Exam 3/ Lecture 3 case study part 1

Question 1

Osteopetrosis: General background information

Answer 1

• Defective osteoclastic bone resorption throughout life
• Bone is made, but not remodeled or resorbed so there is net gain of very bone (= bone sclerosis)
• Loss of (displaced) bone marrow requires bone marrow transplantation
• Affects all bones
• Can occur as an autosomal dominant (ADO, usually adult) or autosomal recessive (childhood, infant)
• Herein, show that dental imaging may be indication of ADO

Question 2

Assess periodontal disease by what?

Answer 2

visual inspection & measurements of plaque (tartar) index (PI) calculus (mineralized tartar) index (CALC), gingival index (GI), bleeding upon probing (BOP), probing depth (PD), clinical attachment (CAL), tooth mobility

Question 3

What is Periodontitis

Answer 3

serious gum infection that damages gums & can destroy jawbone

Question 4

What are different types of periodontitis?

Answer 4

Plaque and non-plaque (HIV, Down’s syndrome)

Question 5

Progression of gingivitis to periodontitis

Answer 5

Question 6

Patient history & presentation

Answer 6

• 44-yr old male with current pain in left leg for past 2 months, impeding function
• History of 6 prior low-impact fractures: right tibia, 2x left humerus, right radius, 2x left femoral neck
• X-rays support prior diagnosis of ADO as sclerosis at base of skull, ‘bone in bone’ at proximal phalanges, fracture of femoral neck with small joint spaces, vertebral end late sclerosis (Rugger jersey spine)

Question 7

Dental examination

Answer 7

• No history of alcohol, smoking
• No buccal complaints or clinical signs associated with infection
• All missing teeth were surgically removed, evidence of dental restoration
• Absence of radiopaque image related to alveolar cortical bone loss

Question 8

Diagnosis: Moderate generalized chronic periodontitis

Answer 8

• Generalized periodontitis >30 affected periodontal sites
• Evidence of periodontitis by tissue/bone destruction
• Moderate periodontitis does not reflect plaque index (paper does not reveal PI or CI), PD, CAL etc
• Suggests non-plaque induced periodontitis due to systemic disease increasing risk for osteomyelitis

Question 9

Outcomes & Discussion points

Answer 9

• Plaque index in this Pt did not explain periodontal damage
• Patients with OP are also subject to periodontal disease/damage
• Since many cases of OP are mild/asymptomatic, dental examination may be first hint of systemic disease when observing non-plaque induced periodontitis
• Given the nature of OP (defective bone resorption leading to poorly remodeled bone), OP can impinge on dental procedures