bone and joints Flashcards
Name the different types of bone
- Woven
- Cortical
- Cancellous
What is cortical bone also known as
Compact or lamellae
What does cortical bone make up
Forms the shaft of long bones
Outlier or covering of flat bones
What is cortical bone made up of
Rings of typ 1 collagen
What is cancellous bone also known as
Trabecular
What is cancellous bone also known as
Trabecular
Where is cancellous bone found
Found inside flat bones and at the end of long bones
What is cancellous bone made up of
Network of non collagen proteins
Where does woven bone form
In early years of non development and at fracture sites
What is woven bone made up of
It is disorganised nd made up of bone mineral
Name the cells involved with bone
- Osteoblasts
- Osteoclasts
- Osteocytes
What are osteoblasts derived from
Local mesenchymal stem cells
What do osteocytes do
Regulate mineralisation and bone resorption
Synthesis collagen matrix
What do osteoblast do
Activate bone formation
What do osteoclasts do
Resorb bone
List teh stages of bone healing following fracture
1, Cellular stage
2. Vascular stage
3. Primary callus
4. Bony callus
5. Mature callus
Give examples of genetic bone diseases
- Osteogenesis imperfecta
- Cleidocranial dysplasia
- Osteopetrosis
What is Osteogenesis imperfecta due to
It is an autosomal dominant condition that leads to collagen defects
List some characteristic presentation of Osteogenesis imperfecta
- Blue sclera
- Deafness
- Bruising easily
- Loose joints/ tendons
- +/- Cardiac complications
- Fracture easily
What is Osteogenesis imperfecta also known as
Brittle bone disesse
What is Osteogenesis imperfecta also known as
Brittle bone disesse
As a dentist what consideration should you make if a patient has Osteogenesis imperfecta
- Take care with extractions due to fracture risk
- GA risk - chest deformity and cardiac issues
- Teeth may be brown/purple or worn
- Soft dentine
What is cleidocranial dysplasia due to
Autosomal dominant condition that is rare and mainly involves the skull and clavicle
List some clinical signs of cleidocranial dysplasia
- Clavicles absent or defective
- Brachycepalic (broad short skull)
- Hypoplastic midface= mandibular protrusion
- +/- Clefts
- Other skeletal defects
List some dental features of cleidocranial dysplasia
- Hyperdontia
- Supernumeraries
- Retained deciduous dentition
- Abnormalities with dentition
What is osteopetrosis also known as
Albers schonberg disease
What is osteopetrosis due to
A rare disorder leading to a defect in osteoclastic activity and bone remodelling leading to excessive bone density
What are some clinical signs of osteopetrosis
- Often no symptoms
- Incidental finding on a radiograph following pt complaining of ‘bone pain’
- Patient may be anaemic or susceptible to infections
List some dental signs of osteopetrosis
- Fractures of the jaw/ osteomyelitis
- Difficulty in irradiating infection
Give examples of acquired bone Disorders
- Rickets/ osteomalacia
- Osteoporosis
- Fibrous dysplasia
- Pagets disease
- primary Hyperparathyroidism
- secondary Hyperparathyroidism
What is rickets
A childhood disease leading o inadequate skeletal mineralisation due to lack of vitamin D or calcium
What is teh treatment fro rickets
Vitamin supplements and dietary advice
What is osteoporosis
A disease lading to diminished bone mass and low bone density which causes fragile bones
What factors can effect or increase the risk of osteoporosis
- Calcium intake
- Reproductive hormones
- Parathyroid gland
- physical activity
Is osteoporosis more common in men or women
Women over the age of 50 (post menopausal)
What are the symptoms of osteoporosis
- Usually asymptotic in early stages
- Back pain
- Reduced height
- Stooped posture
- Unexpected fractures
What is teh treatment for osteoporosis
- Hormone replacement
- Bisphosphoantes
- PTH
- Floride
- Vitamin D Supplements
- Calcitonin
- Exercise
What is fibrous dysplasia
A benign chronic fibro osseous lesion frequently found in the craniofacial region
Scar like tissue grows in the place of normal bone
What is pagets disease
A common disorder that causes changes int eh balance of remodelling of bone
What might a patient with pagets disease complain of
- Bone pain
- Fractures
- Hearing loss
What is teh treatment fro pagets disease
bisphosphonates
calcitonin for pain relief
What dental considerations should we make if we treat a patient with pagets disease
- Enlargement of maxilla seen
- Bulging in the zygomatic area
- Hypercementosis of teeth sometimes
- PT may have an increased risk of bleeding or osteomyelitis post surgery
Which body system regulates blood calcium
The parathyroid and vitamin D levels
What are teh parathyroids
4 small glands foudn on teh posterior aspect of the thyroid glands
What happens when there is a low calcium level in the blood
The parathyroid releases calcitonin which increases the resorption of calcium from the gut and promotes osteoclastic bone resorptions
This increases calcium levels int eh blood
List some of the signs and symptoms of primary hyperparathyroidism
- 50% asymptomatic
- Hypercalcaemia
- Bone pain
- Pathological fracture
- Giant cell tumours
- Peptic ulcers
- Pancreatitis
- Local swelling in teh mandible
What is hyperparathyroidism caused by
Usually a single parathyroid adenoma that can be removed as treatment
What is secondary hyperparathyroidism ALSO known as
Parathyroid hyperplasia
What is secondary hyperparathroyism caused by
Due to a response to persistently low calcium levels
may be due to chronic renal failure or malabsorption
Give examples of joints disorders
- Marfarns
- Ehlers-danlos
- Recurrent TMJ dislocation
What is marinas syndrome
An autosomal dominent connective tissue disorder
How might marinas syndrome present
Long/tall thin body
huge arm span
Name the 3 key areas that are defected in Marfan syndrome
- Skeletal
- Cardiovascular
- Neuro-ocular
list the key features of marfins
Mitral valve prolapse
Aortic dissection
Retinal detachment
Fibrillin 1 mutation
Arachnodactyly (long spider like fingers)
Near sighted
Scoliosis
What is Ehlers dances syndrome
A group of rare disorders fo collagen formation
It is an autosomal dominant condition
List some of the characteristic features of Ehlers dances syndrome
- Hyperextensible skin
- Bruise
- Loose joints
- Recurrent spontaneous dislocations
- Poor healing
What are some issues associated with ehlers danlos syndrome
- Mitral valve prolapse
- Haematological issues- bleeding
- TMJ
- Short teeth/ abnormal roots/ pulp stones
- Micrognathia
- AOB
- Gingival hyperplasia
Give examples of arthritides
- Osteoarthritis
- Rheumatoid arthritis
- Felty sun
- Juvenile arthritis
- Ankyosing spondylitis
- Infective arthritis
- Gout
what Is osteoarthritis
Degenerations of articular cartilage and proliferation of new bone, cartilage and CT
What might patents complain of if they have osteoarthritis
Pain stiffness and swelling in weight baring joints
more common in women
What is the management of osteoarthritis
Analgesia
Joint replacement
What is a key difference between osteoarthritis and rheumatoid arthritis
Osteoarthritis does not have any systemic symptoms whereas rheumatoid arthritis does
What is rheumatoid arthritis
Most commonest form of chronic inflammatory joint disease leadign to symmetrical destruction
more common in women
List some of the clinical features of rheumatoid arthritis
- Stiffness of hands/feet
- Usually worse in the morning
- Redness, tenderness and swelling over joints if acute
- Ulnar deviation usually symmetrical
- Increased disability in teh wrists, elbows, ankles and knees
- C spine involvement
List the radiographic features of rheumatoid arthritis
Initially widening of joint space followed by narrowing erosion and destruction
What is the management for rheumatoid arthritis
- Supportive measures
- Analgesics
- Corticosteroids into joint space
- DMARDs and biologic agens
What dental issues may be seen in patients with rheumatoid arthrits
- Often associated with sjogrens syndrome
- Some changes on an OPT within TMJ
- Increased risk of bleeding, infection and mRONJ due to medication
What is felty syndrome
Patients with rheumatoid arthritis, splenomegaly and neutropenia (it is very rare)
List the different types of juvenile arthritis
- Systemic
- Polyarticular
- Pauciarticular
Who is more commonly affected by juvenile arthritis
Girls in their late childhood
What is juvenile arthritis assicted with
Fever
Nodules
Malaise
Anaemia
What is ankylosing spondylitis
A form of chronic inflammatory arthritis that affects the sacroiliac and spinal joints
Mainly seen young males
What can ankylosing spondylitis cause overtime
Fusion of vertebrae
What issues can ankylosing spondylitiscauwe
Back pain
Stiffness
Eye lesions
Cardiac disease
How is ankylosing spondylitis trearted
Physiotherapy
Exercises
NSAIDS
How is ankylosing spondylitis trearted
Physiotherapy
Exercises
NSAIDS
What is gout
A form of chronic inflammatory arthritis where crystals of monosodium urate monohydrate form in teh joints
What can build up of monosodium urate monohydrate crystals int eh joint cause
- Inflammtory arthritits
- Tenosynovitis
- Bursitis or cellulitis
- Tophaceous deposits
- Urolithiasis
- Renal disease
What can build up of monosodium urate monohydrate crystals int eh joint cause
- Inflammtory arthritits
- Tenosynovitis
- Bursitis or cellulitis
- Tophaceous deposits
- Urolithiasis
- Renal disease
What is gout caused by
High uric acid from breakdown of purines
High blood pressure, diabetes and obesity
What is the treatment for gout
NSAIDS
Allopurinol
