Diseases of Bone Flashcards
4 fibro-osseous lesions of the jaw
- Periapical (cemento-) osseous dysplasia
- Florid (cemento-) osseous dysplasia
- Ossifying fibroma
- Fibrous dysplasia
8 clinical features of PCD/POD
- Very common
- Middle age
- Female/male ratio 9:1
- 3 Black/ 1 Caucasian (also common in SE Asian)
- Affected teeth are vital
- Asymptomatic
- Single or multiple lesions
- No swelling
6 radiographic features of early PCD/POD
- Purely radiolucent
- Not corticated
- Fairly well-defined
- Loss of lamina dura
- PDL intact
- Diff: rarefying osteitis
3 radiographic features of PCD
- Mixed radiolucent/radiopaque
- Radiopacities develop within the radiolucency, grow and coalesce
- The radiolucency stops enlarging
3 differential diagnoses for PCD
- Odontoma
- Cementoblastoma
- OF
Radiographic appearance of late stage PCD
- Mostly radiopaque
- A radiolucent rim surrounds the lesion but is often incomplete
3 differential diagnoses for late stage PCD
- Cementoblastoma
- Osteoma
- Idiopathic osteosclerosis
Define FOD clinically
- Widespread form of PCD
- Multiple lesions
- Lesions are large and often cause swelling
- 4 quadrants can be affected
5 ragiographic features of FOD
- Similar to PCD
- Cotton-wool appearance
- Granular appearance
- Cortication can be present
- Sometimes associated with simple (traumatic) bone cyst
Differential diagnosis for FOD
Paget’s disease
4 clinical features of oddifying fibroma (OF)
- Young adult
- Female > male
- Mandible, molar-premolar region
- Swelling
3 radiographic stages of ossifying fibroma
Lucent, mixed, opaque
7 radiographic features of ossifying fibroma
- Radiolucent initially, often round
- Radiopacities develop in the radiolucency, enlarge and coalesce - granular appearance
- Can be very radiopaque
- Well-defined border, hyperostotic sometimes
- Radiolucent rim
- Resorption and/or displacement of roots
- Expansion
5 differential diagnoses of ossifying fibroma
- AOT
- COC
- CEOT
- PCD
- Ameloblastoma
2 types and 2 subtypes of fibrous dysplasia
- Monostotic (70%)
- Polyostotic (30%)
- Jaffe’s type
- Albright’s syndrome
2 characteristics of Jaffe’s type fibrous dysplasia
- Multiple bones affected
- Cafe-au-lait spots
3 characteristics of Albright’s syndrome
- Multiple bones affected
- Cafe-au-lait spots
- Endocrine abnormalities
- Most common abnormality is precocious sexual development in females
5 clinical features of fibrous dysplasia
- Children
- Incidental finding in many patients
- Swelling in others
- Stops growing with the end of skeletal growth
- Unilateral in the jaws
10 radiographic features of fibrous dysplasia
- Diffuse margins
- Blends with normal bone
- Replacement of the normal bone pattern with an abnormal-looking bone
- Alteration in the bone pattern
- Ground glass, orange peel bone patterns
- Expansion - no perforation of cortex
- Unilateral in the jaws
- Can obliterate the maxillary sinus
- Can displace teeth, resorb roots
- Can displace the mandibular canal superiorly (pathognomonic)
NOTE: Radiopacity increases with the stage of the lesion
5 differential diagnoses for fibrous dysplasia
- CGCG
- OF
- Paget’s
- Osteosarcoma
- Osteomyelitis
4 clinical features of central giant cell granuloma (CGCG)
- 2nd, 3rd decades
- Mandibleémaxilla 2:1
- Anterior region, regions where deciduous teeth were present
- Swelling
7 radiographic features of central giant cell granuloma
- Small lesions are radiolucent and unilocular
- Larger lesions are multilocular with fine, wispy trabeculae
- Fairly well-defined but poorly corticated
- Trabeculae at right angle to the buccal cortex on an occlusal radiograph
- Bulging of buccal cortex produces 2 layers of cortex
- Crosses the midline
- Spectacular root displacement and resorption
4 differential diagnoses for CGCG
- Amelo
- ABC
- OKC
- OF
7 clinical characteristics of cherubism
- Inherited
- Starts in young children, age 2-6
- Bilateral enlargement of the posterior region of the mandible
- Bilateral enlargement of the posterior maxilla can also be present
- Very rarely unilateral
- Lesions stop growing and even regress during adolescence
- Histology resembling central giant cell granuloma
5 radiographic features of cherubism
- Multilocular symmetrical well-defined corticated radiolucencies in the ramus, angle and posterior mandible
- Internal structure similar to CGCG (fine wispy trabeculae giving multilocular appearance)
- Can extend into the condyles posteriorly and anteriorly to the midline in very severe cases
- Expansion of the cortices
- Displacement of erupted teeth, displacement of unerupted teeth anteriorly. Some tooth buds can be missing
4 differential diagnoses for cherubism
- CGCG
- Fibrous dysplasia
- Gorlin-Goltz syndrome (multiple keratocysts)
- Histiocytosis X
How to differentiate cherubism from CGCG and fibrous dysplasia
Cherubism is bilateral while the other two are unilateral
How to differentiate cherubism from Gorlin-Goltz syndrome
Gorlin-Goltz is usually not as symmetrical as cherubism and there is not as much anterior displacement of the teeth
Treatment of cherubism
Cosmetic surgery at the end of skeletal growth
3 clinical forms of idiopathic histiocytosis
- Eosinophilic granuloma
- Hand-Shuller Christian
- Letterer-Siwe
3 clinical features of idiopathic histiocytosis
- Age related
- 10% of patients have oral lesions
- Most lesions are in the mandible
Radiographic appearance of idiopathic histoicytosis skull lesions
Geographic skull
Radiographic appearance of idiopathic histiocytosis jaw lesions
- Central lesions
- Ill-defined
- Solitary
- Periosteal reaction
- Alveolar bone lesions
- Multiple
- Well-defined
- Scooped-out effect
- Teeth floating in air
4 differential diagnoses for idiopathic histiocytosis
- Perio
- Leukemia
- Cyclic neutropenia
- Lymphoma
6 clinical features of Paget`s disease
- Older adults
- Male > Female
- Many bones can be affected, particularly the skull
- Entire bone is affected, so it is bilateral in the jaws (to differentiate from FD)
- Bone pain, swelling, bowing of legs, curvature of spine, large head, diastemas, denture/hat too tight, deafness…
- Serum alkaline phosphatase elevated
2 treatments for Paget’s disease
Calcitonin or bisphosphonate
3 radiographic stages of Paget’s disease
Radiolucent, mixed and radiopaque
6 radiographic features of Paget’s disease
- Alteration of the bone pattern, ground glass, thumb print, cotton wool appearance, linearity in mandible
- Severe expansion of the bone
- Reduction in size of maxillary sinus
- Generalized hypercementosis
- Diastemas
- Increase in density of bone (i.e. in mandible and skull)
2 conditions for which the incidence is inreased in Paget’s disease
- Osteogenic sarcoma (~10%)
- Osteomyelitis in dense bone
3 differential diagnoses for Paget’s disease
- Fibrous dysplasia
- Osteomyelitis
- Metastases
NOTE: FD and osteomyelitis are unilateral while Paget’s is bilateral
3 clinical features of hypeparathyroidism
- Increased PTH parathyroid hormone by the parathyroid glands
- Primary hyperparathyroidism
- Benign tumor of a parathyroid gland
- 2-3 females: 1 male
- Secondary hyperparathyroidism
- In response to hypocalcemia
5 radiographic features of hyperparathyroidism
- Generalized increased radiolucency due to a demineralization of the jaws
- Granular appearance of the bone pattern - ground glass
- Thinning of cotices including inferior cortex and lamina dura of teeth
- Partial or complete loss of lamina dura
- Teeth stand out because the adjacent bone is so radiolucent
- Roots of teeth have a tapered appearance
- Brown tumors histologically identical to CGCG can develop. Radiolucent and can have ill-defined borders
5 clinical features of osteoporosis
- Reduction in bone mass
- Older adults
- Female>male
- Post-menopausal women
- Fracture
4 radiographic features of osteoporosis
- Generalized increased radiolucency of the jaws
- Reduction in the number of trabeculae
- Thinning of cortices including inferior cortex and lamina dura of teeth
- Teeth appear to stand out because the adjacent bone is so radiolucent
Define osteopetrosis
Defect of osteoclasts –> increase in bone mass
May be asymptomatic
3 complications of osteopetrosis
- Fracture
- Cranial nerve palsies
- Osteomyelitis
5 radiographic features of osteopetrosis
- Generalized increased radiopacity of the jaws and all bones of the skeleton
- Increased density can result in disappearance of the trabecular bone pattern
- Mild expansion can be present
- Cortices are less apparent because the adjacent bone is so dense
- Teeth are less apparent because the adjacent bone is so dense
- Malformed roots, missing teeth, delayed eruption often present
7 clinical features of progressive systemic sclerosis
- Chronic autoimmune disease of connective tissue
- 4th, 5th, 6th decades
- 3 females : 1 male
- Hardened, thickened skin
- Limitation of opening
- Xerostomia
- Severity of involvement variable
2 radiographic features of progressive systemic sclerosis
- Generalized widening of the periodontal ligament space
- Bilateral and symmetrical erosions at the site of attachment of muscles
- Coronoid process
- Condylar head
- Angle of mandible
- Digastric region
