Bone Pathology

  1. Most common inherited bone disease 
    Impairment of Type I collagen maturation 
    Clinically: opalescent teeth, maxillary hypoplasia, blue sclera, can present as class 3 malocclusion
    Radiographically: bone fragility, teeth may have obliterated pulps or may be shell teeth
    Osteogenesis Imperfecta
  2. Really hard bone (marble bone disease)
    Defect in remodeling because of dysfunctional osteoclasts
    Progressive loss of marrow space
    Normocytic anemia and hepatosplenomegaly from extra medullary hematopoiesis 
    delayed eruption and osteomyelitis
    Infantile form: severe (AR)
    Radiographically: difficult to differentiate cortical from trabecular bone
  3. Genetic defect in osteoblast differentiation and bone formation 
    Autosomal dominant
    Clinical: large head with frontal and parietal bossing, clavicles absent or hypoplastic, prolonged baby tooth retention, mandibular prognathism, supernumerary teeth
    Cleidocranial dysplasia
  4. An asymptomatic and incidental finding that presents as the area of marrow of sufficient size to be seen radiographically 
    Radiographic (not pathognomonic): RL or with fine trabeculation
    Focal osteoporotic marrow defect
  5. Focal area of increased RO of unknown cause 
    dense bone islands/ exostosis
    NOT condensing osteitis/focal chronic sclerosing osteomyelitis (these are always associated with inflammation)
    Very common and 90% found in mandible
    Usually vital pulp with no or small restorations 
    Radiographically: well-defined rounded or elliptical RO mass, some may be missed RO/RL, not surrounded by a RL rim, may be periapical, interradicular
    Idiopathic osteosclerosis
  6. Inflammation of bone and marrow typically caused by infection
    S. aureus is the most common pathogen
    May be acute or chronic, local pain, swelling and redness, fever, malaise, and leukocytosis 
    May spread to soft tissue with draining sinus
    May separate out a sequester (non-vital bone) or an involcrum (vital bone)
  7. Inhibits osteoclasts and angiogenesis, have the most harmful effectives in IV form
  8. Spontaneous and progressive Destruction of one or more bones
    Replaced by vascular tissue, which eventually fibroses
    Cause unknown 
    See in children and young adults 
    Signs: mobile teeth, pain, malocclusion, deviation of mandible, clinical deformity 
    Radiographically: loss of lamina dura and cortical thinning, RL foci with indistinct boarders
    Massive osteolysis (Gorham Disease)
  9. Abnormal and anarchic resorption and deposition of bone 
    Cause is known: possibly genetic, viral, inflammatory/endocrine
    More common in older white men, in the maxilla
    usually asymptomatic but if symptomatic pain is the most common
    Most cases are polyostotic (multiple bones affected)
    Radiographic: decreased RP, altered trabecular pattern, cotton wool appearance
    Elevated serum alkaline phosphatase!
    Paget's Disease of the bone
  10. Most common in children and young adults
    Most common in the mandible
    Involves the first molar or regions anterior to it  
    Non aggressive (most cases)
    and aggressive types 
    Radiographic: well-demarcated, non-corticated RL lesions, uniloclear (most), or multiloclear, can cause expansion or perforation of cortical plate
    Central Giant Cell Granuloma
  11. AD developmental jaw condition
    Diagnosed between age 2-5 
    Progression until puberty, then stabilization and regression
    Painless bilateral facial swelling, usually symmetrical and in the mandible 
    Radiographically: multiloclear, bilateral RL areas
  12. Cause unknown
    AKA: Hemorrhagic bone cyst, idiopathic bone cavity, traumatic bone cyst, solitary bone cyst 
    Majority found in long bone diaphyses, most last signs and symptoms 
    Radiographic: well-circumscribed RL area, may scallop between roots (high suggestive but not diagnostic), teeth generally vital 
    No epithelial lining-->not a true cyst
    Simple bone cyst
  13. Intraosseous accumulation of blood-filled spaces with CT and reactive bone, 
    Cause and pathogenesis unknown
    Most commonly found in long bones or vertebral column
    Most in posterior jaws, not usually painful 
    Radiographic: uni or multilocular, well-defined or diffuse
    Aneurysmal bone cyst
  14. A non-neoplastic developmental disturbance of bone growth 
    Slow growing, bony expansion and asymmetry 
    Disease burns out after puberty
    Radiographic: RO jaw lesions, ground glass appearance, narrowing of PDL space
    Fibrous Dysplasia
  15. Involves one bone
    80-85% of cases (more common), begins in childhood/adolescence
    Monostotic Fibrous Dysplasia
  16. Involves multiple bones and begins early in life 
    Jaffe-Lichtenstein syndrome: FD+ cafe au lait melanin-pigmented areas
    McCune Albright syndrome: FD+ pigment+ multiple endocrinopathies
    Polyostotic Fibrous Dysplasia
  17. Occurs in the tooth-bearing areas of the jaws and is very common
    focal, periapical and florid types
    Cemento-osseous dysplasia
  18. Cemento-osseous dysplasia that occurs in a single location
    Most common in females, higher percentage in whites than blacks 
    posterior mandible 
    Mixed RO/RL with a thin RL rim 
    Well-defined with irregular boarders
  19. Cemento-osseous dysplasia that is found in the anterior mandible that has multiple foci 
    Most common in black females
    Vital pulp; insignificant restorations
    Opaque mass surrounded by a thing RL rim
    PDL is intact
  20. Cemento-osseous dysplasia that is multifocal
    may be in all four quadrants
    may present with sequestra, usually asymptomatic
  21. How do you differentiate between focal cemento-osseous dysplasia and ossifying fibroma
    • Ossifying fibroma separates cleanly from surrounding bone
    • COD is easily fragmented and gritty
  22. uncommon, benign neoplasm with significant growth potential 
    Not to be confused with peripheral ossifying fibroma, which is reactive and peripheral
    Mandible molar and premolar areas most common site
    Radiographic: well-defined, unilocular lesion, may appear as RL or mixed RL/RO
    Central ossifying fibroma
  23. Benign tumor of compact bone 
    Usually only occur on the bones of the head and jaws 
    If on condyle may affect occlusion
    Radiographic: circumscribed, sclerotic masses, may be uniformly sclerotic or have central trabecular area
    Seen with Gardner syndrome
  24. AD, 100% penetrance disease
    Multiple intestinal polyps, many will transform to adenocarcinomas 
    Multiple epidermoid cysts of skin, Thyroid cancer
    Multiple osteomas are an early sign, supernumerary teeth, impacted teeth, odontomas
    Gardner syndrome
  25. Benign neoplasm arising from osteoblasts 
    most before age 30
    size 2-4 cm in diameter
    Pain is common sign, NOT relieved by aspirin
    well or poorly defined RL lesion with patchy mineralization
  26. Benign neoplasm arising from osteoblasts
    Most smaller than 2 cm in diameter
    Nocturnal pain relieved by aspirin
    well-circumscribed RL defect with a surrounding zone of reactive sclerosis
    Osteoid Osteoma

    think: ooo that hurts! let me take some aspirin
  27. Odontogenic benign tumor of cementoblasts 
    Posterior mandible, children and young adults, pain and swelling in 2/3 of patients 
    RO mass fused to one or more roots with a thin RL line surrounding the mass
  28. Benign neoplasm that produces mature hyaline cartilage
    Uncommon in head and neck, but common elsewhere
    Most on condyle or anterior
    painless and slowly growing 
    RL with central RO areas
  29. Malignancy of bone-forming cells
    Most common malignancy to originate in the bone
    Most are intramedullary, mean age for gnathic is 33 years
    Signs: swelling, pain, toothache, loose or displaced teeth, bleeding, paresthesia 
    Barrington sign-->wide PDL space (multiple teeth)
  30. Malignant tumor of cartilage-forming cells
    More frequently in maxilla
    Presents as a painless mass or swelling
    Radiographic: sun-burst appearance, poorly-defined, RL, RO or mixed
  31. Malignant tumor of bone that occurs mainly in children and young adults 
    Vast majority in caucasians
    Very uncommon in the jaws
    Ewing sarcoma
  32. Most common tumor involving bone
  33. Order in which carcinomas are likely to metastasize to bone
    Breast, Lung, Thyroid, Kidney, Prostate

    BLT Kosher Pickle
  34. Often the first sign of cancer
    More common in mandible than maxilla
    Radiographic: usually poorly defined, diffuse, mostly RL lesion, may cause widened PDL space (garrington sign)
    Cancer mets to bone
Card Set
Bone Pathology
Final Exam Material