Disease of Bone/ Systemic Disease

Question 1

What is fibrous dysplasia?

Answer 1

A benign developmental abnormality

Bone is replaced by calcified fibrous tissue

Question 2

How does early FD appear radiographically?

Answer 2

Early lesions tend to be radiolucent with well-defined border

Question 3

What happens as lesion matures?

Answer 3

More bone is laid down = mottled radiopacity ‘orange peel’

Question 4

How does mature FD appear radiographically?

Answer 4

Ill-defined margins, orange peel look

Question 5

What are complications of FD?

Answer 5

Bony expansion
Lesions maxilla can occlude sinus
Teeth displaced
Root resorprtion

Question 6

What does FD resemble?

Answer 6

Paget’s

Question 7

How to differentiate FD and Pagets?

Answer 7

FD is uncommon middle/ old age

FD unilateral unlike Paget

Question 8

What is cherubism?

Answer 8

Rare inherited fibro-osseous disease of jaw which develops in infancy

Question 9

How does cherubism present?

Answer 9

Painless bilateral expansion of the lower face - followed expansion maxilla

Question 10

What would you see radiographically in cherubism?

Answer 10

Cyst-like radiolucent lesions at posterior aspect of mandible bilaterally, expand into rami and body

Well defined causing bony expansion not cortical perforation

Question 11

Consequence of cherubism?

Answer 11

Bony expansion
Tooth buds displaced/ destroyed
Primary teeth exfoliated early

Question 12

What is Paget’s disease?

Answer 12

Abnormal resorption and disposition of osseous tissue in bones
Affects middle and old age

Question 13

Where is Paget’s commonly seen

Answer 13

Skull

Question 14

How does Paget affect oral cavity?

Answer 14

Affect maxilla > mandible
Enlargement - space between teeth/ dentures not fitting
Can cause hypercementosis

Question 15

What does Paget cause?

Answer 15

Enlargement of bones = COMPRESSION OF NERVES

Question 16

How does Paget’s appear radiographically?

Answer 16

Bony expansion and ‘cotton wool’ appearance

Bone deposition - hyperostosis - thickening and expansion

Question 17

What is osteoporosis?

Answer 17

Persistence of calcified cartilage and marrow spaces obliterated = issue haemopoiesis
Bones become very fragile

Question 18

Oral consequences of osteoporosis?

Answer 18

Delayed eruption and early loss of teeth- children

Cortical structures - lamina dura/ mandible canal walls can be obscured dense bone

Question 19

What causes hyperparathyroidism?

Answer 19

Excess circulation PTH which activates osteoclasts causing Ca to be mobilised from skeleton

Question 20

What happens in hyperparathyroidism?

Answer 20

Ca leached from bones - bones look ‘radiolucent’

Question 21

What radiolucent lesions can be associated w/ hyperparathyroidism?

Answer 21

Brown cell tumour - expansile radiolucent lesion w/ honeycomb pattern

Question 22

What is hyperpituitarism?

Answer 22

Excessive production of growth hormone
In childhood = gigantism
In adults = acromegaly

Question 23

What are the characteristics of acromegaly?

Answer 23

Increased length of ramps and body of mandible
Enlargement paranasal sinus
Prognathic chin - class III
Large hand

Question 24

What would you see on lateral skull radiograph in acromegaly?

Answer 24

Ballooning of sella turcica

Expanded pituitary fossa

Question 25

What is sickle cell anaemia?

Answer 25

Chronic haemolytic blood disorder- red blood cells rapidly destroyed = hyperplasia of bone marrow

Question 26

What happens to bone marrow is sickle cell anaemia?

Answer 26

Expansion of the bone marrow - marrow hyperplasia = thinning cancellous trabeculae

Question 27

What do you see in-between the teeth of sickle cell anaemia pt?

Answer 27

Bony trabeculae coarse = step ladder pattern