Oral lichen planus: comparative efficacy and treatment costs-a systematic review.

OBJECTIVE: To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP). MATERIALS AND METHODS: A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered. RESULTS: Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone. CONCLUSION: Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments.

First Bite Syndrome - An Underrecognized and Underdiagnosed Pain Complication After Temporomandibular Joint Surgery.

PURPOSE: First bite syndrome (FBS) can develop after head and neck surgical procedures. The aim of this study is to identify patients diagnosed with FSB after temporomandibular joint (TMJ) surgery, including their pain characteristics and risk factors for FBS. METHODS: Using a retrospective study design, a cohort of 24 patients with confirmed diagnosis of FBS were identified from the oral and maxillofacial surgery and orofacial pain (OFP) practices at Massachusetts General Hospital and Research Patient Data Registry (RPDR) between 1975 and 2019. The inclusion criteria were facial pain that was triggered by taste stimulus only and followed by a refractory period until the next gustatory stimulus. RESULTS: Of the 24 patients identified, 19 had undergone TMJ surgery, 3 patients had idiopathic FBS, 1 had a parapharyngeal space tumor and 1 developed FBS after facial burns. In the surgical patients, the median duration of onset was 2.75 months post-surgery. Most patients reported pain in the parotid region. Pain was only triggered by a taste stimulus and subsided with subsequent bites of food. 2 patients underwent spontaneous resolution of their symptoms and 1 reported complete resolution with onabotulinum toxin A (BTX) injections. Anxiety and depression were the most common comorbid conditions. CONCLUSION: FBS is an underrecognized pain complication in TMJ surgery patients. A precise history and accurate description of the pain is necessary for correct diagnosis which is important for improved treatment outcomes.