Dalhousie University School of Dental Hygiene DEHY 3115 Clinical Oral Pathology PDF

Dalhousie University School of Dental Hygiene DEHY 3115 Clinical Oral Pathology LESSON 13: Non-neoplastic Diseases of the Bone Lesson Objectives 1. Define each of the words in the vocabulary list for this chapter. 2. Define dysplasia as it relates to bone diseases and differentiate the term...

Dalhousie University School of Dental Hygiene DEHY 3115 Clinical Oral Pathology LESSON 13: Non-neoplastic Diseases of the Bone Lesson Objectives 1. Define each of the words in the vocabulary list for this chapter. 2. Define dysplasia as it relates to bone diseases and differentiate the term from epithelial dysplasia. 3. Define benign fibro-osseous lesions and list the benign fibro-osseous lesions that occur in the jawbones and are described in this chapter. 4. Describe the microscopic appearance of Paget disease of bone and describe its clinical and radiographic appearance when the maxilla or mandible is involved. 5. Describe the radiographic appearance and the cause of giant cell granuloma. 6. Describe the cause of osteomalacia and rickets. 02 Reference Text Chapter 8  Nonneoplastic Diseases of Bone These diseases fall into various categories, and several are discussed in other chapters: Inherited diseases affecting bone: Chapter 6 Benign and malignant neoplasms: Chapter 7 The purpose of this chapter is to delineate several nonneoplastic diseases of bone that are important for a dental hygienist to understand but are not covered elsewhere in the text. 3  Dysplasia In this chapter, Should not be dysplasia refers to the confused with abnormal and dysplasia in the context disordered production of epithelial dysplasia of cementum and bone 4  Benign Fibro-Osseous Lesions Benign fibro-osseous lesions that affect the maxilla and mandible include these types: Periapical cemento-osseous dysplasia Focal cemento-osseous dysplasia Florid cemento-osseous dysplasia Fibrous dysplasia Refer to Box 8.1 Benign Fibro-Osseous Lesions of the jaw in your text 5 Periapical Cemento-Osseous Dysplasia (1 of 2) Relatively common disease of unknown cause that affects periapical bone Occurs most commonly in the anterior mandible of patients older than 30 More common in women than men: Many studies indicate a predilection for black women Early lesions are well circumscribed and radiolucent; with time, they become increasingly calcified Teeth in the affected area are vital Used to be called cementoma but it is not a neoplasm therefore not appropriate 6 Periapical Cemento-Osseous Dysplasia (2 of 2) Diagnosis and treatment – A biopsy may be necessary when characteristic radiographic features are not evident – Histologic examination reveals a fibro- osseous lesion composed of fibrous tissue and calcifications – Early lesions consist of mainly fibrous tissue, whereas older lesions contain numerous calcifications No treatment 7  A condition of disordered cementum and Florid Cemento- bone development Osseous Dysplasia Clinical and radiographic features (1 of 2) – Usually occurs in black women older than 40 years of age – Typically affects more than one quadrant 8  Florid Cemento-Osseous Dysplasia (2 of 2) Masses of irregular opacity are noted that are composed of dense sclerotic bone, cementum, or both Best diagnosed on the basis of its characteristic patient history, clinical presentation, and radiographic appearance Asymptomatic florid cemento-osseous dysplasia does not require treatment 9  Focal Cemento-Osseous Dysplasia (1 of 2) An asymptomatic fibro-osseous lesion Occurs in women between 30 and 50 years of age More common in white people than black people Occurs in posterior mandible Isolated, well-delineated radiolucent-to- radiopaque lesion Less than 1.5 cm in size 10  Focal Cemento-Osseous Dysplasia (2 of 2) Diagnosis and treatment – Biopsy and histologic examination are usually necessary to establish a diagnosis – Composed of numerous gritty pieces of soft and hard tissue: Fibrous connective tissue interspersed with bone trabeculae and cementum-like material 11  Characterized by replacement of bone with Fibrous abnormal fibrous connective tissue interspersed with varying amounts of calcification Histologically, it is a benign fibro-osseous lesion, Dysplasia with vascularized, cellular fibrous connective tissue interspersed with irregular trabeculae of bone 12  Typically a painless, progressive, unilateral enlargement of the mandible or maxilla The classic radiographic appearance is a diffuse radiopacity Fibrous looking like “ground glass” Characterized by cellular fibrous connective tissue Dysplasia interspersed with irregularly shaped bony trabeculae Treatment – Surgical recontouring of bone for cosmetic reasons 13  Types of Fibrous Dysplasia Monostotic fibrous dysplasia Polyostotic fibrous dysplasia 14  Monostotic Fibrous Dysplasia Characterized by involvement of a single bone The maxilla is more frequently involved than the mandible Most commonly diagnosed in children and young adults, with no sex predilection Clinical examination reveals a painless swelling or bulging of the buccal plate Craniofacial fibrous dysplasia – Involves the maxilla with extension into the sinuses and adjacent zygoma, sphenoid, and occipital bones 15  Polyostotic Fibrous Dysplasia Characterized by involvement of more than one bone Typically occurs in children, with a female predilection When long bones are involved, they may exhibit bowing and an associated dull aching pain Patients may have skin lesions appearing as light-brown macules called café au lait spots 16 Types of Polyostotic Fibrous Dysplasia Jaffe type – Involves multiple bones along with café au lait macules on the skin Albright syndrome – Characterized by endocrine abnormalities, precocious puberty in females, stunting or deformity of skeletal growth in both sexes as a result of premature closing of the epiphyseal plates, café au lait spots 17  Paget Disease of Bone (1 of 4) A chronic metabolic bone disease Characterized by resorption, osteoblastic repair, and remineralization of involved bone Unknown cause: May be due to a virus Most commonly occurs in men over age 50 years The maxilla is more commonly affected than the mandible 18  Paget Disease of Bone (2 of 4) Enlargement of affected bone Patient often complains of pain Spaces may increase between teeth as jawbone enlarges 19  Paget Disease of Bone (3 of 4) Radiographically – A patchy radiolucency and radiopacity, “cotton wool” – Hypercementosis, loss of lamina dura, and obliteration of the periodontal ligament may occur 20  Paget Disease of Bone (4 of 4) Serum alkaline phosphatase level is significantly elevated in active disease Histologic examination reveals bony trabeculae surfaced with numerous osteoclasts and osteoblasts Treatment – Bisphosphonate – Experimental; the disease is slowly progressive 21  Central Giant Cell Granuloma (Central Giant Cell Lesion) (1 of 2) Composed of well-vascularized connective tissue containing many multinucleated giant cells Occurs in both peripheral (tissue) and central (bone) locations Brown tumor seen in those with hyperparathyroidism. Should not be excised as it will resolve when hyperparathyroidism is treated. 22  Central Giant Cell Granuloma (Central Giant Cell Lesion) (2 of 2) May experience pain; not common Slow-growing lesion Destructive Unilocular or multilocular radiolucency Sclerotic or ill-defined borders Divergence of roots Treatment: Surgical excision, occasionally recur 23  Aneurysmal Bone Cyst Pseudocyst Consists of blood-filled spaces surrounded by multinucleated giant cells and fibrous connective tissue No epithelial lining Radiographic: “Honeycomb” or “soap bubbles” Treatment – Surgical excision and cryotherapy 24 Aneurysmal Bone Cyst Previous history of trauma to the area has been reported in some cases, but no direct correlation exists. Recurrence is associated with incomplete removal of the original lesion. https://exodontia.info/aneurysmal-bone-cyst/  Osteomalacia Disease of bone that developed over long period of calcium deficiency Usually caused by vitamin D deficiency Associated disease is terms rickets May also be induced by certain tumors Inherited form of vit D deficiency: hypophosphatemic vitamin D–resistant rickets Clinical characteristics – Delayed tooth eruption – Periodontal disease – Pathologic fractures Treatment – Based on identification of the cause 26 Questions 27