Systemic Diseases and Their Effects on Jaws
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Questions and Answers

Which of the following systemic diseases is characterized by an excess of parathyroid hormone (PTH)?

  • Hypoparathyroidism
  • Hyperparathyroidism (correct)
  • Hypophosphatasia
  • Osteopenia

    • What is one of the general radiographic findings observed in systemic diseases affecting the jaws?

  • Localized bone loss
  • Formation of dental caries
  • Increase in overall density
  • Change in the size and shape of the bone (correct)

    • Which condition is NOT typically caused by systemic diseases affecting the jaws?

  • Loss of lamina dura
  • Hypoplasia of enamel
  • Accelerated eruption of teeth
  • Caries development (correct)

    • What metabolic disorder may lead to osteomalacia?

    <p>Rickets</p> Signup and view all the answers

    Which of the following is a systemic condition that results in a decrease in bone density?

    <p>Thalassemia</p> Signup and view all the answers

    In which type of hyperparathyroidism does a benign tumor cause increased PTH and resultant hypercalcemia?

    <p>Primary hyperparathyroidism</p> Signup and view all the answers

    How do systemic conditions typically affect mature teeth?

    <p>They do not affect mature teeth</p> Signup and view all the answers

    Which of the following represents an endocrine abnormality that mobilizes calcium from the skeleton?

    <p>Hyperparathyroidism</p> Signup and view all the answers

    What is a common age range for individuals diagnosed with hyperparathyroidism?

    <p>30 - 60 years</p> Signup and view all the answers

    Which symptom is most directly associated with hypercalcemia as a result of hyperparathyroidism?

    <p>Renal calculi</p> Signup and view all the answers

    Which radiographic feature is characteristic of hyperparathyroidism?

    <p>Ground-glass appearance in the jaws</p> Signup and view all the answers

    What primarily causes true hypoparathyroidism?

    <p>Damage to the parathyroid gland</p> Signup and view all the answers

    Which neurological symptom may indicate hypoparathyroidism?

    <p>Parkinsonism</p> Signup and view all the answers

    What effect can hyperparathyroidism have on dental health?

    <p>Loss of lamina dura</p> Signup and view all the answers

    What is a common feature of brown tumors associated with hyperparathyroidism?

    <p>Cortical expansion</p> Signup and view all the answers

    What is the normal serum PTH level range?

    <p>10 to 55 pg/mL</p> Signup and view all the answers

    What is a common radiographic feature of hypoparathyroidism in the skull?

    <p>Calcification of basal ganglia</p> Signup and view all the answers

    What is a clinical feature of hyperthyroidism in children?

    <p>Premature loss of primary teeth</p> Signup and view all the answers

    Which of the following is NOT a feature associated with hypothyroidism in adults?

    <p>Tachycardia</p> Signup and view all the answers

    What is the primary nutritional deficiency leading to rickets?

    <p>Vitamin D</p> Signup and view all the answers

    What condition is characterized by an imbalance in bone deposition and resorption leading to decreased bone formation?

    <p>Osteopenia</p> Signup and view all the answers

    Which of the following is a clinical feature of osteopenia?

    <p>Bone pain</p> Signup and view all the answers

    Which of the following dental features is often observed in hypothyroidism?

    <p>Thin lamina dura</p> Signup and view all the answers

    What is a recommended management strategy for osteopenia?

    <p>Weight-bearing exercises</p> Signup and view all the answers

    Which symptom is indicative of osteomalacia?

    <p>Bone pain</p> Signup and view all the answers

    What is a common radiographic feature of rickets?

    <p>Thinning or missing of cortical structures</p> Signup and view all the answers

    Which condition is characterized by an overall radiolucent appearance and sparse trabeculae?

    <p>Osteomalacia</p> Signup and view all the answers

    What complication may arise from osteopetrosis due to the lack of vascularity in dense bone?

    <p>Osteomyelitis</p> Signup and view all the answers

    What is the typical clinical feature observed in children with severe osteopetrosis?

    <p>Hydrocephalus</p> Signup and view all the answers

    Which radiographic feature indicates chronic cases of osteomalacia?

    <p>Pseudofractures occurring in ribs</p> Signup and view all the answers

    What dental issue is commonly seen in patients with osteopetrosis?

    <p>Early tooth loss</p> Signup and view all the answers

    Which of the following symptoms is associated specifically with rickets?

    <p>Delayed eruption of teeth</p> Signup and view all the answers

    What is a significant radiographic feature of sickle cell anemia in the jaws?

    <p>General osteopenia</p> Signup and view all the answers

    Which of the following describes the typical appearance of the skull in thalassemia?

    <p>Widening of the diploic space</p> Signup and view all the answers

    What clinical symptoms are associated with a severe exacerbation of sickle cell anemia?

    <p>Severe abdominal pain and high temperature</p> Signup and view all the answers

    Which radiographic feature is not typically seen in patients with sickle cell anemia?

    <p>Increased trabecular density</p> Signup and view all the answers

    What is a common physical feature associated with thalassemia in adults?

    <p>Rodent-like face</p> Signup and view all the answers

    In relation to radiographic features, what is true about the alveolar bone in individuals with thalassemia?

    <p>Large marrow spaces and thin lamina dura</p> Signup and view all the answers

    Which of the following accurately describes the bone condition in sickle cell anemia?

    <p>Thinning of cancellous trabeculae due to hyperplasia</p> Signup and view all the answers

    What is the impact of sickle cell anemia on x-ray imaging of bones?

    <p>May appear underexposed due to inadequate penetration</p> Signup and view all the answers

    Study Notes

    Systemic Diseases Manifested in the Jaws

    • Systemic diseases affect the entire body, and radiographic changes in the jaw reflect these generalized effects.
    • Changes include alterations in bone size, shape, and density.
    • The number, size, and orientation of trabeculae also change.
    • Cortical structures' thickness and density are impacted.
    • Overall bone density can increase or decrease.
    • Systemic conditions affecting bone density typically do not affect mature teeth.
    • Images of teeth can stand out from a radiolucent jaw, showcasing normal tooth density.

    Changes to Teeth and Associated Structures

    • Eruption can be accelerated or delayed.
    • Hypoplasia is observed.
    • Hypocalcification can occur.
    • The lamina dura is sometimes lost.

    Hyperparathyroidism

    • An endocrine disorder featuring excessive parathyroid hormone (PTH).

    • This mobilizes calcium from the skeleton and increases renal calcium reabsorption, leading to increased serum calcium levels.

    • Two types exist: primary and secondary.

      • Primary results from a benign tumor.
      • Secondary arises in certain kidney diseases, compensating for hypocalcemia.

    • Diagnosis involves elevated PTH levels, hypercalcemia, and sometimes elevated serum alkaline phosphatase.

    • Age range is 30-60 years, more common in females.

    • Clinical features include renal calculi, peptic ulcers, cognitive impairment, bone and joint pain, and potential tooth drifting/loss.

    • Radiographic features include:

      • Teeth and associated structures: Loss of lamina dura, tapered appearance of teeth.
      • Jaws : Demineralization and thinning of cortical boundaries (particularly the inferior border of the mandible, the mandibular canal, and maxillary sinuses), overall decreased density and altered trabecular pattern (ground-glass appearance), presence of brown tumors with variable margins, causing cortical expansion.

    • Multiple or solitary brown tumors (differentiate from central giant cell granuloma) can be observed.

    • Other radiographic features include erosions in the phalanges, generalized demineralization, osteitis fibrosa cystica (single or multifocal, badly defined radiolucencies) calcifications in soft tissues (kidneys, joints) and a granular appearance of calvaria and jaw bones (“salt and pepper” skull).

    Hypoparathyroidism

    • True hypoparathyroidism: Damage to the gland, thyroid surgery.
    • Pseudo hypoparathyroidism: Target tissue defect in responding to PTH.
    • Clinical features: Tetany with carpopedal spasms, paresthesia in hands, feet, and mouth, neurologic changes, anxiety, depression, epilepsy, parkinsonism, and chorea.
    • Radiographic features: Calcification of basal ganglia.
    • Tooth features: Enamel hypoplasia, external root resorption, delayed eruption, and root dilaceration.

    Hyperthyroidism

    • Increased thyroxine levels. More common in females.
    • Usually involves diffuse toxic goiter (Graves' disease), toxic nodular goiter, or adenoma.
    • Signs include a high basal metabolic rate (BMR) leading to tachycardia, elevated blood pressure, irritability, and intolerance to heat.
    • Children: Early tooth eruption and premature loss of primary teeth. Excessive bone resorption.
    • Adults: Generalized decrease in bone density.

    Hypothyroidism

    • Low thyroxine levels.
    • Clinical features (in children/adults): Retarded/deteriorated mental/physical development, delayed closure of fontanelles and epiphyses, delay in base of skull ossification, relatively small mandible/maxilla, short roots, thin lamina dura, delayed eruption/exfoliation of teeth, or dull expressionless face, periorbital edema, sparse hairs, doughy skin.
    • Jaw and tooth features: Periodontal disease, potential loss of teeth, enlarged tongue with potential spacing of teeth, and external root resorption

    Osteopenia

    • An imbalance between bone deposition and resorption resulting in reduced bone formation.
    • Histologically, bone may appear normal.
    • Architecture of trabeculae and size/thickness change.
    • Clinical features: Asymptomatic early on, later, bone pain may be a symptom. Most individuals at risk are postmenopausal women.
    • Radiographic features: Overall reduction in bone density, thinning of cortical boundaries, sometimes a thinner lamina dura, reduction in trabeculae number/size.
    • Management includes administration of estrogen, calcium, and vitamin D supplements after menopause, weight-bearing exercise, and oral antiresorptive medications.

    Rickets and Osteomalacia

    • Nutritional deficiencies lead to impaired bone mineralization.
    • Rickets occurs in children.
    • Osteomalacia impacts adults.
    • Clinical features of Rickets: tetany or convulsions in first 6 months of life, craniotabes, softening of parietal bones, short stature, bowing of legs, swelling of wrists and ankles, delayed tooth development/eruption, enamel/dentin hypocalcification.
    • Clinical features of Osteomalacia: Bone pain, muscle weakness, "penguin" gait, tetany, and green stick fractures.
    • Radiographic features of Rickets: Thinning/missing cortical structures, inferior border, mandibular canal, and developing teeth, and overall appearance of radiolucency.
    • Radiographic features of Osteomalacia: Thin cortex, pseudofractures (commonly in ribs, pelvis, and weight-bearing bones, less often mandible), an overall radiolucent appearance, and sparse trabeculae.

    Osteopetrosis

    • Increased bone density, due in infants to progressive loss of marrow and its products; in adults, more benign and may be asymptomatic or present with bone pain, cranial nerve palsies from neural compression.
    • Radiographic features in infants: Very high density, may be fatal in early life, narrowing of bony canals may result in hydrocephalus, blindness, deafness, vestibular nerve dysfunction, and facial nerve paralysis.
    • Radiographic features in adults: May show thicker cortical boundaries and lamina dura, may not show internal structure or roots of teeth, the interface between cortical and cancellous bone may be obscured, the inferior alveolar canal may be more prominent, and the bone may appear underexposed.

    Sickle Cell Anemia

    • A hereditary blood disorder with abnormal hemoglobin and sickle-shaped red blood cells.
    • Clinical features: Mild attacks (fatigue, weakness, shortness of breath, muscle/joint pain); severe exacerbations (sickle cell crises, severe abdominal/muscle/joint pain, high temperature, and circulatory collapse).
    • Jaw features: General osteopenia, thinning of cortical plates, and coarser trabeculation in the alveolar bone.
    • Other radiographic features: Thinning of cancellous trabeculae caused by bone marrow hyperplasia and, potentially, vertebral bodies, long bones, skull, and jaws; often includes widening of the diploic space of the skull, thinning of the inner and outer tables of the skull, and a descriptive pattern called a “hair-on-end appearance”. Osteomyelitis is possible if infections occur.

    Thalassemia

    • Cooly's anemia, Mediterranean anemia.
    • Clinical features in infants: Severely impacts survival, causes short survival time. Clinical features in adults: milder form, prominent cheekbones, protruded premaxilla, a “rodent-like” face.
    • Radiographic features: Widened diploic space of the skull, thinning of the inner and outer tables of the skull, a “hair-on-end appearance” is sometimes descriptive. Also, generalized lucency in long bones; occasional fractures are also possible.
    • Jaw features: large marrow spaces, course trabeculae, thin lamina dura, short roots, potential for a prominent premaxilla leading to malocclusion, and large, coarse trabeculae.

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    Description

    This quiz explores the relationship between systemic diseases and their impact on dental health, particularly the jaws. It covers conditions related to parathyroid hormone, bone density, and common radiographic findings. Test your knowledge on various metabolic disorders and their effects on mature teeth.

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