Bony Lesions

Question 1

What is the role of osteoblasts and osteoclasts?

Answer 1

Osteoblasts - lay down new bone

Osteoclasts - resorb old bone

Question 2

What is the role of the parathyroid during bone metabolism?

Answer 2

Parathyroid:
-Increases excretion of phosphate from kidneys which leads to metabolism of calcium and phosphate from bone

-Causes proliferation of osteoclasts

Question 3

What is a hamartoma?

Answer 3

Benign overgrowth of mature cells/tissues

Question 4

What is the difference between compound and complex odontomas?

Answer 4

Compound - have identifiable tooth shapes although small

Complex - irregular mass with no similarity to teeth

Question 5

What is osteomyelitis?

Answer 5

Painful bone injection typically caused by staphylococcus bacteria and will be treated with antibiotics

Question 6

What is suppuration and how does this effect bone?
(list process in 4 steps)

Answer 6

1. Apical infection results in micro-organism infiltration and inflammatory response
2. The micro-organisms produce toxins which necrose bone
3. The inflammation produces high pressure build-up which causes circulatory death
4. Bone dies from ischaemia

Question 7

What are the 2 contributing factors of bone death?

Answer 7

1. Bone death from toxins
2. Bone death from ischaemia due to local circulatory collapse

Question 8

What is chronic focal sclerosis?

What is Garres?

Answer 8

It is an unusual reaction of bone to infection

Garres is another type of osteomyelitis

Question 9

What is osteoradionecrosis?

Answer 9

Osteoradionecrosis - necrotic bone caused by radiotherapy
-overlying mucosa sloughs away

Question 10

What is osteonecrosis?

What causes osteonecrosis?

Answer 10

Blood flow to bone is disrupted which causes death of bone tissue - osteoclasts are affected

Treatment with bisphosphonates (MRONJ) can cause osteonecrosis - antibiotics will not help to treat it

Question 11

What is fibrous dysplasia?

Answer 11

Areas of bone that are replaced by fibrous tissue

Question 12

What is the difference between monostotic and polyostotic fibrous dysplasia?

Answer 12

Monostotic - one bone involved
Polyostotic - more than one bone involved e.g. Albrights syndrome

Question 13

What is cherubism?

Is this a form of fibrous dysplasia?

Answer 13

Progressive, painless symmetric swelling of jaw with deciduous teeth shedding early and permanent teeth are often defective, missing and displaced

This is NOT a form of fibrous dysplasia

Question 14

What is hyperparathyroidism?

Answer 14

Excess osteoclast activity with increased excretion of phosphate and increased reabsorption of calcium

Present as ‘Brown’s Tumours’ - multiple radiolucency’s on radiographs (not a true tumour)

Question 15

What is Paget’s disease?

How does it affect bones?

How does it present on radiographs?

Answer 15

Paget’s disease - caused by excessive breakdown and formation of bone followed by disorganised bone remodelling

Causes affected bone to weaken and become misshapen and makes patients susceptible to pain, fractures and arthritis in the joints near the affected bone

Presents as ‘woolly’ texture with increased radiolucency’s on radiograph

Question 16

What is odontogenic myxoma and how does it present on a radiograph?

Answer 16

Odontogenic myxoma - scanty spindle/stellate cells in loose mucoid stroma

Soap bubble appearance on radiograph

Question 17

Giant cell granuloma - how does this present?

Answer 17

Radiolucent lesion with smooth or ragged boarder which causes displacement of teeth

Question 18

List 3 primary malignant tumours of bone:

Answer 18

1. Osteosarcoma
2. Fibrosarcoma
3. Chondrosarcoma

Question 19

Osteosarcoma:
1. How does it present?
2. How does it appear on radiograph?
3. How is it treated?

Answer 19

1. Presents with distortion of alveolus, loosening of teeth and bleeding
2. Irregular pattern of radiolucency and radiopacity - ‘sunray’ appearance
3. Treatment - radical excision and chemotherapy - METASTASISE EARLY IF NOT TREATED

Question 20

Which oral cancer can also affect bone?

Answer 20

Oral Squamous Cell Carcinoma

Question 21

What is the term given to metastatic tumours?

How do they present?

How does it appear on radiograph?

Answer 21

Metastatic tumours = Carcinomas

Initially painless with increasing swelling, loosening of teeth and paraesthesia

Ragged radiolucent area in the jaw on radiograph

Question 22

What 3 features indicate significant findings in terms of a suspected bony lesion?

Answer 22

1. Root resorption
2. Loosening of teeth
3. Gingival bleeding