DISEASES OF JAW BONE

Dr : Tareq al_shawabkeh

BY

Inherited and developmental Diseases of bone:

Osteogenesis Imperfecta (brittle bone syndrome)

Osteopetrosis-marble bone disease

Achondroplasia Cleidocranial dysplasia

Cherubism

Achodroplasia Fibro-osseous lesions

Fibrous dysplasia of bone

Cemento-osseous dysplasia

Osteogenesis Imperfecta(brittle bone disease)

Hereditary diseases Caused by mutations in type-1 collagenFour main types:

.Type I: autosomal dominant, blue sclera, premature deafness ,with or without dentinogensis imperfecta

autsomal dominant.: Type II autsomal dominant ,severe osteoporotic bone: Type

III Type IV :similar to type I but more severe

Other abnormatities, joint hypermobility, thin translucent skin ,heart valve defects ,

Osteopetrosis-(marble bone disease)

Rare diseaseExcessive density of all bones

2nd anaemia Weak bone fractures are common Delayed eruption of teeth Osteomyelitis common complication after tooth extraction Radiographicaly

bone densityRoots of the teeth invisible on RG Mandible more affected than maxilla

A chondroplasia

An autosomal dominant traitIt is the most common form of dwarfism Abnormality in endochondral ossification The trunk and head are of normal size but the limbs are excessively short The middle third of the face is retrusive Malocclusion is common No effective treatment

Cleidocranial dysplasia An autosomal dominant trait Abnormalities of the skull,jaws &clavical Dental anamoles are common

Delayed closure of frontale

Nasal bridge is also depressed Partial or complete absence of the clavicles

Dental manifestation Narrow high arched palate

Many or most permanent teeth typically remain embedded in the jaw Many additional unerupted teeth also present Sometimes many dentigerous cysts

cherubismAn autosomal dominant trait

Males are affected about twice as frequently as females But there is reduction in deformity of puberty 2-4 age

Symmetrical swelling ,mandible bilateral ,may affect maxilla

the eye appear upturned to heaven Dental aspect Premature loss of deciduous teeth

Lack of eruption , failure of development of many permanent teeth

Radio graphically Maltilocular radiolucencies with expansion

Fibro-osseous lesions

Characterized by the replacement of normal bone by fibrous tissueA . Osseous dysplasiaFibrous dysplasia

_ monostotic _ polyostotic

Cemento-osseous dysplasia B .Benign neoplasiaOssifying fibroma /cemento-ossifing fibroma

Fibrous dysplasia of bone Monostotic fibrous dysplasia:

More common than polyststic

Affect limb,rib ,skull bone &jaw Maxilla >mandible

Present in achildhood or adolescent but diagnosis at adult life

Painless swelling –fusiform expansion-When max. affected prominence of cheek&buccal expansion Mand. Molar-premolar region

depth of the jaw Tipping, displacement of teeth Radiographically Ground-glass or orange-peel

Treatment: Cosmetic contouring when growing completed

Polystotic fibrous dysplasia

Two to three times are common in females as males

Affecting bones of one limb,especially the lower but the skull,vertebrae,ribs &pelvis

Usually associated with other systems involvement (Albright’s syndrome)Café au lait spotsPrecocious puberty in femaleEndocrine abnormalitiesN.B Margins of lesion merge with surrounding normal boneFew cases of malignant transformation to fibrosarcomaMajority of cases are treated by conservative surgical removal of the lesion

Cemento-osseous dysplasia

More in women than men Occurs predominantly in the mandible

>30 yrs of age Clinically May be multiple and small <1cm diameterLesions are multiple,large &involve one or more quadrants

Alveolar osteitis (dry socket)

A localized inflammation of the bone following either the failure of a blood clot to form in the socket ,or premature loss or disintegration of the clot Occurs mainly in the mandible Severe pain few days after extraction ,foul taste

Predisposing factor:Paget diseaseAfter radiotherapy Excessive use of V.CExcessive mouth rinsing

Focal sclerosing (condensing) oseitis

Periapical inflammation Result from low-grade irritation &or high tissue resistanceSeen at the apex of the a tooth, most commonly 1st Per MolarAsymptomatic

Suppurative osteomyelitis

Divided clinically into acute & chronic types Anaerobic organisms predominateMandible >maxilla Clinically acute suppurative present with Pain, swelling ,pyrexia &malaise ,trismus ,paraesthesia of the lip &mobility of teeth Chronic present with chronic suppuration &discharge of pus through one or More intraoral or extraoral sinuses

radiograph Moth _eaten radiolucency

OSTEOMYLITIS

Sclerosing osteomyelitis

Is a controversial condition Localized lesions are identical to focal

sclerosing osteitis Diffuse lesion are complication of low grade infection

Chronic osteomyelitis with proliferative periostitis (garres osteomyelitis periostitis ossificans)

Seen almost in the mand in children &young adultsBony hard swelling on the

outer surface of the mandShow a focal subperiosteal overgrowth of bone with asmooth surface on the outer cortical plate

Chronic periostitis associated with hyaline bodies (pulse granuloma,vegetable granuloma)

An unusual form of chronic periositis Histologically With hyaline ring-shaped bodies accompanied by foreign-body ,giant-cell reaction

associated with fibrous thickening of the periosteum ,periostitis, chronic suppurationThe vegetable material access to the tissues via a tooth socket, surgical flap, open root canal ,or through other breach in the mucosa such as Traumatic ulceration associated with ill-fitting

denture

Radiation injury & osteoradionecrosis

Radiation affects the vascularity of the bone Causing a proliferation of the blood vesselsInfection may spread resulting in extensive osteomyelitis &painful necrosis of the boneSloughing of the overlying oral &occasionally soft tissues

Metabolic and endocrine disorders of bone

OsteoporosisPrimary hyperparathyroidismsecondary hyperparathyroidismRickets and osteomalaciaAcromegaly

osteoporosisResult either when the bone loss is excessive or opposition of bone is reduced

In postmenopausal women

Female more than male

Is accentuated in several other diseases cushing syndrome, thyrotoxicosis & primary hyperparathyroidism

Normal composition but it is reduced in quantity, radiolucency of bone ,

Primary hyperparathyroidismCommon disease

Seen in middle aged women Results from excessive parathormone secretionExcess secretion of the hormone results in hypercalcaemia &hypercalciuria Histologically

Osteoclastic activity ,focal areas of bone resorption result in the formation brown tumours

Secondary hyperparathyroidism

Occurs in response to chronic hypocalcaemiaAs a result of chronic renal failureThe bone changes are complex and are mixture of those associated with osteomalacia & hyperparathyroidism

Rickets and osteomalacia

Rickets and osteomalacia are due to deficiency \resistance to the action of vit D Lack of exposure to sunlight or dietary causesThe bone present is normally mineralizedDental abnormalities include Enamel hypoplasia

width of the predentine Large amounts of interglobular dentine

acromegaly

Excessive secretion of growth hormone After fusion of epiphysisEnlarged jaw and protrusiveSpaced teeth & macroglossiaLips ,,nose ) ) Enlarged soft tissue

Pagets disease of boneA etiology involves genetic & environmental factors, paramyxovirus infection

Affect old ages >40 yrs Can be divided into three phases:

1-an initial predominantly osteolytic phase

2-an active stage of mixed osteolysis &osteogenesis 3-apredominantly osteoblastic or sclerotic phase clinically:

Cranial nerve compression

Enlarge of the maxilla

In dentate pts derangement of the occlusion ,spacing of the teeth

Hypercementosis Difficulty in extraction , postextraction haemorrhage Highly vascular marrow ,bone pain

N.B blood chemistry ALK- phosphatase Radio graphically appear as cotton-wool appearance

Central giant cell granuloma F >M In the second and third decadesMandible more than maxillaSwelling of the bone , growth may sometimes be rapid Radiograhically Apprear as a well-defined radiolucent area

,perforation of the cortexInvolved teeth may be displaced

,roots show resorptionHistologically Showing collections of multinucleated osteoclast-like giant cells in a vascular spindle cell stroma

Torus palatinus ,torus mandibularis, & other exostoses

Bony outgrowths Unknown etiologyOccurs at either midline of the palate(torus palatinus),or on the lingual surface of the mandible in the PM region (torus mandibularisMand. Tori are bilateral Palatal tori > mand. Tori

Dense bone island

Localized area of sclerotic boneIn the premolar-molar region of the mandible Radiographically Well-defined , denseNot surrounded by radiolucent space

Tumours of boneBone-forming tumours

(a)Benign osteoma

osteoblastoma

(b)Malignant osteosarcoma

Cartilage-forming tumours

(a)Benign chondroma

(b)Malignant chondrosarcoma

Marrow tumours

(a)Myeloma

(b)Other types

Fibrous tumours

Benign ossifying (cemento-ossifying) fibroma

Tumours -like lesions in the bone

(a )Langerhans cell histiocytosis

(b )Haemangioma of bone

Metastatic tumours

Osteoma &osteoblastoma OsteomaBenign-slow growing of boneMandible>maxilla Histologically : can be divided into compact and cancellous types Solitary , multiple osteomas occur as afeature of Gardner syndromeOsteoblastomaRare tumour in the jawsHistologically &radiographically it reembles the cementoblastoma but it is not related to the root of the teeth

osteosarcoma

Commonest malignant tumor of the boneAround 30 years of age RadiographicallyAppear as a radiolucent

,radiopaqe or mixed lesion

Histologically Formation of abnormal osteoid or bone by malignant osteoblasts

Chondroma & chondrosarcomaRare tumours Ant part of the max &post part of the mandOriginate in the condylar processesChondroma is a benign tumour characterized by formation of mature cartilagePrognosis for chondrosarcoma is better for mand compared to max

Myeloma

Neoplasm composed of plasma cellMultiple myeloma or Solitary myeloma

50- 70 yrsAffect the skull ,, vertebra ribs and pelvic Radiographically Punched out RL

Ossifying (cemento-ossifying) fibroma

Benign neoplasm Consist of fibrous tissue containing varying amounts of bony trabeculae &rounded calcified bodies Clinically Most often in the PM-molar region of the mandibleRadiologicallyWell-demarcated radiolucent area as the lesion matures

,varying amounts of calcified tissue are deposited

Langerhans cell histiocytosisMale more than female Under 20 yrs old It presents in one of three main ways:As a solitary lesion in the bone

Multifocal eosinophilic (hand schuller – christion syndrome )

(3)As disseminated multiorgan disease

Radiographs Show either a solitary or multiple osteolytic lesions Teeth may appear to be floating in air

Haemangioma of bone

Rare lesion Mandible>maxillaRadiographicallyMultilocular honey-comb appearance Aspiration will reveal fresh blood

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