Chapter 14 Flashcards
What are some signs that bone lesions are benign?
Asymptomatic, grows slowly (corticated rim) and by expansion (displaces teeth and expands cortex), symmetrical, and does not metastasize
What are some signs that bone lesions are malignant?
Symptomatic, grows rapidly, invades and destroys adjacent structures, asymmetrical, ragged/poorly defined margins (destroys cortex), capable of metastases
What term describes a group of heritable disorders that has defective type I collagen maturation?
Osteogenesis Imperfecta
What are the characteristics of bone in osteogenesis imperfecta?
Thin cortex, fine trabeculation, diffuse osteoporosis, and fractures heal inappropriately
When is osteogenesis imperfecta usually noticed?
At birth, as infants are born with multiple bone fractures
How many people are affected with osteogenesis imperfecta?
About 1 in 8000
What are some signs and symptoms of osteogenesis imperfecta?
Bone fragility, blue sclera, altered teeth, hearing loss, long bone and spine deformation, joint hyperextensibility
What are some radiographic features of osteogenesis imperfecta?
Osteopenia (low bone density), bowing/angulation/deformity or long bones, multiple fractures, wormian bones in the skull
What are some oral manifestations of osteogenesis impefecta?
Teeth with a blue to brown translucency (opalescent), premature pulpal obliteration, class III malocclusion
What is the goal of therapy for osteogenesis imperfecta?
Manage symptoms, manage fractures (so patients may be on bisphosphonates)
What term describes a skeletal disorder with a marked increase in bone density?
Osteopetrosis (marble bone disease)
What is the cause of osteopetrosis?
A defect in remodeling caused by a failure of normal osteoclast function
What are the 2 major clinical patterns of osteopetrosis?
Infantile and Adult osteopetrosis
What is the difference between infantile and adult osteopetrosis?
Infantile is discovered early on and has severe manifestations with a poor prognosis. Adult osteopetrosis is discovered later in life is has less severe manifestations, with a long term survival
What are some of the manifestations of infantile osteopetrosis?
Widespread increase in skeletal density, marrow failure, frequent fractures, cranial nerve compression, facial deformities, delayed tooth eruption, osteomyleitis in post tooth infraction
What is another name for adult osteopetrosis?
Benign osteopetrosis
What are some significant oral complications that are a result from osteopetrosis?
Fracture and osteomyelitis after tooth extraction
What term describes a syndrome characterized by dental and clavicle abnormalities?
Cleidocranial dysplasia
How many people are affected by cleidocranial dysplasia?
1 in 1,000,000
Are the clavicles usually present in cleidocranial dysplasia?
Yes, but they show varying degrees of hypoplasia (they are absent in 10% of cases)
What are some characteristics of people with cleidocranial dysplasia?
Short stature, big head with pronounce frontal bossing, ocular hypertelorism, broad base of nose, unusual mobility of shoulders
What are some oral manifestations associated with cleidocranial dysplasia?
High arched palate, increased prevalence of cleft palate, retention of deciduous teeth, delayed eruption of permanent teeth, and supernumerary teeth
What is the treatment for cleidocranial dysplasia?
No treatment exists for bone anomalies, and treatment of dental problems is difficult
What term describes an area of hematopoietic marrow that produces a radiolucency?
Focal osteoporotic marrow defect
What is the clinical presentation of a focal osteoporotic marrow defect?
A lesion of variable size with ill defined borders and no jaw expansion, typically asymptomatic
Where and in what population do focal osteoporotic marrow defects usually occur?
75% in woman in the posterior mandible
How is a focal osteoporotic marrow defect diagnosed?
Incisional biopsy, but once dx is confirmed no tx is necessary
What term describes a focal area of increased radiodensity that is of unknown causes and cannot be attributed to anything else?
Idiopathic osteoscleorosis
What are some other conditions that may be confused with idiopathic osteosclerosis, and why are they different from idiopathic osteosclerosis?
Condensing osteitis - infection; focal cemento-osseous dysplasia, has radiolucent rim; cementoblastoma - is fused with the tooth
How many Americans have idiopathic osteosclerosis?
About 5% of Americans
When does idiopathic osteosclerosis usually occur?
Cases arise in teenage years, then remain static
What are the clinical characteristics of idiopathic osteosclerosis?
Asymptomatic, no cortical expansion, well defined
Where does idiopathic osteosclerosis usually occur?
In the mandible, and about 80% are associated with the root apex
When should idiopathic osteoscerosis be biopsied?
If there are symptoms, continued growth or cortical expansion
What term describes a disease characterized by abnormal resorption and deposition of bone, and is of unknown cause?
Paget’s disease of bone
What does Paget’s disease cause?
Distortion and weakening of affected bones = bowing, simian stance (monkey like stance)
What population is most commonly affected by Paget’s disease of bone?
Older adults, males, caucasians
What is a common complaint of Paget’s disease of bone?
Bone pain, osteoarthritis, joint pain and limited mobility
What bones are most commonly affected by Paget’s disease of bone?
Vertebrae, pelvis, skull and femur
In how many cases does jaw involvement occur in Paget’s disease of bone?
About 20%
What does jaw involvement in Paget’s disease of bone result in?
Maxillary disease is more common than mandibular, resulting in an enlargement of the middle 1/3 of the face = leontiasis ossea (lionlike face); alveolar ridges are symmetrical and grossly enlarged
What are some radiographic characteristics of Paget’s disease of bone?
Patchy or sclerotic areas (cotton wool appearance), general hypercementosis (premolars usually affected)
What diagnostic test can be done to confirm Paget’s disease of bone?
A blood test = high elevations of alkaline phosphatase levels with normal calcium and phosphorous levels
How is Paget’s disease of bone treated?
NSAIDs for pain, antiresorption agents for those with phosphatase levels above normal (bisphosphonates)
What is a recognized complication of Paget’s disease of bone?
Development of a malignant bone tumor (osteosarcoma) in up to 10% of cases = poor prognosis
What term describes a non-neoplastic lesion of bone, that causes painless bone expansion from medullary bone?
Central giant cell granuloma
At what age and in what population are central giant cell granulomas more common?
Before 30, and in females
Where are central giant cell granulomas most common?
In the mandible, anterior and they frequently cross the midline!
What are some radiographic features of a central giant cell granuloma?
Radiolucent lesion which may be unilocular or multilocular, typically well defined with noncorticated margins
What must patients be evaluated for if they have a central giant cell granuloma?
Hyperarathyroidism – histopathology identical to brown tumor of hyperparathyroidism and lesions of cherubism
How is a central giant cell granuloma treated?
Currettage
How likely is a central giant cell granuloma to recur?
About 20% recur
What is cherubism?
A developmental, autosomal dominant jaw condition that involves the bilateral posterior mandible, and the infraorbital rim/orbital floor = chubby cheeks, wide rim of exposed sclera
When does cherubism occur?
Between the ages of 2-5
What is unique about the progression of cherubism?
The disease will progress until puberty then stabilize and slowly regress
What are some oral manifestations of cherubism?
Widening and distortion of the alveolar ridges, and failure of tooth eruption
What are some radiographic characteristics of cherubism?
Multilocular, expansile and radiolucent lesions
What term describes a benign, empty or fluid filled cavity within bone?
Traumatic bone cyst, aka simple bone cyst
Why is the name “traumatic bone cyst” a misnomer?
Because the lesion does not have an epithelial lining
What is the cause of a traumatic bone cyst?
Trauma-hemorrhage theory is the most widely accepted etiology – clot forms and dissoves but never triggers bone formation
What is the most common location of tramautic bone cysts?
Long bones, but some are found in the mandible of patients aged between 10 and 20
What are some clinical and radiograhic characteristics of a traumatic bone cyst?
Asymptomatic, vital teeth, with a well defined, radiolucent defect with scalloping around teeth
How is a traumatic bone cyst treated?
Surgical exploration to confirm diagnosis and is usually curative
What term describes a blood filled cavity within bone?
Aneurysmal bone cyst
Why is the term “aneurysmal bone cyst” a misnomer?
Because it is not a true cyst because it has no epithelial lining
Where do aneurysmal bone cysts usually occur?
In long bones, but rarely in the posterior mandible of patients around 20
What are some clinical and radiographic findings of an aneurysmal bone cyst?
Painful, rapid swelling with a well defined, radiolucent lesion with cortical expansion, usually unilocular = “blow out” or ballooning distention of the affected bone (BLOOD SOAKED SPONGE)
How is an aneurysmal bone cyst treated?
Curretage or enucleation
How likely is an aneurysmal bone cyst to recur?
About 10-60%, usually due to inadequate removal of the first lesion
