As far as Benign non-odontogenic tumors of bone go, these 2 are similar, but what differentiates them is size.
- More than 2cm is Osteoblastoma
- Less than 2cm is Osteoid osteoma
- Very similar disease processes, very RARE, but usually in males under 30
- Painful swelling relieved by Aspirin
This benign non-odontogenic tumor is always used to a tooth
- Similar to Osteoblastoma and osteoid osteoma, are Very rare.
- ROOT FUSION is the defining feature.
- Can seem similar to Cementoosseus dysplasia but the radiolucent rim is most uniformly thin, Spoke wheel pattern can sometimes be seen
The hard bone equivalent of Fibromatosis (soft tissue growth of spindle cells)
- Desmoplastic fibroma (benign aggressive)
- Only occurs in bone, seen in young patients, posterior mandible, diagnosis based on histology.
Most bening lesions do this to teeth and bone
- Because benign lesions have separate plane of cleavage from the normal anatomy
- Also because they are slow growing, if it were fast growing it will resorb bone
Most common tumor dentist encounter
- Exostosis (tori), is really just a hyperplasia of cortical plate (not a true neoplasm)
- Cause unknown, palatal and mandibular common
A true bone neoplasm needs to be
- A neoplasm of mature compact of cancellous bone
- Histologically identical to exostosis
- Most common in frontal and ethmoid sinus or lingual mandible posterior to premolar or mandibular condyle.
Multiple osteomas of craniofacial complex...
Gardner syndrome, can lead to malignant adenomatoid malignant polyps
Most benign neural tumors
- Schwannoma (more common in bone, from schwann cells only) and Neurofibromma
- True neoplasms of neuroectodermal origin
- Commonly in Neurovascular canals and foramina
Multiple beningn neural tumors Neurofibromatosis I (von recklinhausen disease of skin. Can be intra-extra osseus with potential for malignant transformation.
Non-neoplastic mass of vascular tissue, more common in young girls with throbbing pain and pulsation.
- Hemangiona and Arteriovenous malformation.
- Risk of lethal exsanguination, Serpinginous appearance of vascular canals.
- Outside of bone have sunray specules, without the facial Mass like osteosarcoma
- Can be seen as a phleboliths and resorption of adjacent bone
Radiographic lesions that looks malignant and have an irregular radiopaque internal pattern, with a widening of the PDL
- Chondrosarcomas (very rare in jaws, in joints, cartilage)
- Osteoblastic metastasis (breast for women or prostate for men)
- ALL 3 should be in the differential diagnosis
Rare bone neoplasm, clinically accompanied by signs of inflammation
- Ewings sarcoma
- Very rare in jaws, more in mandible posterior
Lesion that presents as a multiple, well defined, with punched-out radiolucencies.
- Multiple Myeloma
- Most common hematologic cancer in bone
- In black men 60s-70s common
- Aggressive systemic disease
Lesion that presents as a multiple, well defined, with punched-out radiolucencies.
- Non-hodgkins lymphoma
- Presents with widening PDL space and dissolving bone
- Heterogenous group of malignancies of lymphoreticular origin
- Adult patient
Lesion that characteristically presents as scooped out radiolucencies at the mid-root level.
- Langerhans cell histiocytosis
- Seems like periodontal disease, but the epicenter is at the midroot level of the teeth (scooped out)
- - Usually multifocal
For maligant lesions what must always be on the radiographic differential diagnosis?
- Metastatic carcinoma to the jaw bones
- Spread of malignant neoplasms originating from sites below the clavicles to the jaw bones
- Usually elderly patient, bilateral presentation
- Common types of cancer that metastasize to jaw use Mnemonic BLT CKP (cold kosher pickle)
- Breast, Lung, Thyroid, Colon, Kidney, Prostate, these cancers travel up the Venous plexus to the jaws
In older patients osteosarcoma can also be a sign of
- Pagets disease of bone.
- Osteosarcoma: malignant mesenchymal neoplasm that produces osteoid (immature bone), young adult male (30s-40s), painful agressive
- In patients with previous radiation, osteosarcoma secondary to post-irradiation.
- Posterior, max=min
- ***Ill-defined bone sclerosis and irregular widening of PDL (MUST put Osteosarcoma and chondrosarcoma 2nd cuz rare)
What is the order of development of the sinuses?
- Maxillary, Ethmoidal (pre birth), Sphenoid (at 2 yrs old) and Frontal (at 4 yrs old)
- Waters view (head tilted back) gives the best view of sinuses because they dont overlap
- - Cone beam CT are now best for sinuses
- - Panoramic xrays can see Pneumatization of alveolar processes
Localized submucosal accumulation of fluid forming a sessile, dome-shaped swelling along the sinus border?
- Antral Pseudocyst (not a true cyst)
- it is a common radiographic finding on panoramic xrays on floor of maxillary sinus
- Non-corticated opacity, unknown origin, self resolving
Deposition of mineral salts around exogenous or endogenous nidus, in sinus.
- Antrolith (stone in sinus)
- Can be small (incidental finding) or large (painful, discharge)
- Non-resolving can be considered Asgergillosis (mycetoma fungal ball), refer
Sinus mucosa becomes 10 to 15 times thicker than normal when inflamed from infection or allergen.
Mucositis (common finding)
Sinus mucosa becomes inflamed and thickened from infection or allergen, leading to blockage of sinus drainage and retention of sinus secretions.
- Sinusisits (10% are from dental infections)
- Acute sinusitis - usually from common cold, fluid
- Chronic sinusitis- thick mucosa, tenderness from pain, rhinitis, asthma, cystic fibrosis
Examples of malignant neoplasms in the sinus
- Salivary gland like adenocarcinoma
- * Notice loss of cortical bone, no sinus walls or floors. Missing anatomy
- Refer Biopsy for any unexplained radiopacity in Max sinus of a 40+ year old pt
Lamellar, periosteal reaction from periapical inflammatory disease, onion ring effect.
- Exudate from infected tooth diffuses through cortical bone, lifts and stimulates the periosteal lining to produce layers of new bone.
These 3 inflammatory processes of the jaws have the share the same disease mechanism, but are clinically classified using different terms based on the site and extent of the inflammation
- Periapical inflammation- can also cause condensing osteitis and progress to osteomyelitis.
These 3 jaw conditions have the same radiographic appearance, but have to be clinically correlated for proper diagnosis
- Osteoradionecrosis (ORN)
- Medicated-related oseteonecrosis of the jaws (MRONJ)
If inflammation in jaw spreads to two or more teeth and surrounding bone structures it is...
- Mostly seen in the mandible
- Inflammatory causes bone ischemia and bone sequestrum can be seen
- In children we can see Onion skin/lamellar periosteal reaction, in adults we dont see this reaction much because of osteogenic potential is less.
- Enlarged mandible can be seen when sequestrae gets filled in with bone
- Long bones in kids is Ewings sarcoma
If radiographs show generalized decrease in bone density of jaws (thin cortices, granular cancellous bone or loss of lamina dura), refer to a physician for lab tests and suspect...
- Brown tumor or hyperparathyroidism: localized focus of radiolucency
- Mandibular prognathism and incisor flaring: Acromegaly
- Premature shedding of primary incirors: Hypophosphatasia
- Enamel hypoplasia, Enlarged pulp chamber, PA abscess with no obvious infection: Hypophosphatemia, Vit D deficiency
Woman complaining of stones, bones and abdominal groans (ulcer) with an association with Brown tumors (giant cell lesions).
- Primary hyperparathyroidism: uncontrolled hormone production by parathyroid neoplasm, exophthalmus, T4 elevated, TSH depressed
- Secondary: due to low calcium serum levels
- Terciary: Renal Osteodystrophy
Penguin Gait, (adult or kid names?), Gigantism (adullt or kid names)
- Rickets: Kids
- Ostemalacia : Adults
- Gigantism: kids
- Acromegaly: Adult
Enlarged pulp chambers and root canals.
What are the factors controlling CBCT dose?
- 1. Exposure parameters: kVp, mA, exposure (least for diagnostic image) time
- 2. Size of FOV (ALWAYS USE THE SMALLEST)
- 3. Scan of arc
- 4. Frame rate
- * Scatter is proportionate to volume
Indications for CT scan
- Dental implants
- Impacted teeth
- Inflammatory PA disease
- Acute dental trauma
- Follow-up dental trauma
- CBCT limitations compared to medical CT
- - Higher image noise
- - No soft tissue information
Danger in hyperthyroidism
- Thyroid storm, Thyrotoxicosis
- Delerium, hyperthermia, tachycardia, mortality 40%
- Most Thyroid problems are hypo (which is better)
Parathyroid does this..
- Produces PTH which controlled serum calcium levels (calcitonin)
- Hypocalcemia, Faliure of tooth eruption and hypoplastic enamel
- Need vitamin D
- - Pseudohypoparathyroidism can be seen too: hypoplasia, blunted of apices large pulp chambers.
Endocrine condition where primary teeth are lost early because of the lack of cementum production
- Decrease of serum alkaline phosphatase
- Increase of phosphoethanolamine in urine and blood
X-linked dominant condition that affects metabolism of vitamin D.
- Vitamin-D resistant rickets
- Bowed limbs, PA abscess and fistula can be visible with small lesions
- Early treatment with calcitriol, endo on teeth, monitor serum and calcium levels
Chronic iron deficiency, anemia, glossitis and dysphagia also associated with esophageal SCC
- Plummer-vinson syndrome
- Common in women 30-50
- Angular chelitis also seen
- Iron supplimentation
GI disorders with oral manifestations
- Chrons disease: transmural (patchy iflammation) granulomatous inflammation colon, intestines, Oral lesions can be the initial manifestations. Weight loss, swelling in mouth, lips, firm, cobble stone, aphthous ulcers, non-necrotizing granuloma
- Ulcerative colitis: Chronic inflammatory disease of colon, presenting with diarrhea, rectal bleeding, abdominal pain, weight loss, increased colon cancer , recurrent oral ulcers, fissures
Rare condition of oral manifestations of inflammatory bowel disease
- Pyostomatitis Vegetans
- Serpentine pustules, yellow, elevated
- oral lesions appear at the same time as bowel movements.
- Treated with prednisone
Deposition of amyloid, represents a wide range of conditions, associated with multiple myeloma or chronic infections.
- Types:Reactive systematic, localized dermal, hereditary, hemodialysis associated.
- Macroglossia: can be massive, Gingiva spongy, xerostomia in salivary glands
- Rectal/salivary biopsy to confirm, deposit of eosinophilic material
- No treatment available for most types, chemo drugs, death due to cardiac failure, arrythmias, renal failure
A rare complication of renal failure, with inflammatory complications in the mouth
- Uremic stomatitis
- Can be painful, bad taste, burning mouth, Odor of ammonia or urine can be detected.
- Lesions self resolve
Acquired dermatologic condition characterized by velvety skin, skin lesions, can be associated with GI malignancies.
- Acanthosis Nigricans
- Benign form can be inherited
- Malignant form usually adenocarcinoma of the GI tract, Thickening of skin
- Oral involvements:common with malignant form, lip tongue, thickening areas, hyperkeratosis
- Treatment: workup for GI testing