Bone Pathology

Question 1

What is compact bone?

Answer 1

Mature cortical lamellar bone
- osteons around central harvesian canal

Question 2

What induces bone remodelling?

Answer 2

Mechanical stimuli

Systemic hormones
- parathyroid hormone
- Vit D3
- oestrogen

Cytokines

Question 3

Give some developmental abnormalities of bone

Answer 3

Osteogenesis imperfecta

Achondroplasia
- poor endochondrial ossification
- Tyrion Lannister

Osteopetrosis
- lack of osteoclast activity
- marrow obliteration

Question 4

What is fibrous dysplasia?

Answer 4

Genetic disorder with slow growing asymptomatic bony swelling
- bone replaced by fibrous tissue

Monostotic - one bone

Polyostotic - multiple bones

Question 5

Presentations of fibrous dysplasia

Answer 5

Cotton wool / orange peel on radiograph

Unilateral swelling / asymmetry clinically

Bony swellings intra orally

Question 6

What is rareifying osteitis?

Answer 6

Localised loss of bone in response to inflammation
- always a secondary to primary pathology

• if near apex of tooth - look for pulpal / apical diagnoses

Question 7

What is sclerosing osteitis?

Answer 7

Localised increase in bone density in response to low grade inflammation

Most common around apex of tooth with necrotic pulp

Question 8

What is idiopathic osteosclerosis?

Answer 8

Localised increase in bone density of unknown cause

Question 9

How identify between idiopathic osteosclerosis vs scelosing osteitis?

Answer 9

Sensibility test tooth involved

Question 10

Aetiology of bone necrosis in jaw?

Answer 10

Osteomyelitis
- acute or chronic

Avascular necrosis
- anti-resoprtive medication
- age related ischaemia

Irradiation
- ORN

Question 11

What is osteoporosis and its clinical/radiographic features?

Answer 11

Bone atrophy where resorption exceeds formation

• symptomless
• weak bone
• enlarged antrum
• loss of normal bone markings

Question 12

Basic what is rickets / osteomalacia

Answer 12

Osteoid forms but fails to calcify

• low calcium
• lack of sunlight and Vit D
• malabsorption or renal issues

Question 13

How does hyperparathyroidism affect bones?

Answer 13

Calcium released from bones to serum
- generalised osteoporosis

90% parathyroid adenoma
- increased PTH

Question 14

What is cherubism?

Histology?

Answer 14

Multicystic/locular lesions in multiple quadrants
- grow before about 7
- regress over puberty

Vascular giant cell lesions

Question 15

What is pagets disease?
Clinical symptoms?

Answer 15

Alteration in bone remodelling

Bone swelling, pain, nerve compression

Question 16

Radiographic signs of pagets?

Answer 16

Variable bone pattern

Loss of lamina dura

Hypercementosis

Migration

Question 17

Give some lesions of the cementum

Answer 17

Cementoblastoma
- neoplasm attached to root

Cemento-osseous dysplasia’s
- start as radiolucency

Question 18

What is osteosarcoma?

Answer 18

Malignant tumour of bone

• if in elderly, likely pagets linked
• more mandibular
• metastases

Question 19

What is Cemento osseous dysplasia?

Answer 19

• often single lesion associated with apex of tooth

Florid cemento osseous dysplasia
- mutliple lesions at apex of teeth, often mandibular incisors

• swelling can extend into floor of mouth

Question 20

Histology pagets

Answer 20

Osteoclastic and osteoclastic activity

Active with increased bone turnover

Question 21

Give some bone tumours

Answer 21

Osteoma
- solitary
- cortical bone
- slow growing

Osteoblastoma
- rare
- very active growth

Question 22

What is ossifying fibroma

Answer 22

• slow growing benign neoplasm
• well demarcated and sometimes encapsulated
  (Difference vs fibrous dysplasia)
• calcified bodies and bony trabeculae inside, similar to FD

Question 23

What is cementoblastoma?

Answer 23

Odontogenic tumour
- formation of mass of cementum attached to roots of tooth