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DMD3 > Bone Diseases > Flashcards

Bone Diseases Flashcards

1
Q

How common are tori?

A

2 - 10% of adults have them.

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2
Q

What are tori and exostoses?

A

Exophytic, hard, uninodular or multinodular bony masses covered by mucosa

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3
Q

What are the clinical features of tori and exostoses?

A

Torus palatinus and torus mandibularis on the
midline of palate and lingual mandible (usually
bilateral and symmetric)

Often site of bisphosphonate-associated
osteonecrosis

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4
Q

How common are exostoses?

A

27% of adults have them

Males have them more often than females 5:1 ratio

More than 90% having of people with exostoses have concurrent tori

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5
Q

What are exostoses?

A

Outgrowths of bone that are nodular or sessile
frequently on buccal aspects of mandible and
maxilla or ascending arch of the palate

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6
Q

What causes tori and exostoses?

A

Chronic irritation

Periosteal proliferation

Bone formation

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7
Q

Is a biopsy needed for tori and exostoses?

A

Only needed if there is radiographic change over time.

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8
Q

What are the differential diagnoses for tori and exostoses?

A

Condensing osteitis

True osteomas

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9
Q

What is condensing osteitis? (Not examinable)

A

Similar to idiopathic osteosclerosis but is found very close to the apices of teeth and is likely reactive to chronic occlusal trauma
or low-grade inflammation or odontogenic infection.

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10
Q

What are True osteomas? (Not examinable)

A

True osteomas are associated with Gardner syndrome
(autosomal dominant condition associated with
mutation in the APC gene and development of colonic
polyps and carcinoma, desmoid tumors, supernumerary
teeth, and skin cysts).

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11
Q

What is osteomyelitis?

A

inflammatory condition of the
bone, which begins as an infection of the
medullary cavity, rapidly involves the
haversian systems, and extends to involve
the periosteum of the affected area

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12
Q

How common is osteomyelitis?

A

Only 2 out of every 10,000 people get osteomyelitis

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13
Q

What are the predisposing factors to osteomyelitis?

A

Diabetes (most cases of osteomyelitis stem from diabetes)

Sickle cell disease

HIV or AIDS

Rheumatoid arthritis

Intravenous drug use

Alcoholism

Long-term use of steroids

Hemodialysis

Poor blood supply

Recent injury

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14
Q

What are potential sources of infection?

A
  1. Periapical infection
  2. Periodontal pocket’s
  3. Acute gingivitis
  4. Penetrating and contaminated injuries
  5. Tooth extraction
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15
Q

What are the signs and symptoms of osteomyelitis?

A

Fever, irritability, fatigue

Nausea

Tenderness, redness, and warmth in the area
of the infection

Swelling around the affected bone

Lost range of motion

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16
Q

How is osteomyelitis classified based on the Hjorting-Hansen E method?

A

Acute osteomyelitis is mainly in children

Chronic osteomyelitis is classified into primary and secondary osteomyelitis. Primary = non-suppurative, secondary = suppurative

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17
Q

When does osteomyelitis become chronic?

A

After 4 weeks.

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18
Q

What happens to the bone during osteomyelitis?

A

Inflammation causes thrombosis of vessels in the bone marrow and suppuration causes peri-osteal stripping due to pus accumulation. Bone and marrow undergo necrosis.

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19
Q

What is alveolar osteitis?

A 
Localized inflammation of
bone following either failure
of blood clot to form in
socket, or premature loss or
disintegration of clot.

This is dry socket which is an unpredictable complication of tooth extraction.

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20
Q

What causes alveolar osteitis?

A 
Failure of blood clot
formation due to Poor
blood supply as in:
. Paget’s disease.
. Osteopetrosis.
. Following radiotherapy.
. Excessive use of vasoconstrictor
in local anesthesia.
Premature loss of blood
clot may be due to:
. Excessive mouth rinsing.
. Fibrinolysis by
proteolytic bacteria.
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21
Q

What are the clinical featurs of alveolar osteitis?

A
  1. Intense pain
  2. Most frequently seen in:
    - 3rd molar extraction
    - Difficult extraction with trauma
    - Smoker .
  3. tooth socket appears empty and dry
  4. jaw bone is visible in the tooth socket
  5. Bad breath and Unpleasant taste .
  6. Swollen of regional lymph node .
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22
Q

What are the histopathological features of alveolar osteitis?

A

Histological section of socket wall reveal formation of necrotic bone containing empty lacunae

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23
Q

What are the types of osteonecrosis?

A

Osteoradionecrosis

Osteochemonecrosis: Medication induced (bisphosphonates), phosphorous necrosis of the jaw (exposure to white phosphorus)

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24
Q

How does radiotherapy lead to osteonecrosis?

A

Radiation -> Hypoxia/hypocellular/hypovascular -> Superinfection/chronic nonhealing wound caused by trauma

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25
Q

Why are bisphosphonates used?

A

Can be for:

Osteoporosis

Multiple myeloma

Metastatic cancer

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26
Q

Why do bisphosphonates cause osteonecrosis?

A

Apoptosis -> Inhibition of release of BMP, ILG1, ILG2 (important for remodelling) -> Reduced bone turnover/resorption -> Reduced serum calcium -> Hypermineralization (sclerotic changes in lamina dura of alveolar bone)

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27
Q

Where is central giant cell granuloma most common?

A

A non-neoplastic, reactive lesion seen in all age groups.

Affecting females more than males

In the anerior mandible (70%)

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28
Q

What are the symptoms of a central giant cell granuloma?

A

Painless expansion

Radiograph: Unilocular to multilocular radiolucency and can be between 0.5 - 10cm large

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29
Q

What are the histological features of a central giant cell granuloma?

A

Multinucleated giant
cells

Spindled stroma

Erythrocyte extravasation

Hemosiderin deposits

Fibrosis

Osteoid formation

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30
Q

How is Central Giant Cell Granuloma treated?

A

Curettage

intra-lesional steroids

Calcitonin

Interferon alpha 2a

Resection

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31
Q

What are the differential diagnoses of a central giant cell granuloma?

A

Central giant cell granuloma

Brown tumor –hyperparathyroidism

Aneurysmal bone cyst

Cherubism

Giant cell tumor

Benign fibro-osseous lesion

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32
Q

What are the potential prognoses of a central giant cell granuloma?

A

It can be aggressive or non aggressive

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33
Q

What is the recurrence rate of a central giant cell granuloma?

A

15 - 20%

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34
Q

What is a cyst?

A

A cyst is a pathological cavity filled with fluid, semi-fluid or gaseous contents and is
not created by an accumulation of pus.

35
Q

What causes a cyst?

A

Epithelial proliferation + hydrostatic/osmotic factors

Keratin formation

Bone resorption (Prostaglandins and collagenase)

36
Q

What are the typical clinical features of a cyst?

A

Noticeable swelling

Discharge into the mouth

Pain due to a secondary infection

37
Q

How is a cyst diagnosed?

A

Combination of adequate history, clinical examination, and selected investigations need to be completed.

38
Q

Which odontogenic cysts are most common?

A

Odontogenic cysts are more common than non-odontogenic cysts and are divided into:

Radicular (60 - 75%)

Dentigerous (10 - 15%)

Keratocyst (5 - 10%)

Paradental (3 - 5%)

gingival and lateral periodontal cysts form <1% of all cysts

39
Q

What are the types of radicular cysts?

A

Periapical

Lateral

Residual

40
Q

What are the clinical features of radicular cysts?

A

Affects non-vital teeth

Upper lateral incisor most commonly affected

Rare in deciduous teeth

Asymptomatic on expansion -> springy -> egg shell crackling -> fluctuation

Infection results in pain

41
Q

Which patients most commonly get radicular cysts?

A

Peak in 4th and 5th decades

Most common radicular cysts and makes up 60 -75% of all jaw cysts

42
Q

What do radicular cysts look like on radiograph?

A

Often monolocular

Well defined out line and well corticated.

Has uniform radiolucency

43
Q

How do radicular cysts occur?

A

Initiated by cell rest of malassez being activated by the products of necrotic pulps.

The central cells degenerate and die and this leads to cavitation and cyst formation.

The cysts then enlarge due to osmolality of the inside of the cyst increasing as the breakdown products get smaller and more osmotically active and this leads to the wall becoming a semi-permeable membrane

44
Q

What is contained within a radicular cyst?

A

Breakdown products of cells

Serum proteins

Water and electrolytes

Cholesterol crystals

45
Q

What are the histological features of a radicular cyst?

A

Periapical granuloma with epithelial proliferation -
polymorphs in epithelium

Cyst lined by irregular, non-keratinised stratified
squamous epithelium

Foam cells, lymphocytes, plasma cells, cholesterol
clefts, surrounding fibrosis

Lining becomes thinner and less inflamed

10% contain hyaline (Rushton) bodies

46
Q

What kind of cyst is a dentigerous cyst?

A

It is an odontogenic, developmental cyst

47
Q

What is a dentigerous cyst?

A

A cyst enclosing the crown of an unerupted tooth it is a cyst of the follicle and is usually attached to the cementoenamel junction

48
Q

What causes a dentigerous cyst?

A

Intrafollicular fluid begins to accumulate between the enamel and the reduced enamel epithelium. Pressure of the tooth on the impacted follicle leads to obstruction of venous outflow, serum transudation, and exudation)

49
Q

Who is most commonly affected by dentigerous cysts?

A

Children and young adults (permanent teeth are usually affected)

M:F 1.6:1

50
Q

Which teeth are most commonly affected by a dentigerous cyst?

A

Permanent teeth; upper canine and lower 3rd molars

51
Q

What are the clinical features of a dentigerous cyst?

A

Painless enlargement

Tilting of tooth

Root resorption

52
Q

What are the histopathological features of dentigerous cysts?

A

Clear yellow fluid

Purulent if infected

Lined by flattened, non-keratinized stratified squamous epithelium

Continuous with the reduced enamel epithelium

Mucous and ciliated columnar metaplasia

Fibrous wall with variable inflammation

53
Q

What is an eruption cyst?

A

An extra-alveolar dentigerous cyst affecting deciduous teeth and permanent molar

54
Q

What do eruption cysts look like?

A

Causes fluctuant bluish swelling

Haemorrhage into the cyst is common

55
Q

What is the prognosis if an eruption cyst?

A

Most spontaneously resolve especially if marsupialized

56
Q

Where are odontogenic keratocysts typically located?

A

Usually present on the mandible (70 - 80%) on the ramus/angle of the mandible (50%)

57
Q

How common are odontogenic keratocysts? Who most commonly gets them?

A

5 - 10% of all cysts

M>F

58
Q

What are the clinical features of an odontogenic keratocyst?

A

Mostly on the mandible especially on the ramus/angle

Often asymptomatic

Can cause swelling, discharge, pain, pathological fracture, tooth displacement, and rarely can lead to buccal expansion.

Has a high recurrence rate

59
Q

What are the developmental origins of the odontogenic keratocyst?

A

Derived from the dental lamina or it’s remnants (cell rests of Serres)

Originates from the enamel organ (tooth primordium) of a tooth before hard tissues develop (normal tooth or supernumerary teeth can cause this)

60
Q

What are the radiographic features of an odontogenic keratocyst?

A

Well demarcated radiolucency

Pseudolocular or multilocular, often with scalloped periphery

Root or tooth displacement

61
Q

What are the histopathological features of an odontogenic keratocyst?

A

Regular stratified squamous epithelium

Thin epithelial later (5 - 8 cells thick)

Palisaded basal layer

Corrugated surface which can be parakeratnised or orthokeratinised

Thin, friable fibrous capsule - little inflammation

Satellite (daughter) cysts

62
Q

How do odontogenic keratocysts enlarge?

A

Cancellous enlargement antero-posteriorly

Little or no bucco-lingual expansion -> Large, especially in angle and ramus of the mandible

63
Q

How common is recurrence in odontogenic keratocysts?

A

Up to 60% recurrence rate

64
Q

How do odontogenic keratocysts recur?

A

They have a large size and an infiltrative nature

They tend to form multiple minicysts and satellite cysts

65
Q

Why do odontogenic keratocysts recur so often?

A

They have intinsic growth potential, form multiples of themselves, and satellite cysts.

In people with Gorlin-Goltz they recur spontaneously

66
Q

What are the features of Gorlin-Goltz syndrome?

A

Multiple keratocysts

Multiple basal cell naevi (carcinomas)

Skeletal abnormalities (bifid ribs, spine defects)

Frontal bossing (large forehead growth) and hypertelorism (Large distance between the eyes)

Calcification of the falx cerebri

67
Q

What are the types of non-odontogenic developmental cysts?

A

Nasopalatine duct cysts

Nasolabial cyst

68
Q

What is a naso-palatine cyst?

A

An incisive canal cyst formed by the remnants of the nasopalatine duct

69
Q

Who most commonly gets a naso-palatine duct cyst?

A

M:F 4:1

30 - 60 years of age

70
Q

What are the clinical features of a naso-palatine duct cyst?

A

Swilling of the midline of the palate

Pain and discharge (mucoid and salty)

71
Q

What is a nasolabial cyst?

A

Bilateral swelling in the nasolabial fold below alae and leading to loss of the fold

72
Q

What do nasolabial cysts result in?

A

Swelling, pain, and difficulty with nasal breathing

73
Q

What does a simple bone cyst look like clinically?

A

Empty intra-osseus bone cavity

Usually asymptomatic (painless swelling)

74
Q

What causes simple bone cysts?

A

Uncertain, thought to be caused by trauma which leads to intra-medullary haemorrhage

75
Q

Which people most commonly have simple bone cysts?

A

10 - 20 years of age

Male > females

76
Q

Where are simple bone cysts seen on the face?

A

Mandibular body (molar-premolar)

77
Q

What does a simple bone cyst look like on radiology?

A

Often seen incidentally.

1 - 10cm radiolucency that can be well or ill defined.

Scalloping seen between tooth roots of vital teeth

No root resorption often seen

78
Q

What are the typical surgical findings of a simple bone cyst?

A

Aspiration - serosanguinous fluid

Empty bone cavity

Smooth bone walls

Scant fibrous tissue

79
Q

What are the histological findings of a simple bone cyst?

A

Cortical bone cap

Bone resorption - remodeling

Membranous fibrovascular tissue

Fibrin - hemorrhage

No epithelial lining

80
Q

How is a simple bone cyst treated?

A

Surgical exploration

Stimulate haemorrhage into the defect to stimulate rapid spontaneous healing.

81
Q

What is the prognosis of a simple bone cyst?

A

Prognosis is excellent and recurrence is rare.

Following up the patient is important.

Associated with fibro-osseus lesions

82
Q

What is stafne’s bone defect?

A

Static bone cavity of the mandible or lingual salivary gland inclusion defect

83
Q

How common and who commonly gets stafne’s cysts?

A

Middle-aged men typically. Prevalence of this condition is estimated to be around 0.1 - 0.48%

84
Q

What is the differential diagnosis of stafne’s cyst?

A

Other radiolucent lesions of the jaws

DMD3 (53 decks)

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