Bone Disorders - part II Flashcards
1
Q
cemento-osseous dysplasia (COD) is malignant
A
false, benign
2
Q
T/F: COD may be a reactive process
A
true
3
Q
where may COD originate from?
A
fibroblasts of PDL vs. defect in bone remodeling
4
Q
what is the most common fibro-osseous lesion encountered in clinical practice of dentistry?
A
COD
5
Q
what are the 3 different types of COD?
A
- periapical COD
- focal COD
- florid osseous dysplasia
6
Q
what is obtained at the time of surgery for COD?
A
multiple small gritty fragments
7
Q
COD is commonly seen in who?
A
- black females
- east Asian females
- white females
8
Q
focal type COD is reported to be more common in who?
A
white females
9
Q
T/F: COD can affect both genders and any ethnic group
A
true
10
Q
T/F: COD is usualyl found incidentally on x-ray
A
true
11
Q
where does COD affect?
A
tooth-bearing areas of jaws
12
Q
clinical features of COD
A
- asymptomatic
2. swelling, discomfort unusual
13
Q
T/F: COD teeth test NON-vital
A
false, vital
14
Q
COD ranges radiographically from?
A
from completely radiolucent to densely radiopaque with a thin radiolucent rim (PDL remains intact)
15
Q
what does the florid osseous dysplasia show radiographically?
A
multiple “cotton wool” type radiopacities in at least 2 quadrants of the jaws
16
Q
what might the florid osseous dysplasia seen radiographically be associated with?
A
simple bone cyst
17
Q
severity of periapical COD
A
mild
18
Q
severity of focal COD
A
moderate
19
Q
severity of florid osseous dysplasia
A
severe
20
Q
where does periapical COD typically affect?
A
mandibular anterior region usually, but maxillary anterior as well
21
Q
who is especially affected by periapical COD?
A
middle-aged black females
22
Q
how does periapical COD initially appears as?
A
initially unilocular radiolucencies at apices, central opacity develops gradually
23
Q
T/F: COD is symptomatic
A
false, asymptomatic
24
Q
what can perioapical COD be confused with?
A
- hypercementosis
- idiopathic osteosclerosis
- benign cementoblastoma
25
who does focal COD more often affects?
white females
26
where does focal COD affect?
body of mandible
27
how does focal COD appear radiographically?
unilocular radiolucency or radiopacity with thin radiolucent rim
28
T/F: focal COD is asymptomatic
true
29
what can focal COD be confused with?
1. ossifying fibroma
| 2. a true neoplasm
30
who is most commonly affected by florid osseous dysplasia?
middle-age or older black females
31
T/F: usually only one quadrant of the jaw is affected by florid osseous dysplasia
false, multiple
32
florid osseous dysplasia is generally asymptomatic unless what?
overlying mucosa ulcerates resulting in bony sequestration (e.g. from ill'fitting denture)
33
T/F: dental implants are NOT recommended for pts with florid osseous dysplasia
true
34
florid osseous dysplasia lesions tend to be what?
hypovascular
35
hypovascular florid osseous dysplasia lesions are prone to what?
1. necrosis
2. infection
3. osteomyelitis with minimal provocation
4. reduced ability to heal
36
histopathologic features of COD
1. cellular fibrous CT with embedded mineralize tissue resembling either immature (woven) bone or cellular cementum
2. fragmented specimen
3.
37
what does the mineralized product of COD resemble histopathologically?
ginger root
38
T/F: mature COD lesions have more mineralized product than cellular stroma histopathologically
true
39
florid osseous dysplasia can show densely mineralized tissue with what histopathologically ?
necrotic debris and inflammation
40
diagnosis of COD is based on what?
clinical and radiographic features
41
what can be used to confirm the diagnosis of COD?
by bx if indicated
42
tx for periapical COD
none indicated
43
why might biopsy be indicated for focal COD?
to rule out other disease processes
44
T/F: bx is NOT necessary for florid osseous dysplasia
true
45
regular visits for dental prophylaxis and OHI is indicated to prevent what in COD pts?
to prevent perio disease and need for endo
46
T/F: COD pts should be encouraged to retain their teeth
true
47
ideally, why should surgical procedures should be avoided in COD pts?
onset of sysmptoms associated with exposure of sclerotic bone to oral cavity
48
T/F: management of symptomatic COD pts with secondary osteomyelitis is difficult
true
49
tx for management of symptomatic COD pts
1. debridement
2. abx (often not efffective)
3. chlorhexidine rinse
50
prognosis for periapical and focal COD
excellent
51
T/F: the initial appearance of focal COD may be the first sign of florid OD
true
52
prognosis for florid osseous dysplasia
good
53
when would prognosis of COD be guarded?
if secondarily infected requiring debridement and ATB
54
T/F: malignant transformation of COD is rare
true
55
osteoporotic bone marrow defect
area of hematopoietic bone marrow of sufficient size to cause a radiographic radiolucency
56
what is the pathogenesis of osteoporotic bone marrow defect
unknown
57
what may osteoporotic bone marrow defect resemble?
metastatic disease
58
where does osteoporotic bone marrow defect usually occur?
1. posterior body of mandible
| 2. often at old EXT site
59
who is usually affected by osteoporotic bone marrow defect?
middle-aged female
60
T/F: osteoporotic bone marrow defect is often found incidentally on radiographs
true
61
T/F: osteoporotic bone marrow defect is symptomatic
false, asymptomatic
62
radiolucency of osteoporotic bone marrow defect can appear circumscribed but may show what on closer inspection?
may show ill-defined borders and a fine trabecular pattern
63
histopathologic features of osteoporotic bone marrow defect
1. fatty and hematopoietic marrow
| 2. no abnormal osteoblastic or osteoclastic activity
64
what is often indicated to establish diagnosis of osteoporotic bone marrow defect?
biopsy
65
prognosis of osteoporotic bone marrow defect
excellent
66
once osteoporotic bone marrow defect is diagnosed, what is needed?
no further tx needed
67
other terms for idiopathic osteosclerosis
1. dense bone island
2. enostosis
3. bone whorl
4. focal periapical osteopetrosis
5. bone scar
68
idiopathic osteosclerosis
focally increased area of dense bone
69
what causes idiopathic osteosclerosis?
unknown
70
T/F: idiopathic osteosclerosis is usually found incidentally on radigraphs
true
71
T/F: idiopathic osteosclerosis has a male predilection
false, NO gender predilection
72
when does most idiopathic osteosclerosis arise?
most arise late 1st to early 2nd decade, peak prevalence in 3rd decade
73
T/F: idiopathic osteosclerosis occasionally regresses
true
74
when does idiopathic osteosclerosis usually stabilize?
at skeletal maturity
75
clinical features of idiopathic osteosclerosis
1. asymptomatic
2. no expansion
3. remain static or slow enlarge
76
radiographic features of idiopathic osteosclerosis
1. radiopaque
| 2. borders blend with surrounding trabeculae, but occasionally may be sharp
77
where is the most common site for idiopathic osteosclerosis
mandibular pre-molar/molar area
78
T/F: in the past, idiopathic osteosclerosis was not distinguished from inflammatory or other lesions
true
79
what may idiopathic osteosclerosis be confused with?
1. condensing osteitis
2. hypercementosis
3. cementoblastoma
80
histopathologic features of idiopathic osteosclerosis
1. dense vital bone
| 2. may see fibrofatty marrow
81
tx for idiopathic osteosclerosis
none indicated unless symptoms or cortical expansion
82
if idiopathic osteosclerosis is noted in childhood, what should be done?
periodic radiographs until lesion stabilized
83
what is needed in order to establish diagnosis of idiopathic osteosclerosis?
biopsy
84
prognosis of idiopathic osteosclerosis
excellent
85
other terms for simple bone cyst
1. traumatic bone cyst
| 2. hemorrhagic bone cyst
86
simple bone cyst
empty or fluid-filled bone cavity
87
why is simple bone cyst not a true cyst?
lacks an epithelial lining thus is a pseudocyst
88
T/F: simple bone cyst is usually an incidental finding
true
89
etiology of simple bone cyst
unknown
90
trauma-hemorrhage theory of simple bone cyst
trauma causing hematoma but not fracture and without subsequent organization and repair of hematoma, liquefies instead
91
T/F: simple bone cyst is related to trauma
nah, questionable
92
who is affected by simple bone cyst?
seen in 1st and 2nd decade
93
what is the gender predilection of simple bone cyst in jaws?
no gender predilection
94
what is the gender predilection of simple bone cyst in other bones?
male predilection
95
where does simple bone cyst typically occur?
1. posterior mandible
| 2. symphysis
96
clinical features of simple bone cyst
1. typically painless
| 2. no expansion, but possible
97
radiographic features of simple bone cyst
1. well-delineated
2. unilocular but can be multilocular
3. often scallops between roots
98
T/F: it is difficult to obtain specimen of simple bone cyst
true, usually just fragments of bone
99
histopathologic features of simple bone cyst
1. bone fragments are lined by inflamed granulation tissue
| 2. no epithelial lining
100
tx of simple bone cyst
surgical exploration and curettage to induce bleeding (an empty cavity within bone is found at time of surgery)
101
why would hemorrhage be indicated for tx of simple bone cyst?
hemorrhage organizes and lesion heals
102
how many months after surgery of simple bone cyst does radiogrpahic findings become normal?
~12-17 months
103
when is periodic radiographs of simple bone cyst warranted?
until complete resolution
104
T/F: recurrence rate is low for simple bone cyst
true
