This document summarizes various diseases that can affect the jaw bone. It discusses inherited conditions like osteogenesis imperfecta and achondroplasia. It also covers infections like osteomyelitis, inflammatory conditions like fibrous dysplasia, and tumors originating from bone or other tissues that can develop in the jaw. For each condition, it provides details on characteristics, clinical presentation, radiographic appearance, and other relevant information.
2. Inherited and developmental Diseases
of bone :
Osteogenesis Imperfecta (brittle bone syndrome)
Osteopetrosis-marble bone disease
Achondroplasia
Cleidocranial dysplasia
Cherubism
Achodroplasia
Fibro-osseous lesions
Fibrous dysplasia of bone
Cemento-osseous dysplasia
3. Osteogenesis Imperfecta(brittle
bone disease)
Hereditary diseases
Caused by mutations in type-1 collagen
Four main types :
.Type I: autosomal dominant, blue sclera, premature deafness ,with
or without dentinogensis imperfecta
autsomal dominant.:Type II
autsomal dominant ,severe osteoporotic bone:Type III
Type IV :similar to type I but more severe
Other abnormatities, joint hypermobility, thin translucent
skin ,heart valve defects,
4. Osteopetrosis-(marble bone
disease)
Rare disease
Excessive density of all bones
2nd anaemia
Weak bone fractures are common
Delayed eruption of teeth
Osteomyelitis common complication after tooth
extraction
Radiographicaly
bone density
Roots of the teeth invisible on RG
Mandible more affected than maxilla
5. A chondroplasia
An autosomal dominant trait
It is the most common form of dwarfism
Abnormality in endochondral ossification
The trunk and head are of normal size but the limbs
are excessively short
The middle third of the face is retrusive
Malocclusion is common
No effective treatment
6. Cleidocranial dysplasia
An autosomal dominant trait
Abnormalities of the skull,jaws &clavical
Dental anamoles are common
Delayed closure of frontale
Nasal bridge is also depressed
Partial or complete absence of the clavicles
Dental manifestation
Narrow high arched palate
Many or most permanent teeth typically remain
embedded in the jaw
Many additional unerupted teeth also present
Sometimes many dentigerous cysts
7. cherubism
An autosomal dominant trait
Males are affected about twice as frequently as females
But there is reduction in deformity of puberty2-4 age
Symmetrical swelling ,mandible bilateral ,may affect maxilla
the eye appear upturned to heaven
Dental aspect
Premature loss of deciduous teeth
Lack of eruption , failure of development of many permanent teeth
Radio graphically
Maltilocular radiolucencies with expansion
8. Fibro-osseous lesions
Characterized by the replacement of normal bone by
fibrous tissue
A . Osseous dysplasia
Fibrous dysplasia
_ monostotic
_ polyostotic
Cemento-osseous dysplasia
B .Benign neoplasia
Ossifying fibroma /cemento-ossifing fibroma
9. Fibrous dysplasia of bone
Monostotic fibrous dysplasia:
More common than polyststic
Affect limb,rib ,skull bone &jaw
Maxilla >mandible
Present in achildhood or adolescent but diagnosis at adult life
Painless swelling –fusiform expansion-
When max. affected prominence of cheek&buccal
expansion
Mand. Molar-premolar region
depth of the jaw
Tipping, displacement of teeth
Radiographically
Ground-glass or orange-peel
Treatment:
Cosmetic contouring when growing completed
10. Polystotic fibrous dysplasia
Two to three times are common in females as males
Affecting bones of one limb,especially the lower but
the skull,vertebrae,ribs &pelvis
Usually associated with other systems
involvement (Albright’s syndrome)
Café au lait spots
Precocious puberty in female
Endocrine abnormalities
N.B
Margins of lesion merge with surrounding
normal bone
Few cases of malignant transformation to
fibrosarcoma
Majority of cases are treated by conservative
surgical removal of the lesion
11. Cemento-osseous dysplasia
More in women than men
Occurs predominantly in the mandible
>30 yrs of age
Clinically
May be multiple and small <1cm diameter
Lesions are multiple,large &involve one or more
quadrants
12. Alveolar osteitis (dry
socket)
A localized inflammation of the bone following
either the failure of a blood clot to form in the
socket ,or premature loss or disintegration of the
clot
Occurs mainly in the mandible
Severe pain few days after extraction ,foul taste
Predisposing factor:
Paget disease
After radiotherapy
Excessive use ofV.C
Excessive mouth rinsing
13. Focal sclerosing (condensing)
oseitis
Periapical inflammation
Result from low-grade irritation &or high tissue
resistance
Seen at the apex of the a tooth, most commonly
1st Per Molar
Asymptomatic
14. Suppurative osteomyelitis
Divided clinically into acute & chronic types
Anaerobic organisms predominate
Mandible >maxilla
Clinically
acute suppurative present with
Pain, swelling ,pyrexia &malaise ,trismus ,paraesthesia of th
lip &mobility of teeth
Chronic present with
chronic suppuration &discharge of pus through one or
More intraoral or extraoral sinuses
radiograph
Moth _eaten radiolucency
OSTEOMYLITIS
15. Sclerosing osteomyelitis
Is a controversial condition
Localized lesions are identical to focal
sclerosing osteitis
Diffuse lesion are complication of low grade
infection
16. Chronic osteomyelitis with
proliferative periostitis
(garres osteomyelitis
periostitis ossificans)
Seen almost in the mand in children &young
adults
Bony hard swelling on the
outer surface of the mand
Show a focal subperiosteal overgrowth of
bone with asmooth surface on the outer
cortical plate
17. Chronic periostitis associated with
hyaline bodies (pulse
granuloma,vegetable granuloma)
An unusual form of chronic periositis
Histologically
With hyaline ring-shaped bodies accompanied by
foreign-body ,giant-cell reaction
associated with fibrous thickening of the periosteum
,periostitis, chronic suppuration
The vegetable material access to the tissues via a
tooth socket, surgical flap, open root canal ,or
through other breach in the mucosa such as
Traumatic ulceration associated with ill-fitting
denture
18. Radiation injury &
osteoradionecrosis
Radiation affects the vascularity of the bone
Causing a proliferation of the blood vessels
Infection may spread resulting in extensive
osteomyelitis &painful necrosis of the bone
Sloughing of the overlying oral &occasionally
soft tissues
19. Metabolic and endocrine
disorders of bone
Osteoporosis
Primary hyperparathyroidism
secondary hyperparathyroidism
Rickets and osteomalacia
Acromegaly
20. osteoporosis
Result either when the bone loss is excessive or opposition
of bone is reduced
In postmenopausal women
Female more than male
Is accentuated in several other diseases cushing syndrome,
thyrotoxicosis & primary hyperparathyroidism
Normal composition but it is reduced in quantity,
radiolucency of bone,
21. Primary hyperparathyroidism
Common disease
Seen in middle aged women
Results from excessive parathormone
secretion
Excess secretion of the hormone results in
hypercalcaemia &hypercalciuria
Histologically
Osteoclastic activity ,focal areas of bone
resorption result in the formation brown
tumours
22. Secondary
hyperparathyroidism
Occurs in response to chronic hypocalcaemia
As a result of chronic renal failure
The bone changes are complex and are mixture
of those associated with osteomalacia &
hyperparathyroidism
23. Rickets and osteomalacia
Rickets and osteomalacia are due to deficiency
resistance to the action of vit D
Lack of exposure to sunlight or dietary causes
The bone present is normally mineralized
Dental abnormalities include
Enamel hypoplasia
width of the predentine
Large amounts of interglobular dentine
24. acromegaly
Excessive secretion of growth hormone
After fusion of epiphysis
Enlarged jaw and protrusive
Spaced teeth & macroglossia
Lips ,,nose ))Enlarged soft tissue
25. Pagets disease of bone
A etiology involves genetic & environmental factors, paramyxovirus
infection
Affect old ages >40 yrs
Can be divided into three phases:
1-an initial predominantly osteolytic phase
2-an active stage of mixed osteolysis &osteogenesis
3-apredominantly osteoblastic or sclerotic phase clinically:
Cranial nerve compression
Enlarge of the maxilla
In dentate pts derangement of the occlusion
,spacing of the teeth
Hypercementosis
Difficulty in extraction , postextraction haemorrhage
Highly vascular marrow ,bone pain
N.B blood chemistry ALK- phosphatase
Radio graphically appear as cotton-wool appearance
26. Central giant cell
granuloma
F >M
In the second and third decades
Mandible more than maxilla
Swelling of the bone , growth may sometimes be rapid
Radiograhically
Apprear as a well-defined radiolucent area
,perforation of the cortex
Involved teeth may be displaced
,roots show resorption
Histologically
Showing collections of multinucleated osteoclast-like giant
cells in a vascular spindle cell stroma
27. Torus palatinus ,torus
mandibularis, & other
exostosesBony outgrowths
Unknown etiology
Occurs at either midline of the palate(torus
palatinus),or on the lingual surface of the
mandible in the PM region (torus
mandibularis
Mand. Tori are bilateral
Palatal tori > mand.Tori
28. Dense bone island
Localized area of sclerotic bone
In the premolar-molar region of the mandible
Radiographically
Well-defined , dense
Not surrounded by radiolucent space
29. Tumours of bone
Bone-forming tumours
(a)Benign osteoma
osteoblastoma
(b)Malignant osteosarcoma
Cartilage-forming tumours
(a)Benign chondroma
(b)Malignant chondrosarcoma
Marrow tumours
(a)Myeloma
(b)Other types
Fibrous tumours
Benign ossifying (cemento-ossifying) fibroma
Tumours -like lesions in the bone
(a) Langerhans cell histiocytosis
(b) Haemangioma of bone
Metastatic tumours
30. Osteoma &osteoblastoma
Osteoma
Benign-slow growing of bone
Mandible>maxilla
Histologically : can be divided into compact and
cancellous types
Solitary , multiple osteomas occur as afeature of Gardne
syndrome
Osteoblastoma
Rare tumour in the jaws
Histologically &radiographically it reembles the
cementoblastoma but it is not related to the root of the
teeth
31. osteosarcoma
Commonest malignant tumor of the bone
Around 30 years of age
Radiographically
Appear as a radiolucent
, radiopaqe or
mixed lesion
Histologically
Formation of abnormal osteoid or bone by
malignant osteoblasts
32. Chondroma & chondrosarcoma
Rare tumours
Ant part of the max &post part of the mand
Originate in the condylar processes
Chondroma is a benign tumour characterized
by formation of mature cartilage
Prognosis for chondrosarcoma is better for
mand compared to max
33. Myeloma
Neoplasm composed of plasma cell
Multiple myeloma or Solitary myeloma
50 -70 yrs
Affect the skull ,, vertebra ribs and pelvic
Radiographically
Punched out RL
34. Ossifying (cemento-ossifying)
fibroma
Benign neoplasm
Consist of fibrous tissue containing varying amounts
of bony trabeculae &rounded calcified bodies
Clinically
Most often in the PM-molar region of the mandible
Radiologically
Well-demarcated radiolucent
area as the lesion matures
,varying amounts of calcified
tissue are deposited
35. Langerhans cell
histiocytosis
Male more than female
Under 20 yrs old
It presents in one of three main ways:
As a solitary lesion in the bone
Multifocal eosinophilic (hand schuller – christion
syndrome )
(3)As disseminated multiorgan disease
Radiographs
Show either a solitary or multiple osteolytic lesions
Teeth may appear to be floating in air
36. Haemangioma of bone
Rare lesion
Mandible>maxilla
Radiographically
Multilocular honey-comb appearance
Aspiration will reveal fresh blood