Bone Disorders - part II Flashcards
cemento-osseous dysplasia (COD) is malignant
false, benign
T/F: COD may be a reactive process
true
where may COD originate from?
fibroblasts of PDL vs. defect in bone remodeling
what is the most common fibro-osseous lesion encountered in clinical practice of dentistry?
COD
what are the 3 different types of COD?
- periapical COD
- focal COD
- florid osseous dysplasia
what is obtained at the time of surgery for COD?
multiple small gritty fragments
COD is commonly seen in who?
- black females
- east Asian females
- white females
focal type COD is reported to be more common in who?
white females
T/F: COD can affect both genders and any ethnic group
true
T/F: COD is usualyl found incidentally on x-ray
true
where does COD affect?
tooth-bearing areas of jaws
clinical features of COD
- asymptomatic
2. swelling, discomfort unusual
T/F: COD teeth test NON-vital
false, vital
COD ranges radiographically from?
from completely radiolucent to densely radiopaque with a thin radiolucent rim (PDL remains intact)
what does the florid osseous dysplasia show radiographically?
multiple “cotton wool” type radiopacities in at least 2 quadrants of the jaws
what might the florid osseous dysplasia seen radiographically be associated with?
simple bone cyst
severity of periapical COD
mild
severity of focal COD
moderate
severity of florid osseous dysplasia
severe
where does periapical COD typically affect?
mandibular anterior region usually, but maxillary anterior as well
who is especially affected by periapical COD?
middle-aged black females
how does periapical COD initially appears as?
initially unilocular radiolucencies at apices, central opacity develops gradually
T/F: COD is symptomatic
false, asymptomatic
what can perioapical COD be confused with?
- hypercementosis
- idiopathic osteosclerosis
- benign cementoblastoma
who does focal COD more often affects?
white females
where does focal COD affect?
body of mandible
how does focal COD appear radiographically?
unilocular radiolucency or radiopacity with thin radiolucent rim
T/F: focal COD is asymptomatic
true
what can focal COD be confused with?
- ossifying fibroma
2. a true neoplasm
who is most commonly affected by florid osseous dysplasia?
middle-age or older black females
T/F: usually only one quadrant of the jaw is affected by florid osseous dysplasia
false, multiple
florid osseous dysplasia is generally asymptomatic unless what?
overlying mucosa ulcerates resulting in bony sequestration (e.g. from ill’fitting denture)
T/F: dental implants are NOT recommended for pts with florid osseous dysplasia
true
florid osseous dysplasia lesions tend to be what?
hypovascular
hypovascular florid osseous dysplasia lesions are prone to what?
- necrosis
- infection
- osteomyelitis with minimal provocation
- reduced ability to heal
histopathologic features of COD
- cellular fibrous CT with embedded mineralize tissue resembling either immature (woven) bone or cellular cementum
- fragmented specimen
3.
what does the mineralized product of COD resemble histopathologically?
ginger root
T/F: mature COD lesions have more mineralized product than cellular stroma histopathologically
true
florid osseous dysplasia can show densely mineralized tissue with what histopathologically ?
necrotic debris and inflammation
diagnosis of COD is based on what?
clinical and radiographic features
what can be used to confirm the diagnosis of COD?
by bx if indicated
tx for periapical COD
none indicated
why might biopsy be indicated for focal COD?
to rule out other disease processes
T/F: bx is NOT necessary for florid osseous dysplasia
true
regular visits for dental prophylaxis and OHI is indicated to prevent what in COD pts?
to prevent perio disease and need for endo
T/F: COD pts should be encouraged to retain their teeth
true
ideally, why should surgical procedures should be avoided in COD pts?
onset of sysmptoms associated with exposure of sclerotic bone to oral cavity
T/F: management of symptomatic COD pts with secondary osteomyelitis is difficult
true
tx for management of symptomatic COD pts
- debridement
- abx (often not efffective)
- chlorhexidine rinse
prognosis for periapical and focal COD
excellent
T/F: the initial appearance of focal COD may be the first sign of florid OD
true
prognosis for florid osseous dysplasia
good
when would prognosis of COD be guarded?
if secondarily infected requiring debridement and ATB
T/F: malignant transformation of COD is rare
true
osteoporotic bone marrow defect
area of hematopoietic bone marrow of sufficient size to cause a radiographic radiolucency
what is the pathogenesis of osteoporotic bone marrow defect
unknown
what may osteoporotic bone marrow defect resemble?
metastatic disease
where does osteoporotic bone marrow defect usually occur?
- posterior body of mandible
2. often at old EXT site
who is usually affected by osteoporotic bone marrow defect?
middle-aged female
T/F: osteoporotic bone marrow defect is often found incidentally on radiographs
true
T/F: osteoporotic bone marrow defect is symptomatic
false, asymptomatic
radiolucency of osteoporotic bone marrow defect can appear circumscribed but may show what on closer inspection?
may show ill-defined borders and a fine trabecular pattern
histopathologic features of osteoporotic bone marrow defect
- fatty and hematopoietic marrow
2. no abnormal osteoblastic or osteoclastic activity
what is often indicated to establish diagnosis of osteoporotic bone marrow defect?
biopsy
prognosis of osteoporotic bone marrow defect
excellent
once osteoporotic bone marrow defect is diagnosed, what is needed?
no further tx needed
other terms for idiopathic osteosclerosis
- dense bone island
- enostosis
- bone whorl
- focal periapical osteopetrosis
- bone scar
idiopathic osteosclerosis
focally increased area of dense bone
what causes idiopathic osteosclerosis?
unknown
T/F: idiopathic osteosclerosis is usually found incidentally on radigraphs
true
T/F: idiopathic osteosclerosis has a male predilection
false, NO gender predilection
when does most idiopathic osteosclerosis arise?
most arise late 1st to early 2nd decade, peak prevalence in 3rd decade
T/F: idiopathic osteosclerosis occasionally regresses
true
when does idiopathic osteosclerosis usually stabilize?
at skeletal maturity
clinical features of idiopathic osteosclerosis
- asymptomatic
- no expansion
- remain static or slow enlarge
radiographic features of idiopathic osteosclerosis
- radiopaque
2. borders blend with surrounding trabeculae, but occasionally may be sharp
where is the most common site for idiopathic osteosclerosis
mandibular pre-molar/molar area
T/F: in the past, idiopathic osteosclerosis was not distinguished from inflammatory or other lesions
true
what may idiopathic osteosclerosis be confused with?
- condensing osteitis
- hypercementosis
- cementoblastoma
histopathologic features of idiopathic osteosclerosis
- dense vital bone
2. may see fibrofatty marrow
tx for idiopathic osteosclerosis
none indicated unless symptoms or cortical expansion
if idiopathic osteosclerosis is noted in childhood, what should be done?
periodic radiographs until lesion stabilized
what is needed in order to establish diagnosis of idiopathic osteosclerosis?
biopsy
prognosis of idiopathic osteosclerosis
excellent
other terms for simple bone cyst
- traumatic bone cyst
2. hemorrhagic bone cyst
simple bone cyst
empty or fluid-filled bone cavity
why is simple bone cyst not a true cyst?
lacks an epithelial lining thus is a pseudocyst
T/F: simple bone cyst is usually an incidental finding
true
etiology of simple bone cyst
unknown
trauma-hemorrhage theory of simple bone cyst
trauma causing hematoma but not fracture and without subsequent organization and repair of hematoma, liquefies instead
T/F: simple bone cyst is related to trauma
nah, questionable
who is affected by simple bone cyst?
seen in 1st and 2nd decade
what is the gender predilection of simple bone cyst in jaws?
no gender predilection
what is the gender predilection of simple bone cyst in other bones?
male predilection
where does simple bone cyst typically occur?
- posterior mandible
2. symphysis
clinical features of simple bone cyst
- typically painless
2. no expansion, but possible
radiographic features of simple bone cyst
- well-delineated
- unilocular but can be multilocular
- often scallops between roots
T/F: it is difficult to obtain specimen of simple bone cyst
true, usually just fragments of bone
histopathologic features of simple bone cyst
- bone fragments are lined by inflamed granulation tissue
2. no epithelial lining
tx of simple bone cyst
surgical exploration and curettage to induce bleeding (an empty cavity within bone is found at time of surgery)
why would hemorrhage be indicated for tx of simple bone cyst?
hemorrhage organizes and lesion heals
how many months after surgery of simple bone cyst does radiogrpahic findings become normal?
~12-17 months
when is periodic radiographs of simple bone cyst warranted?
until complete resolution
T/F: recurrence rate is low for simple bone cyst
true
