Sales Training 2014 - Dentistry

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Diagnostic Oral Medicine

the bone to infection, the source being a large cari- ous cavity in an associated tooth or deep coronal restoration. Condensing osteitis is commonly seen in children and young adults and mostly involves mandibular premolars. Mild pain may be associated with an infected pulp. HISTOPATHOLOGIC FEATURES The bony trabec- ulae are thick and the interstitial marrow tissue is scanty, fibrotic and infiltrated with a few lympho- cytes. Osteocytic lacunae appear empty. Many rever- sal and resting lines are present leading to a pagetoid appearance. DIFFERENTIAL DIAGNOSIS It has to be differenti- ated from 1. Benign cementoblastoma: Periodontal membrane space obliterated. Well-circumscribed dense radiopacity limited by a uniform thin radiolu- cent line. 2. Focal cemento-osseous dysplasia: This has a radiolucent border. TREATMENT Depending on the condition of the associated tooth, endodontic therapy or extraction is indicated. In some patients, dense bone of extracted socket may not show remodelling on the roentgeno- gram, when the condition is referred to as bone scar . Osteoradionecrosis (ORN) Radiotherapy treatment of head and neck cancers has its own short-term and long-term side effects. ORN (Table 15.1) is necrosis or death of the bone of maxilla or mandible following radiation therapy for cancer of the head and neck regions, when these bones are directly in the field of radiation. The inci- dence of ORN of those undergoing radiotherapy is about 8%. PATHOGENESIS The damage to the capillaries and arterioles results in an initial hyperaemia, endarteri- tis, thrombosis and eventual obliteration leading to a restricted blood flow followed by complete elimina- tion of the blood flow. This leads to hypocellularity, hypoxia and hypovascularity.

chronic focal sclerosing osteomyelitis which is limited to the alveolar process and may occur in both jaws. Chronic diffuse sclerosing osteomyelitis Chronic diffuse sclerosing osteomyelitis is charac- terised by the proliferation of bone to a low-grade infection, the infection being an extension of diffuse periodontal disease. CLINICAL FEATURES Chronic diffuse sclerosing osteomyelitis occurs in adults and has no sex predi- lection or racial predilection. It involves the mandi- ble, affects both the basal bone and the alveolar process, and is usually unilateral. During acute exac- erbation, there is mild pain and the bone is tender with mild suppuration. Fever and leukocytosis usu- ally do not occur, although erythrocyte sedimenta- tion rate may be increased (Table 15.1). RADIOGRAPHIC FEATURES Radiograph shows patchy areas of radiolucency and radiopacity, some- times bilateral, involving extensive areas of bone giv- ing a cotton-wool appearance. Rarely, the maxilla may also show similar picture. It resembles Paget’s disease (generalised hypercementosis of the teeth) and cemento-osseous dysplasia (initially radiolucent, later becomes radiopaque predominantly with a thin peripheral radiolucent rim) (Table 15.1). HISTOPATHOLOGIC FEATURES Histological pic- ture shows dense irregular trabeculae of the bone some of which are bordered by osteoblasts. Foci of osteoclasts are seen. Bone trabeculae are separated by fibrous tissue with small capillaries, proliferating fibroblasts and occasional lymphocytes and plasma cells. Alternating resorption and deposition of the new bone gives the bone a mosaic pattern. TREATMENT High doses of antibiotics are indi- cated for acute exacerbation. Tooth present in the sclerotic area may have to be extracted. Chances of infection and delayed healing of the extracted socket must be explained to the patient. This is due to hypovascularity of the sclerotic bone.

Chronic focal sclerosing osteomyelitis (Condensing osteitis) It is an unusual reaction of

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