The mammalian target of rapamycin (mTOR) inhibitor sirolimus is effective in reducing incidence of graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT). Agents that inhibit the mTOR pathway are known to be associated with significant and potentially dose-limiting toxicities, including stomatitis. The objective of this study was to report the clinical features and management outcomes of sirolimus-associated oral ulcers in the context of post-HSCT prophylaxis of GVHD. Seventeen patients, from a study cohort of 967, who were treated with sirolimus as prophylaxis for GVHD after allogeneic HSCT at the Dana-Farber/Brigham and Women's Cancer Center developed oral ulcers and were referred to the oral medicine clinic for evaluation and treatment over a period of 6 years. Clinical characteristics (appearance, anatomic site, size) and therapeutic outcomes (time to complete resolution) were documented. Median time to onset of oral ulceration was 55 days after allogeneic HSCT (range, 6 to 387 days); 92.9% of ulcers were located on nonkeratinized mucosa, with the ventrolateral tongue the most common site of involvement. Thirteen patients were treated with topical corticosteroid therapy; 12 of these patients also required intralesional corticosteroid injections. Clinical improvement (resolution of the lesions and improvement of symptoms) was noted in all cases, with no reported adverse events. Median time to complete resolution after onset of therapy was 14 days (range, 2 to 70 days). Patients receiving sirolimus for GVHD prophylaxis may develop painful oral ulcerations, which can be effectively managed with topical steroid treatment. Further prospective studies are needed to better elucidate the incidence of this complication, identify risk factors, and evaluate the effectiveness of interventions.
Background
Medication-related osteonecrosis of the jaw (MRONJ) is a complication affecting patients who are being treated with antiresorptive or antiangiogenic medication. These patients require meticulous treatment planning and management strategies. This research aimed to assess the knowledge of dental practitioners and students in their professional years regarding MRONJ.
Methods
A cross-sectional study was conducted among 345 dental practitioners and students in their professional years of both genders, in governmental and private dental schools. The data was collected using an electronic and paper-based self-administered structured questionnaire with six sections. The data was entered and analyzed using SPSS Version 23, and a P-value <0.05 was considered significant. A Chi-square test was used to compare the categorical variables.
Results
Though more than half of the sample 68% received information about antiresorptive and antiangiogenic drugs during their studies, the level of knowledge was low. The primary diseases targeted by antiresorptive and antiangiogenic medications were not known by the majority of the sample. Almost half of the sample could not identify any antiresorptive or antiangiogenic medication and only 28.1% knew the correct definition of MRONJ.
Conclusion
The level of knowledge regarding MRONJ is a concern, necessitating more educational courses and workshops.
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