Radiographic Density in Oral Medicine

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Radiopaque lesions appear lighter on a radiograph
Types of radiopaque lesions:
- Radiopaque lesions with well-defined borders
  - Represent a benign or inflammatory process
- Radiopaque lesions with ill-defined borders
  - Indicate a more aggressive or neoplastic process

Can be due to:
- Inflammatory conditions
- Metabolic conditions
- Fibro-osseous lesions
- Malignant processes

Majority of jaw lesions are radiolucent (>80%)
Jaw lesions can be described based on:
- Density relative to adjacent bone
- Borders (well-defined or ill-defined)
- Number of loculi (unilocular or multilocular)
- Aetiology (inflammatory, neoplastic, etc.)

Evaluating the effect of a lesion on surrounding structures helps in inferring the behaviour of the lesion
Features to consider:
- Displacement of teeth
- Resorption of teeth
- Cortical destruction or expansion

Radiographic features vary depending on the time course of the lesion
Early stages:
- Loss of bone density
- Widening of the periodontal ligament space
- No evidence of sclerotic bone reaction
Later stages:
- More extensive bone loss
- Cortical destruction or expansion

Odontogenic keratocyst:
- Typically occurs in the mandible
- Well-defined, radiolucent lesion
- May displace teeth
- May cause cortical expansion
Ameloblastoma:
- Typically occurs in the mandible
- Multicystic, radiolucent lesion
- May displace teeth
- May cause cortical expansion
Fibrous dysplasia:
- Typically occurs in the maxilla
- Radiolucent, ground-glass appearance
- May cause cortical expansion
- May displace teeth
Cementoblastoma:
- Typically occurs in the mandible
- Periapical, sclerotic, sharply marginated lesion
- Fuses directly to the tooth root
- More common in children and young adults

Alterations observed on panoramic radiographs that might compromise oral and general health
Examples:
- Calcified stylohyoid complex
- Arterial calcifications
- Sialolithiasis
- Phleboliths
- Tonsilloliths

Considered normal when it does not extend below the mandibular foramen
Considered elongated when it extends below the mandibular foramen
Causes:
- Local chronic irritations
- History of trauma
- Endocrine disorders in female at menopause
- Persistence of mesenchymal elements, bone tissue growth, and mechanical stress or trauma during stylohyoid ligament development

Dystrophic calcification
Deposited calcium salts in chronically inflamed or necrotic tissues
Indicate a high risk of cardiovascular disease### Atherosclerotic Plaques
Atherosclerotic plaques in the extracranial carotid vascular path are the primary cause of vasculocerebral embolism and obstructive diseases.
Plaques develop when fatty substances, cholesterol, platelets, cellular waste products, and calcium are deposited in the artery lining.
Risk factors for atherosclerosis include: diabetes mellitus, obesity, hypertension, smoking, inadequate diet, chronic kidney disease, and menopause.

Calcified carotid atheroma initially develops at the bifurcation of arteries, soft tissues of the neck, and adjacent to the greater horn of the hyoid bone and the cervical vertebrae C3 and C4 or the intervertebral space between them.
Radiographically, calcified carotid atheroma appears radiopaque, usually multiple and irregularly shaped, with a vertical distribution and internally heterogeneous radiopacity.

Sialolithiasis is the most common disease of the salivary glands, characterized by obstruction of salivary secretion by a calculus, associated with swelling, pain, and infection of the affected gland.
Imaging features of sialolithiasis may include a single sialolith in the right submandibular gland, calcification in the right parotid gland and its duct, calcifications in the right submandibular and parotid glands, and multiple microliths in the parotid gland on both sides.

Phleboliths are idiopathic calcifications that result from the deposition of calcium in normal tissue, despite normal serum levels of calcium and phosphate.
Phleboliths are calcified thrombi found within vascular channels, often in the presence of hemangiomas or vascular malformations.
Imaging features of phleboliths may include multiple phleboliths on the right side.

Tonsilloliths are calcifications within a tonsillar crypt, which involve primarily the palatine tonsil, caused by dystrophic calcification as a result of chronic inflammation.
Imaging features of tonsilloliths may include multiple tonsilloliths in the lower one-third of the mandibular ramus on both sides.