Exam 1 - Radiolucencies 2 Flashcards
- An African American female presents complaining that her lower front teeth “seem to be moving.” Tenderness to percussion, slight labial expansion. Pano shows large unilocular radiolucency from the mandibular right 1st PM to left 1st PM.
Does the displacement of teeth suggest a benign or malignant process?
Benign - malignant tumors tend to invade surrounding tissue, and benign tumors are typically better defined and circumscribed.
Malignant lesions tend to loosen teeth, where benign lesions tend to move teeth.
- An African American female presents complaining that her lower front teeth “seem to be moving.” Tenderness to percussion, slight labial expansion. Pano shows large unilocular radiolucency from the mandibular right 1st PM to left 1st PM. Teeth are vital.
Differential diagnosis?
- Central Giant Cell Granuloma
- Non-odontogenic cyst
- Odontogenic keratocyst
- An African American female presents complaining that her lower front teeth “seem to be moving.” Tenderness to percussion, slight labial expansion. Pano shows large unilocular radiolucency from the mandibular right 1st PM to left 1st PM.
With these histologic features, what other pathologic condition must be ruled-out clinically?
Hyperparathyroidism
- 43 y/o African/American female presents with 2 small radiolucencies at the apices of her mandibular central incisors. Teeth are vital.
Differential diagnosis?
- Osseos dysplasia
- Periapical cemento-osseous dysplasia (primarily in black women)
- Florid periapical cemento-osseous dysplasia
- Glandular Odontogenic Cyst
- Fibrous dysplasia
- 43 y/o African/American female presents with 2 small radiolucencies at the apices of her mandibular central incisors. Teeth are vital.
Provisional diagnosis?
- Periapical cemento-osseous dysplasia
How would you establish a diagnosis with Periapical cemento-osseous dysplasia?
Do not biopsy
- Pulp test teeth
- Get pano to see if focal (posterior) or florid (multiple locations)
- Obtain medical and dental history
- Record any symptoms
How should Periapical cemento-osseous dysplasia be treated?
- No treatment necessary - they can remodel and go away on their own.
- Notice the maturation sequence
- 63 y/o female presents with pain in right maxilla for about 2 months. Area of exposed bone 2-3cm, ill-defined radio-opacity. Med Hx of multiple myeloma, had chemo therapy and taking intravenous Zometa (zolenroic acid).
What is the most likely cause of the osteonecrosis?
- Usually bisphosphonate-related
- They are known to cause bisphosphonate related osteonecrosis of the jaw - as they inhibit osteoclasts and normal bone turnover is affected.
- 63 y/o female presents with pain in right maxilla for about 2 months. Area of exposed bone 2-3cm, ill-defined radio-opacity. Med Hx of multiple myeloma, had chemo therapy and taking intravenous Zometa (zolenroic acid).
What is the suggested mechanism of action of Zometa? And what is the half-life?
- Inhibits the breakdown of bone by inhibiting osteoclast activity and induces osteoclast apoptosis, therefore reducing bone turnover
- Half-life = 10-12 years
- 63 y/o female presents with pain in right maxilla for about 2 months. Area of exposed bone 2-3cm, ill-defined radio-opacity. Med Hx of multiple myeloma, had chemo therapy and taking intravenous Zometa (zolenroic acid).
What is the management process like for this patient?
- Drug holiday before surgical interventions
- Invasive dental procedures should be avoided during treatment (RCT rather than extract)
- 34 y/o white male is asymptomatic with a 4-5mm radiopacity distal to #18, with no expansion.
Differential diagnosis?
- Retained asymptomatic 3rd molar
- Idiopathic osteosclerosis (90% mandible)
- Condensing osteitis
- 34 y/o white male is asymptomatic with a 4-5mm radiopacity distal to #18, with no expansion.
What clinical test is indicated to further evaluate this lesion?
And what is the provisional diagnosis?
- Pulp vitality testing
- Pulp non-vital
- Condensing osteitis
- Pulp vital (IN THIS CASE)
- Idiopathic Osteosclerosis
- Pulp non-vital
- Idiopathic Osteosclerosis
- 26 y/o african-american female developed lucency in body of left mandible, dentist diagnosed it as periapical infection and extracter her posterior teeth. Lesion grew, clinical expansion of cortex, multiple foci of opacification.
Differential diagnosis? And what is the correct diagnosis?
- Complex odontoma (most dont get this big)
- Cemento-osefying fibroma
- Gorlin cyst
- 17 y/o white male developed pain in right posterior mandible. 2 cm radiopaque mass attached to distal root of the mandibular 1st molar. Mass surrounded by a thin radiolucent zone. Tooth reported as vital.
Differential diagnosis?
- Benign Cementoblastoma (if vital)
- Condensing osteitis (usually no lucency surrounding opacity)
- Osteoblastoma
- 17 y/o white male developed pain in right posterior mandible. 2 cm radiopaque mass attached to distal root of the mandibular 1st molar. Mass surrounded by a thin radiolucent zone. Tooth reported as vital.
What would be the provisional diagnosis if the tooth was nonvital?
- Condensing osteitis
