Generalized Radiopacities

Question 1

Fibrous Dysplasia (polystotic)
Disease mechanism:

Answer 1

• Is a localized change in normal bone metabolism that
  results in the replacement of all the components of
  cancellous bone by fibrous tissue containing varying
  amounts of abnormal-appearing bone.

Question 2

Fibrous Dysplasia (polystotic)
▪ Affects

Answer 2

more than one bone

Question 3

Fibrous Dysplasia (polystotic)
age

Answer 3

Usually found in children younger than 10 years of
age

Question 4

Fibrous Dysplasia (polystotic)
▪ Jaffe-Lichtenstein Syndrome or Jaffe type

Answer 4

• Polyostotic FD with cutaneous pigmentation (café au lait
  spots)

Question 5

▪ McCune-Albright Syndrome
(2)

Answer 5

• Polyostotic FD with cutaneous pigmentation (café au lait
  spots) and endocrinopathies
• Affects almost exclusively women

Question 6

Florid COD
Disease Mechanism
* FCOD is a widespread form of
* If PCOD is identified in three or four quadrants or is
extensive throughout one jaw, it usually is —.

Answer 6

Periapical cementoosseous dysplasia (PCOD)
FCOD

Question 7

Florid COD
Normal cancellous bone is replaced with

Answer 7

dense,
acellular amorphous bone in a background of
fibrous connective tissue.

Question 8

Florid COD
* Poor vascular supply:

Answer 8

(susceptibility to infection).

Question 9

Florid COD
Clinical Features:
* gender, age
* Predilection for (race)
* symptoms
* Extensive lesions often have an associated —
* If the lesions become secondarily infected, features of — may develop
* Teeth in the involved bone are —

Answer 9

Most patients are female and middle-aged, although the age range is broad.
African Americans and Asians.
Often FOD produces no symptoms (incidental finding).
bony swelling.
osteomyelitis
vital

Question 10

Florid COD
Imaging Features
Internal Structure
(2)

Answer 10

• Can vary from radiolucent - mixed -
  almost totally radiopaque.
• The radiopaque regions can vary from
  small oval and circular regions to large,
  irregular and amorphous.

Question 11

Florid COD
Effects on Surrounding Structures
* Large lesions can displace the
* The roots of associated teeth may have

Answer 11

nferior IAC inferiorly, the floor of the
maxillary sinus superiorly and enlarge the alveolar bone.
hypercementosis

Question 12

Florid COD
Differential Diagnosis:

Answer 12

• Osteomyelitis (may appear similar to the sequestrum seen in
  osteomyelitis): This is not to be confused with a situation where
  FOD has become secondarily infected, resulting in osteomyelitis.
  The foci of amorphous bone that are secondarily infected have a
  wider and more profound radiolucent border.

Question 13

Florid COD
Management
(3)

Answer 13

• Under normal circumstances, FOD does not require treatment.
• No age limit is apparent for the cessation of growth of FOD.
• Because of the propensity to develop secondary infections in FOD, oral hygiene is important
  in order to avoid odontogenic infections.

Question 14

Paget’s Disease
Disease Mechanism
* Is a skeletal disorder involving osteoclasts resulting
in

Answer 14

abnormal resorption and apposition of poorquality bone in one or more bones.

Question 15

Paget’s Disease
May involve many bones, but it is not a —
skeletal disease.

Answer 15

generalized

Question 16

Paget’s Disease
* It is initiated by

Answer 16

an intense wave of osteoclastic
activity, with resorption of normal bone resulting in
irregularly shaped resorption cavities. After a
period of time, osteoblastic activity starts.

Question 17

Paget’s Disease
Clinical Features
* Age
* At age 65 years, the incidence of involvement in — is approximately twice that
of —.
* Affected bone is enlarged and commonly deformed because of the poor quality
of bone formation, resulting in (3). The — also enlarge when affected.
* Separation and movement of teeth may occur, causing —
* — is uncommon.
* Patients may also have ill-defined neurologic pain as the result of bone
impingement on —
* Patients have severely elevated levels of —

Answer 17

Affects later middle and old age (3.5% of individuals older than 40 years of age)
men, women
bowing of the legs, curvature of the spine, and enlargement of the skull. jaws
malocclusion. Dentures may fit poorly.
Jaw pain
foramina and nerve canals.
serum alkaline phosphatase

Question 18

Paget’s Disease
Imaging Features
Location:
* Often in the (4)
* It affects the — about twice as often as the —.
*

Answer 18

pelvis, femur, skull, and vertebrae and infrequently in the jaws.
maxilla, mandible
Although this disease is bilateral, occasionally it affects only one
maxilla, or the involvement may be significantly greater on one side.

Question 19

Paget’s Disease
Internal Structure:
* Generally, the appearance of the internal structure depends
on the developmental stage of the disease: three radiographic
stages although these often overlap in the clinical setting:

Answer 19

1. Early radiolucent resorptive stage.
2. A granular or ground-glass appearance.
3. A denser, more radiopaque appositional late stage.
   These stages are less apparent in the jaws.

Question 20

Paget’s Disease
Internal Structure: Radiographic pattern
* Linear:
* Granular:
* — appearance.

Answer 20

The trabeculae may be long and may align
themselves in a linear pattern, which is more common
in the mandible.
Similar to that of fibrous dysplasia.
Cotton-wool

Question 21

Paget’s Disease
Effects on Surrounding Structures:
* Always — an affected bone (3x, 4x)
* The outer cortex may be
* The — may become less evident and may be altered
into the abnormal bone pattern.
* Exuberant and irregular —
* The teeth may become

Answer 21

enlarges
thinned but remains intact.
lamina dura
hypercementosis
spaced or displaced in the enlarging
jaw.

Question 22

Paget’s Disease
Management
* Usually managed —
* — may be required to correct deformities
* Extraction sites heal —.
* Higher incidence of —
* –% of cases develop osteosarcomas

Answer 22

medically (bisphosphonates).
Surgery
slowly
osteomyelitis
10

Question 23

Osteopetrosis
A.K.A:

Answer 23

Marble Bone disease or Albers-Schoenberg Disease

Question 24

Osteopetrosis
Disease Mechanism
▪ Is an inherited disorder of bone that results from a defect in the

Answer 24

differentiation and function of osteoclasts → Abnormal formation of
bone and abnormal bone turnover thereafter.

Question 25

Osteopetrosis
▪ The failure of bone to remodel causes the bones to become

Answer 25

densely
mineralized, fragile, and susceptible to fracture and infection

Question 26

Osteopetrosis
▪ — is retarded and cranial nerves may be compressed
▪ Prevalence:

Answer 26

Hematopoiesis
1 in 100,000 to 500,000.

Question 27

Osteopetrosis
Clinical Features
▪ Three clinical forms:

Answer 27

▪ Infantile malignant:
▪ Intermediate:
▪ Benign or Adult type:

Question 28

Osteopetrosis
▪ Infantile malignant:

Answer 28

Autosomal recessive. Apparent short after birth. Fatal within the first few years of
life

Question 29

Osteopetrosis
▪ Intermediate:

Answer 29

Autosomal recessive or dominant. Occurs in the first decades of life and can allow a
normal life expectancy. Severity is variable

Question 30

Osteopetrosis
▪ Benign or Adult type:

Answer 30

Autosomal dominant. Full life expectancy. Mild symptoms in late childhood to
adulthood.

Question 31

Osteopetrosis
Infantile
▪ Progressive deposition of bone results in narrowing of bony canals and foramina →
▪ Diminished marrow spaces→
▪ Delayed

Answer 31

sensorineural and sensorimotor deficits including hydrocephalus, blindness, deafness, vestibular nerve dysfunction, and facial nerve paralysis, etc
Affects hematopoietic development of blood cells
dental eruption

Question 32

Osteopetrosis
Adult:
▪ symptoms
▪ It may be discovered at
▪ Diminished marrow spaces secondary to the deposition of
bone →

Answer 32

May be entirely asymptomatic or have mild signs and symptoms.
any time from childhood into
adulthood as an incidental finding, or it may manifest as a
bone fracture.
Affects hematopoietic development of blood cells
→ anemia, leukopenia, and thrombocytopenia.

Question 33

Osteopetrosis
The increased bone density and relatively poor vascularity:

Answer 33

Higher risk of osteomyelitis.

Question 34

Osteopetrosis
Imaging Features
Effects on the teeth and jaws.
▪ Because this condition is systemic, the changes affect
▪ The bone may be so dense that
▪ The lamina dura and cortical boundaries
▪ Effects on teeth: (4)

Answer 34

all bones (it is bilateral and symmetrical)
teeth roots and other structures within the bone may not be apparent
are thickened or blended into the surrounding dense bone

missing teeth, malformed roots and crowns,
poorly calcified teeth and delayed eruption as a result of the
increased bone density.

Question 35

Osteopetrosis
Management
(2)

Answer 35

▪ Bone marrow transplantation to attempt to
stimulate the formation of functional osteoclasts.
▪ When osteomyelitis develops it is difficult to treat,
and a combination of antibiotics and hyperbaric
oxygen therapy is used. Prevention of odontogenic
inflammatory disease is key