Jay Saepoo

Heterotopic hair in the oral cavity is a rare condition, with possible etiologies including prior skin graft reconstruction, oral and maxillofacial trauma, or, in some clinical context, no identifiable cause. We report a case of a patient with trichotillomania who presented with a persistent sinus track opening between teeth #9 and #10 and a well-defined periradicular lesion in the area. Microscopically, it revealed a partially lined cyst-like entity containing terminal hairs, associated with a foreign body-type giant cell reaction. The patient admitted to a habit of repeatedly pulling and plucking her hair, placing it in her mouth, and occasionally pressing it against the area of concern. To our knowledge, this is the first reported case of an intraosseous hair-induced cyst-like entity with foreign body reaction in the anterior maxilla associated with trichotillomania.

Objectives: This study aimed to assess the prevalence, purposes, and clinical outcomes of off‐label gabapentin prescriptions, and to identify potential risks of gabapentin misuse.Methods: A retrospective cohort study was conducted from January 2014 to December 2022 at a single‐referral dental hospital. The study reviewed demographic data, clinical information, outcomes, side effects, and co‐prescribed drugs, utilizing statistical analyses to address objectives.Results: Among 1365 patients, 87 received gabapentin, representing about 6.37% of off‐label prescriptions. Trigeminal neuralgia (TN) was the most common indication (52.87%), often chosen as the clinician's first choice (51.72%), followed by use as an interim medication pending HLA‐B*15:02 results (14.94%). Nortriptyline was frequently co‐prescribed. Overall, gabapentin was prescribed at a mean dosage of 726.44 ± 42.87 (SE) mg per day, with a common dose range of 300–900 mg/day. Patients with TN and other neuropathies/facial pain experienced significant pain reduction from baseline (mean difference = −4.73 ± 0.77, p < 0.0001, and −3.06 ± 0.91, p = 0.0036, respectively). However, only 5 patients achieved a full response (NRS = 0) to gabapentin. Six patients (0.44%; 6 out of 1365 patients) received off‐label gabapentin without clinical diagnosis or treatment records, possibly indicating misuse.Conclusions: Off‐label gabapentin use was prevalent, especially in cases of TN. Despite significant pain reduction observed, only a small number of patients achieved pain‐free periods with their neuropathic pain condition. Therefore, optimal dosing is advisable. Off‐label gabapentin use also benefits patients as an interim medication while waiting for carbamazepine‐related gene screening in the Thai population and as a main drug therapy for HLA‐B*15:02 gene‐positive patients. Given the high prevalence of off‐label use and its potential to interact and enhance centrally mediated effects with other drugs, pre‐screening could aid in identifying potential risks of misuse and abuse.

Purpose This scoping review aimed to identify factors associated with the recurrence of ameloblastoma. Methods Systematic searches were conducted in PubMed, Scopus, and EMBASE, based on the board research question: “What factors are related to the recurrence of ameloblastoma?”. English-language observational studies addressing the risk and preventive factors associated with recurrent ameloblastoma were included and data were extracted. Results Eighty-three retrospective observational studies met the inclusion criteria. The identified prognostic factors for recurrence included: (1) Tumor size/diameter/volume, (2) cortical bone perforation/ soft tissue invasion, (3) multilocular radiolucency, (4) impacted tooth–involving lesions, (5) root resorption, (6) WHO classification – conventional (solid/multicystic) ameloblastoma, (7) histological subtype – mural invasion of unicystic ameloblastoma, (8) conservative treatment modalities – simple enucleation, curettage, and marsupialization, and (9) non-extraction/preservation of involved teeth. No strong evidence linked immunohistochemical expression to recurrence. Interestingly, BRAF p.V600E remained controversial in terms of recurrence, despite being a frequent finding in ameloblastoma. Conclusion Certain clinical characteristics, radiographic findings, histological subtypes, and treatment choices of ameloblastoma can help identify patients at high risk of recurrence. Further prospective studies to evaluate the prognostic factor model and research on immunohistochemistry are required.

Background: Oral candidiasis occasionally occurs in patients with oral lichen planus (OLP) or lichenoid reaction (OLR). However, not all patients undergoing corticosteroid therapy develop Candida superinfection. Thus, the identification of prognostic risk factors may help to identify patients at risk of Candida superinfection.Methods: A retrospective cohort study was conducted to review patients with OLP/OLR who received steroid therapy at a single dental hospital between January 2016 and December 2021. The prevalence of Candida superinfection and prognostic factors were assessed.Results: Eighty‐two eligible patients with OLP/OLR were retrospectively reviewed. The overall prevalence of Candida superinfection during the study period was 35.37%; the median time‐to‐event between initiation of corticosteroid therapy and diagnosis of superinfection was 60 days (interquartile range; 34–296). The ulcerative type of OLP/OLR, number of topical steroid applications, poor oral hygiene, and oral dryness were significantly associated with superinfection (p < 0.05; Fisher's Exact test) and were identified as prognostic factors in univariable risk ratio regression. Multivariable risk ratio regression revealed the ulcerative type of OLP/OLR and number of topical steroid applications were significant prognostic factors for Candida superinfection in patients with OLP/OLR.Conclusion: Candida superinfection occurs in approximately one‐third of patients with OLP/OLR undergoing corticosteroid therapy. Patients with OLP/OLR should be closely monitored in the first 2 months (60 days; median time to infection) after steroid prescription. The ulcerative type of OLP/OLR and a higher number of topical steroid applications per day may represent prognostic factors to identify patients at risk of Candida superinfection.

Objectives: To determine the factors associated with public hospital dentists’ awareness of HLA‐B*15:02 screening in trigeminal neuralgia (TN) and the national gene screening policy in Thailand.Methods: Cross‐sectional study. A validated questionnaire was distributed to public hospital dentists with at least 1 year of practice in Southern Thailand (n = 760) to assess their knowledge of TN, carbamazepine (CBZ) use, awareness of HLA‐B*15:02 screening, and the gene screening policy.Results: A total of 385 dentists participated (50.7% response rate); 81.3% of respondents were aware of HLA‐B*15:02 screening. However, 18.7% of dentists were not aware of the importance of gene testing. Furthermore, dentists who were aware of gene screening had significantly better knowledge of TN diagnosis and CBZ use than “unaware” dentists. Awareness of HLA‐B*15:02 screening was also significantly associated with dental specialty. Moreover, 80.5% of respondents were not aware of the gene screening policy. The primary problems related to the policy were its inefficient publication, poor implementation, and lack of clinical practice guidelines (CPGs) to encourage dentists to follow the policy and prescribe gene tests.Conclusion: While most hospital dentists were aware of the necessity of HLA‐B*15:02 screening prior to prescribing CBZ in TN, the majority were unaware of the national gene screening policy. Dental specialty and knowledge were associated with awareness of HLA‐B*15:02 screening.