A Patient Undergoing Treatment of Hematologic Malignancy Reports for Oral Evaluation.

Oral lesions are commonly seen in patients with acute myeloid leukemia (AML) and may be the first clinical signs of disease. It is important for the dental provider to be able to recognize the oral manifestations of AML to allow for timely referral to a medical specialist. Patients with AML may receive treatment through chemotherapy, targeted drug therapies, or stem cell transplantation, which can involve oral complications and therefore necessitate case-specific patient education, dental evaluation, and treatment planning.

Patient Receiving Hematopoietic Stem Cell Transplantation Reports for Dental Clearance.

Patients planned for hematopoietic stem cell transplantation (HSCT) routinely undergo dental evaluation. Conditioning before HSCT engenders immunosuppression that may lead to flares of oral infections. Before transplantation, the dental provider should educate the patient on the oral complications of HSCT and identify and treat dental needs as appropriate to the patient's medical status. Dental evaluation and treatment must be performed in close coordination with the patient's oncology team.

Scaling and Root Planning in a Patient Taking Chronic Corticosteroid Therapy for Lupus Erythematosus.

The dental provider should be aware of the oral manifestations of systemic lupus erythematosus (SLE). Patients with SLE may be on chronic oral corticosteroids, which can increase the risk for periodontitis and opportunistic oral infections in addition to inducing multiple systemic adverse effects. Disease complications such as lupus nephritis and comorbid antiphospholipid antibody syndrome can further impact dental decision-making including around medications to prescribe or hemostatic measures to employ during treatment. Patients with SLE on systemic corticosteroid therapy usually do not require steroid supplementation before or after non-surgical or surgical dental treatment.

Patient with Crohn's Disease Presents for Pain in Relation to Maxillary Teeth.

Crohn's disease has been associated with poor oral health and oral health-related quality of life. Myriad-specific and nonspecific oral lesions have been associated with Crohn's disease. Oral lesions in patients with Crohn's disease may be a source of referred pain, especially if mucosal ulcerations or orofacial granulomatosis are involved. The dental provider can play an important role in evaluating for and/or managing oral lesions in patients with Crohn's disease and thereby improving patients' oral health and quality of life.

A Patient with Hypothyroidism in Need of Periodontal Connective Tissue Graft Surgery.

Hypothyroidism is a condition characterized by thyroid hormone deficiency and can be caused by a variety of factors. Untreated or chronic hypothyroidism can present in adult patients as myxedema, which is characterized by symptoms including fatigue, generalized slower metabolism, weight gain, depressed mood, dry skin, and brittle hair. Hypothyroidism can have various oral manifestations, particularly in children, in whom it can delay the eruption of the dentition. Dental management of patients with hypothyroidism depends on the etiology and status of the disease and requires the consideration of other organ systems affected.

A 65-Year-Old Man with Recent History of Radiation Therapy to the Head and Neck Reporting for Treatment of a Non-restorable Tooth.

Patients with a history of head and neck radiation involving or adjacent to tooth-bearing areas are at increased risk of developing osteonecrosis following dental procedures. The dental provider should thus aim to preserve the patient's dentition after radiation therapy. Root canal therapy with coronectomy may be an option for a nonrestorable tooth, whereas atraumatic extraction can be considered if retaining the tooth is impossible. When treating a patient with a history of head and neck radiation, it is recommended that the dental provider reviews the patient's radiation records and consults with the patient's radiation oncologist to better stratify treatment risks.

Probing Estrogen Sulfotransferase-Mediated Inflammation with [11C]-PiB in the Living Human Brain.

BACKGROUND: 2-(4'- [11C]Methylaminophenyl)-6-hydroxybenzothiazole ([11C]-PiB), purportedly a specific imaging agent for cerebral amyloid-ß plaques, is a specific, high affinity substrate for estrogen sulfotransferase (SULT1E1), an enzyme that regulates estrogen homeostasis. OBJECTIVE: In this work, we use positron emission tomography (PET) imaging with [11C]-PiB to assess the functional activity of SULT1E1 in the brain of moyamoya disease patients. METHODS: Ten moyamoya subjects and five control patients were evaluated with [11C]-PiB PET and structural MRI scans. Additionally, a patient with relapsing-remitting multiple sclerosis (RRMS) received [11C]-PiB PET scans before and after steroidal and immunomodulatory therapy. Parametric PET images were established to assess SULT1E1 distribution in the inflamed brain tissue. RESULTS: Increased [11C]-PiB SRTM DVR in the thalamus, pons, corona radiata, and internal capsule of moyamoya cohort subjects was observed in comparison with controls (p ≤ 0.01). This was observed in patients without treatment, with collateralization, and also after radiation. The post-treatment [11C]-PiB PET scan in one RRMS patient also revealed substantially reduced subcortical brain inflammation. In validation studies, [11C]-PiB autoradiography signal in the peri-infarct area of the rat middle cerebral arterial occlusion stroke model was shown to correlate with SULT1E1 immunohistochemistry. CONCLUSION: Strong [11C]-PiB PET signal associated with intracranial inflammation in the moyamoya syndrome cohort and a single RRMS patient appears consistent with functional imaging of SULT1E1 activity in the human brain. This preliminary work offers substantial and direct evidence that significant [11C]-PiB PET focal signals can be obtained from the living human brain with intracranial inflammation, signals not attributable to amyloid-ß plaques.