Bone Pathology

Question 1

what are the general principles of bone remodelling?

Answer 1

• Mechanical stimuli
• Systemic hormones (PTH, Vit D3, Oestrogen)
• Cytokines
• Complex interactions promoting cell & bone matrix growth

Question 2

special tests to assess bone health?

Answer 2

• blood calcium levels
• osteoblast & clast activity
• Parathyroid hormone
• Vit D assays

Question 3

what type of bone developmental abnormalities can you get, where can you find them?

Answer 3

Torus (Developmental, exostosis)

Torus Palatinus (middle of palate)

Torus/Tori Mandibularis (Lingual aspect of mandible

Question 4

what are some BONE DEVELOPMENTAL ABNORMALITIES?

Answer 4

• osteogenesis imperfecta
• achondroplasia
• osteopetrosis

Question 5

What is osteogenesis imperfecta?

Answer 5

• collagen defect
• inherited
• weak bones, multiple fractures

Question 6

what is achondroplasia?

Answer 6

• inherited
• dwarfism
• poor endochondral ossification (cartilage not properly replaced by bone)

Question 7

what is osteopetrosis?

Answer 7

• lack of osteoclast activity
• failure of resorption
• marrow obliteration

Question 8

what is fibrous dysplasia?

Answer 8

bone disorder characterized by abnormal growth and replacement of normal bone tissue with fibrous connective tissue, leading to weakened and deformed bones

Question 9

what is the histology of active fibrous dysplasia?

Answer 9

“fibro-osseous”

fibrous replacement of bone
- cellular fibrous tissue
- bone (metaplastic or woven)

Question 10

what is rarefying osteitis?

Answer 10

localised loss of bone in response to inflammation
- occurring secondary to another form of pathology
- if at apex, consider apical periodontitis/granuloma/abscess

Question 11

what is sclerosing osteitis?

Answer 11

localised increase in bone density in response to low-grade inflammation,
most common around apex of tooth with necrotic pulp

Question 12

what is idiopathic osteosclerosis?

Answer 12

localised increase in bone density of unknown cause

Question 13

what is alveolar osteitis?

Answer 13

dry socket, delayed healing
- complication of extraction
- difficult lower molar XLA
- severe pain, loss of clot, bone sequestra
- varied aetiology

Question 14

what is osteomyelitis?

Answer 14

rare endogenous infection

acute or chronic (suppuration is rare)

Question 15

aetiology of bone necrosis?

Answer 15

• osteomyelitis (acute or chronic)
• avascular necrosis (age related/anti-resorptive medication)
• radiation (osteoradionecrosis)

Question 16

anti-resorptive meds affecting bone?

Answer 16

• osteoclast inhibitors (osteoporosis, paget’s, bone metastases)
• osteonecrosis (mandible>maxilla)
• Management (conservative - XLA last resort)

Question 17

what are examples of metabolic bone diseases?

Answer 17

• osteoporosis
• rickets & osteomalacia
• hyperparathyroidism

Question 18

what is osteoporosis?

Answer 18

bone atrophy: resorption>formation

clinical features:
- symptomless
- weak bone

radiographic features:
- loss of normal bone markings

Question 19

aetiology of osteoporosis?

Answer 19

• sex hormone status
• age
• calcium & physical activity

Question 20

what is rickets & osteomalacia?

Answer 20

Vit D deficiency
- lack of sun
- diet
- malabsorption
- renal cause

Osteoid forms but fails to calcify

Rickets
- poor endochondral bone
- low calcium
- raised alkaline phosphatase

Question 21

what is hyperparathyroidism?

Answer 21

an abnormally high concentration of parathyroid hormone in the blood, resulting in weakening of the bones through loss of calcium.

Question 22

giant cell lesions of the jaws?

Answer 22

• peripheral giant cell epulis
• central giant cell granuloma

Question 23

what is cherubism?

Answer 23

Cherubism is a disorder characterized by abnormal bone tissue in the jaw.

Question 24

what is paget’s disease of bone?

Answer 24

a chronic (long-lasting) disorder that causes bones to grow larger and become weaker than normal.

Question 25

what are DENTAL CHANGES in pts with pagets disease of bone?

Answer 25

• loss of lamina dura
• hypercementosis
• migration (due to bone enlargement)

Question 26

what are types of bone tumours?

Answer 26

• osteoma (bone growing on other bone, small usually benign)
• osteoblastoma (usually larger and more aggressive, can become malignant)

Question 27

what is it, and clinical and histology features of ossifying fibroma?

Answer 27

substitution of bone by fibrous tissue

Clinical:
- slow growing
- mainly mandible
- radiologically well-defined

Histology:
- cellular fibrous tissue
- immature bone
- acellular calcifications

Question 28

what are types of cementum lesions?

Answer 28

• cementoblastoma (neoplasm attached to root)
• cemento-osseous dysplasia

Question 29

what is and characteristics of osteosarcoma?

Answer 29

highly aggressive bone cancer that arises from osteoblasts,

age 30s

Characteristics:
- mandible > maxilla
- local destruction
- recurrence & metastasis (secondary growth)