Oral pathology - Disease of-jaw-bone
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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.
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Oral pathology - Disease of-jaw-bone
- 1. DISEASES OF JAW BONE Dr :Tareq al_shawabkeh BY
- 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