How Have the Diagnosis and Treatment of Chronic Recurrent Multifocal Osteomyelitis Changed Over Time?

PURPOSE: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory condition characterized by sterile bone lesions. There appears to be a shift in the diagnostic modalities and treatment over the past decades despite insufficient published data. The purpose of this study was to document: 1) the number of patients diagnosed with CRMO, 2) patient demographics, 3) disease characteristics at presentation, 4) diagnostic modalities employed, and 5) treatments prescribed at our institution over a 30-year period. METHODS: This single-center, retrospective cohort study included children diagnosed with CRMO who presented between 1990 and 2020. The electronic medical records were queried using numerous search terms. Patients were excluded if CRMO was included in the differential diagnosis but was not confirmed at the time of chart review or if CRMO was suspected early in the disease course but the patient was ultimately diagnosed with another condition. The predictor (time in years) and outcome variables (diagnostic modalities and treatment types) were tested using bivariate analyses using IBM SPSS, Version 27 (IBM Corp., Armonk, NY). RESULTS: A total of 224 patients were diagnosed with CRMO during the observation period (68.3% female; 67.4% white). The number of patients diagnosed over the past decade rose by 215%, as compared to the previous 2 decades (1990 to 2010). Regional magnetic resonance imaging (83.8%) and biopsy (66.5%) were the most utilized diagnostic modalities over the past decade, with a statistically significant decline in the proportion of biopsies performed (66.5% during the past decade vs 84.9% in the previous 2 decades, P = .01). Over the past decade, nonsteroidal anti-inflammatory drugs (40.1%), disease-modifying antirheumatic drugs (27.1%), and tumor necrosis factor inhibitors (21.1%) were the most commonly used treatments, with a statistically disproportionate increase in the use of tumor necrosis factor inhibitors (21.1% during the past decade vs 3.8% in the previous 2 decades, P < .001). CONCLUSIONS: This is one of the largest CRMO cohort studies and the only study to observe changes in diagnostic modalities and treatment over a 30-year period. Future studies should assess the impact of variations in clinical presentation, time to diagnosis, diagnostic modalities, and management as predictors of disease outcomes.

Influence of Residency Training Program on Pursuit of Academic Career and Academic Productivity Among Oral and Maxillofacial Surgeons.

PURPOSE: The purpose of the study was to examine the impact of residency training institutions on the pursuit of a career in academic oral and maxillofacial surgery and assess variables associated with academic productivity. MATERIALS AND METHODS: This was a cross-sectional study of full-time academic oral and maxillofacial surgeons (OMSs) in the United States. The primary predictor variable was program of residency training. Secondary predictors included gender, fellowship training, advanced degrees, and private practice affiliation. The primary outcome variable was the number of graduates in a ful-time academic position. Academic productivity (h-index, publication number) was a secondary outcome. Descriptive, logistic and linear regression analyses were computed. RESULTS: The study sample consisted of 294 full-time academic OMSs in 82 training programs. The top 10 high-output residency programs were identified and graduates from these programs were more likely to have a medical degree (OR = 1.99, 9% CI: 1.17 - 3.36, p=0.0108), higher h-indices (11.03 vs 7.96, p = 0.0032) and higher number of publications (40.3 vs 25.6, p = 0.003). Faculty characteristics associated with higher h-indices included a medical degree (10.33 vs 7.66, p = 0.0067), PhD (15.23 vs 8.38, p = 0.0002), MPH (17.47 vs 8.66, p = 0.0040) and fellowship training (11.15 vs 7.76, p = 0.0012). There were no significant differences between genders in having a medical degree, completing a subspecialty fellowship, or academic productivity. Female surgeons represented 16.33% of academic OMSs and were more likely to have entered academia more recently based on duration in years of academic appointment (12.48 versus 21.08; p < 0.001). CONCLUSIONS: Ten programs have trained 29.6% (n = 87) of all full-time academic OMSs. These programs' graduates were more likely to have a medical degree, higher h-indices, and greater number of publications.

Assessment of global health programs at accredited dental schools in the United States.

PURPOSE: Oral diseases pose a serious global health challenge. As such, dental education must integrate global health with emphasis on scalable and sustainable solutions. The aim of our study was to capture the scope of global health programs offered to dental students in the United States and identify ways in which dental schools may modify their curricula to improve global health knowledge and accessibility for students. MATERIALS AND METHODS: For this cross-sectional, cohort study, the investigators sent a confidential and electronic survey to 213 faculty members at the 67 accredited dental schools in the United States. This voluntary survey was distributed in September and October of 2020 with answers being self-reported. RESULTS: A total of 40 different schools are represented in this study, representing 59.7% of accredited dental schools in the United States. Using descriptive statistics, the results present existing global health opportunities, barriers preventing schools from expanding global health education, and necessary resources that schools without a program need to establish one. CONCLUSION: Our results demonstrate promising findings, in relation to global health being a vital part of dental education. However, there is an urgent need for enhanced and more structured education in this space. As the global burden of oral disease contributes to the degree and severity of noncommunicable diseases worldwide, the development of a sustainable, preventive primary care approach must integrate oral health, making future dental professionals a crucial component of global health.