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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
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This benign non-odontogenic tumor is always used to a tooth
- Cementoblastoma
- 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
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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.
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Most bening lesions do this to teeth and bone
- Expand
- 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
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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
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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.
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Multiple osteomas of craniofacial complex...
Gardner syndrome, can lead to malignant adenomatoid malignant polyps
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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.
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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
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Radiographic lesions that looks malignant and have an irregular radiopaque internal pattern, with a widening of the PDL
- Osteosarcoma
- 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
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Rare bone neoplasm, clinically accompanied by signs of inflammation
- Ewings sarcoma
- Very rare in jaws, more in mandible posterior
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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
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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
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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
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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
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In older patients osteosarcoma can also be a sign of
- Pagets disease of bone.
- 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)
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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
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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
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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
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Sinus mucosa becomes 10 to 15 times thicker than normal when inflamed from infection or allergen.
Mucositis (common finding)
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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
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Examples of malignant neoplasms in the sinus
- SCC
- Lymphoma
- Salivary gland like adenocarcinoma
- Melanoma
- Sarcoma
- * 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
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Lamellar, periosteal reaction from periapical inflammatory disease, onion ring effect.
- Periostitis
- Exudate from infected tooth diffuses through cortical bone, lifts and stimulates the periosteal lining to produce layers of new bone.
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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.
- Periocorinitis
- Osteomyelitis
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These 3 jaw conditions have the same radiographic appearance, but have to be clinically correlated for proper diagnosis
- Oseomyelitis
- Osteoradionecrosis (ORN)
- Medicated-related oseteonecrosis of the jaws (MRONJ)
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If inflammation in jaw spreads to two or more teeth and surrounding bone structures it is...
- Osteomyelitis
- 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
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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
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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
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Penguin Gait, (adult or kid names?), Gigantism (adullt or kid names)
- Rickets: Kids
- Ostemalacia : Adults
- Gigantism: kids
- Acromegaly: Adult
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Hypophosphatemia showsteeth
Enlarged pulp chambers and root canals.
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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
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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
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Danger in hyperthyroidism
- Thyroid storm, Thyrotoxicosis
- Delerium, hyperthermia, tachycardia, mortality 40%
- Most Thyroid problems are hypo (which is better)
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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.
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Endocrine condition where primary teeth are lost early because of the lack of cementum production
- Hypophosphatasia
- Decrease of serum alkaline phosphatase
- Increase of phosphoethanolamine in urine and blood
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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
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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
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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
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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
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Deposition of amyloid, represents a wide range of conditions, associated with multiple myeloma or chronic infections.
- Amyloidosis
- 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
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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
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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
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