral infections in persons with diabetes, recommendations to dentists include the use of prophylactic antibiotics
for patients with poorly controlled diabetes undergoing invasive
oral procedures. The aim of this study was to compare parameters,
such as immune proles, in patient with diabetes and in patients
without DM after dental extraction, as well as the impact of glucose
control.
Methods: The clinical trial included 44 subjects with diabetes (DM) and 14 controls (CG). All participants underwent
extractions of erupted teeth. Clinical assessments of healing were
performed on day 3, 7, 21, and 60 after surgery. Glycated
hemoglobin (A1c), neutrophil chemotaxis, oxidative burst,
neutrophil and monocytes phagocytosis were measured at the
time of the extraction.
Results: On day 60, all sockets were epithelialized, with no
signs of infection, and asymptomatic. At the time of extraction,
35(79%) individuals from the DM group presented with A1c>
6.5%, 14(32%) showed decreased chemotaxis, 4(9%) decreased
neutrophil phagocytosis, 6(14%) decreased monocyte phagocytosis and 12(27%) decreased oxidative burst. Seven individuals
with diabetes showed incomplete alveolar wound epithelialization
21 days after surgery, and among them 5 presented with
A1c>6.5% and 2 with A1c6.5%, 2 presented with decreased
neutrophil chemotaxis, 1 with decreased monocyte phagocytosis,
and 1 presented with decreased neutrophil phagocytosis and
oxidative burst. No one from the CG showed any delay in healing. There was no signicant difference between the groups with
respect to socket epithelialization (p0.1783).
Conclusions: This preliminary study showed normal healing of a postextraction alveolar socket at 60 days, despite the poor
glucose control and impaired neutrophil functions among patients
with diabetes.
Funding Source(s): FAPESP 2009/10934-5

LOWER CHOLESTEROL ASSOCIATED WITH ORAL

RINSE IN GINGIVITIS PATIENTS CJ Gauntt, K
McCloskey, PB Siegel, G Siegel, Biomedical Development
Corporation, San Antonio, TX
Objectives: The purpose of this study was to evaluate
a novel iodine-based oral rinse for safety and for use in reducing
gingivitis and biological markers of inammation in otherwise
healthy human subjects.
Methods: All subjects received dental prophylaxis at the
beginning of the study. Study participants were randomized to
receive either a placebo rinse or a once-daily, 30 second iodinebased oral rinse. Subjects were evaluated four times over a three
month period and dental assessment indices for gingivitis, plaque,
and bleeding scores were collected. Blood tests were performed to
assess safety and to determine the effects of the oral rinse on
relative levels of biological markers of inammation and lowdensity lipoprotein cholesterol (LDL-C). Statistical analysis was
performed using Students t-test and the nonparametric MannWhitney U-test.
Results: No treatment-related adverse events were observed.
Results showed that after three months of treatment, LDL-C in the
iodine-based oral rinse treatment group was signicantly (p<.05)
lower compared to the Placebo group.
Conclusions: The novel iodine-based oral rinse was shown
to be safe in the study. The use of this iodine-based oral rinse may

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September 2013
be associated with lower LDL-C. Additional studies are needed to
further dene the efcacy of the once-daily iodine oral rinse and
evaluate its effect on biological markers of inammation.
Funding Source(s): NIH/NHLBI R44HL101821-01

NON-EXPOSED BISPHOSPHONATE-INDUCED OSTEONECROSIS OF THE JAWS. CHARACTERICS & IMPLICATIONS FOR CLASSIFICATION M Schiodt, J Reibel,
P Oturai, Copenhagen University Hospital, Copenhagen,
Denmark
Objectives: Non-Exposed Bisphosphonate (BP)-induced
Osteonecrosis of the jaws ONJ (NE-ONJ) does not t into the
clinical denition of ONJ, which requires exposed bone for 8+
weeks (Ruggerio 2006). Purpose: To report characteristics of
NE-ONJ compared to (exposed) E-ONJ.
Methods: The cohort consists of 102 consecutive patients.
They were treated with BP for multiple myeloma (n21),
mammary gland cancer (n39), prostate cancer (n7), other
cancers (n2), or osteoporosis (n33). The criteria used for
diagnosing NE-ONJ were: 1. previous treatment with BP; 2. no
precious jaw radiation; 3. no exposed bone in the oral cavity; 4.
oral or extraoral stula, jaw pain, swelling, and/or sequestrum
formation on imaging and; 5. Necrotic bone tissue on
histopathology.
Results: Among 102 ONJ patients 14 were NE-ONJ and 88
E-ONJ. The age and gender distribution was similar in the two
groups. Mandible was affected in 66%, maxilla in 24%. Mean
pain VAS score was 3.1. The NE-ONJ and E-ONJ were similar in
all important clinical signs and symptoms, except bone exposure.
The histopathology showing necrotic bone was unexpected in
some cases. Treatment was conservative in 23% (+/-antibiotics)
of the E-ONJ, and 14% of NE-ONJ, and surgical in 77% and
86%, respectively. At nal examination, NE-ONJ and E-ONJ
were free of symptoms in 85%, and 79%, respectively.
Conclusions: NE-ONJ represents a signicant proportion
of ONJ cases, and should be identied and treated. The similar
medical history, clinical symptoms, signs, and response to treatment suggest that E-ONJ and NE-ONJ belong to the same
biologic disease condition. Therefore, it is recommended to
establish global consensus criteria which include NE-ONJ in the
group of ONJ.

PERIODONTAL STATUS AND BACTEREMIA IN ALLOGENEIC HEMATOPOIETIC STEM CELL RECIPIENTS JE

Raber-Durlacher, AMGA Laheij, JB Epstein, M Epstein, G
Geerligs, GN Wolffe, JP Donnelly, NMA Blijlevens,
Academic Medical Center, Amsterdam, Netherlands
Objectives: Periodontal infections may not only affect the
oral tissues, but bacteria may translocate into the blood stream via
ulcerated pocket epithelium. This study investigated whether any
association could be found between the presence of an inamed
and infected periodontium and the development of bacteremia
during neutropenia following allogeneic hematopoietic stem cell
transplantation (HSCT) with oral viridans streptococci (OVS),
and coagulase negative staphylococci (CONS).
Methods: Eighteen patients underwent a periodontal examination prior to HSCT. Patients were classied as periodontally
healthy (all periodontal pocket depths (PPD)  4 mm and
bleeding on probing (BOP)  10%) or as having gingivitis/
periodontitis (PPD  4 mm and BOP > 10%). Oral mucositis
(OM) was scored using the Daily Mucositis Score. Blood cultures
were taken at least twice weekly. Associations between nominal