Bone Pathology

Question 1

What is rarefying osteitis

Answer 1

Localised loss of bone in response to inflammation.

Always occurring secondary to another form of pathology

Question 2

Where is sclerosing osteitis most commonly found

Answer 2

Around the apex of a tooth with a necrotic pulp

Question 3

What is sclerosing osteitis

Answer 3

Localised increase in bone density in response to low grade inflammation
Need to address this

Question 4

What might sclerosing osteitis lead to if not addressed

Answer 4

External root resorption

Question 5

What is idiopathic osteosclerosis

Answer 5

Localised increase in bone density of an unknown cause

Question 6

Where is idiopathic osteosclerosis most commonly seen

Answer 6

In the premolar-molar region of the mandible

Question 7

How would you tell between sclerosing osteitis and idiopathic osteosclerosis if you were unsure

Answer 7

Sensibility test the teeth - sclerosing osteitis occurs around around apex of a non vital tooth

Question 8

What are 4 things that are thought to be predisposing factors related to dry socket

Answer 8

Female
Contraceptive pill
Lower jaw, further back in the mouth
Smokers

Question 9

What is osteomyelitis

Answer 9

Inflammation of the medullary cavity of a bone casued by infection - rare but serous condition that required urgent specialist Managment

Question 10

What is garres sclerosing osteomyelitis ?

Answer 10

This is a chronic sclerosing osteomyelitis with a proliferative

This is a rare condition that is usually associated with a chronic periapical periodontitis or sometimes a chronic periocoronitis

Question 11

What is the principle clincal feature in garres osteomyelitis

Answer 11

Swelling

Question 12

Radiographically what would we see in garres osteomyelitis

Answer 12

Area of sclerosing osteitis in the mandible and there would be evidence of new periosteal bone at the periphery of the mandible

Question 13

What is osteoporosis

Answer 13

Bone atrophy ; the bone resorption exceeds formation

Question 14

What are three clincal features of osteoporosis

Answer 14

Symptomless
Week bone
Antrum enlarged

Question 15

Name 3 conditions that may result in secondary osteoporosis

Answer 15

Hyperthyroidism
Cushing syndrome
Diabetes mellitus

Question 16

If a paitent has a giant cell granuloma what condition would you want to test for

Answer 16

HYPERTHYROIDUSM

Question 17

What would a serum biochemistry show for someone with pagers disease

Answer 17

Raised alkaline phosphate

Question 18

What are three dental changes that would be seen in a patient with pagers disease of the bone

Answer 18

Loss of lamina dura
Hypercementosis of multiple teeth
Migration due to bone enlargement

Question 19

Why does hyperthyroidism cause osteoporosis

Answer 19

Because it caused the calcium to be mobilised from the bones

Question 20

For a patient with a osteoma what syndrome would we consider

Answer 20

Gardner Syndrome - multiple polyps in the colon which are a high risk of malignant change

Question 21

If a patient has florid cemento-osseous dysplasia why would we be worried about extraciting this

Answer 21

Because there is not a proper vascularity or ability to heal

Question 22

Osteosarcoma is a rare malgnant tumour of the jaw - what might be the patients presenting complaint

Answer 22

Unexplained mobility of teeth

Question 23

What is fibrous dysplasia

Answer 23

Slow growing apsymtopatic bone swelling

Bone is being replaced by fibrous tissue

Will stop once patient stops growing

Question 24

What are the two clincal phenotypes of fibrous dysplasai

Answer 24

Monostotic ; single bone ( more common)

Polyostotic ; many bones

Question 25

What is Albrights syndrome ,what age group foes it affect , what will be sene on the skin

Answer 25

Polyostotic fibrous dysplasia
Early puberty
Melanin pigment

Question 26

What is osteomyelitis

Answer 26

Invasion of bacteria into cancellous bone causes soft tissue inflammation and oedema in the closed bone marrow space.
Oedema in the enclosed space leads to increased hydrostatic pressure higher than the BP of the feeding arteries.
Comprised blood supply then results in soft tissue necrosis
Bacteria proliferate as normal bone defences are not able to reach tissue

Question 27

Osteomyelitis is rare but if it does occur it is more likely in the mandible than the maxilla - why is this

Answer 27

This is because the maxilla has a much richer blood supply , the sole blood supply of the mandible is the inferior alveolar nerve

Question 28

Osteomyelitis rarely occurs when the host defences are intact - what are some instances that they may not be

Answer 28

Odontogenic infection and fractures of the mandible

Diabetes - poor nutrition- cancer etc

Question 29

Osteomyelitis takes around 10-12 days to present on a radiograph - when it does what may it look like

Answer 29

Moth eaten appearnce
Increased radioluceny

Question 30

What is the management of osteomyelitis

Answer 30

Swabs must be taken to get a culture sensitivity

Antibiotic - penicillin from 6- 12 weeks

Surgical - drain pus if Posisble, remove any n vital teeth in the area of infection, debridement the area
Excision of necrotic bone until you reach actively bleeding bone tissue