Section 1
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Cherubism Treatment: Most lesions spontaneously regress after puberty. Mild cases may require only observation. However, treatment typically is indicated for patients with aggressive lesions, severe functional impairment, or marked facial deformity. Surgical intervention may consist of curettage, recontouring, partial resection, or complete resection
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Section 1
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Cherubism Treatment: Most lesions spontaneously regress after puberty. Mild cases may require only observation. However, treatment typically is indicated for patients with aggressive lesions, severe functional impairment, or marked facial deformity. Surgical intervention may consist of curettage, recontouring, partial resection, or complete resection
Usually first becomes evident at 2-5 years of age In the mandible, lesions frequently develop in the angles, ascending rami, and coronoid processes, but the condyles usually are spared Histologically, giant cells express markers suggestive of osteoclastic origin. The stroma tends to be more loosely arranged than that in giant cell granulomas. In some cases, reveals eosinophilic, cuff-like deposits surrounding small blood vessels.
Central giant cell granuloma Treatment: Hyperparathyroidism should be ruled out since lesions are histologically identical to Brown tumors. Central giant cell granulomas of the jaws usually are treated by thorough curettage.
More than 60% of cases before age 30 Females Most common in anterior regions and mandible Giant cell lesions of the jaws exhibit few to many multinucleated giant cells in a background of ovoid to spindle-shaped mononuclear stromal cells.
Hypodontia Treatment: No treatment may be required for a single missing tooth; prosthetic replacement often is needed when multiple teeth are absent.
Burkitt lymphoma Treatment: Burkitt lymphoma is an aggressive malignancy that usually results in the death of the patient within 4 to 6 months after diagnosis if it is not treated. Treatment generally consists of an intensive chemotherapeutic regimen.
Related to EBV Malignancy usually affects children - peak prevalence around 7 years of age The growth of the tumor mass may produce facial swelling and proptosis. Pain, tenderness, and paresthesia are usually minimal, although marked tooth mobility may be present because of the aggressive destruction of the alveolar bone. Premature exfoliation of deciduous teeth and enlargement of the gingiva or alveolar process may also be seen. On viewing the lesion on low-power magnification, a classic "starry-sky" pattern is often appreciated—a phenomenon that is caused by the presence of macrophages within the tumor tissue
Gemination Treatment: In gemination, if the double teeth have separate pulps, hemisection may be successful without root canal therapy. In double teeth that share a common pulp, endodontic therapy is necessary if sectioning is considered. Selected shaping with or without placement of full crowns has been used in many cases. Other patients exhibit pulpal or coronal anatomic features that are resistant to reshaping and require surgical removal with prosthetic replacement.
Fusion Treatment: In double teeth that share a common pulp, endodontic therapy is necessary if sectioning is considered. Selected shaping with or without placement of full crowns has been used in many cases. Other patients exhibit pulpal or coronal anatomic features that are resistant to reshaping and require surgical removal with prosthetic replacement.
Non-Hodgkin lymphoma Treatment: The treatment of a patient with non-Hodgkin lymphoma is based on several factors, including the stage and grade of the lymphoma, the overall health of the patient, and the patient's pertinent past medical history. Low-grade (indolent) lymphomas - some authorities recommend no particular treatment because these tumors are slow growing and tend to recur despite chemotherapy For high-grade (aggressive) lymphomas, the treatment of localized disease consists of radiation plus chemotherapy.
Occurs primarily in adults Most commonly develops in lymph nodes Radiographs usually show an ill-defined or ragged radiolucency, although in the early stages, the radiographic changes may be subtle or nonexistent. If untreated, then the process typically causes expansion of the bone, eventually perforating the cortical plate and producing a soft tissue swelling. Such lesions have been mistaken for a dental abscess, although a significant amount of pain is not present in most cases. Histopathologically characterized by a proliferation of lymphocytic-appearing cells that may show varying degrees of differentiation.
Gardner syndrome Treatment: Refer for prophylactic colectomy. Dental management typically involves surgical extraction of impacted teeth, removal of odontomas, and prosthodontic treatment. Orthodontic tooth movement may be difficult due to increased bone density from the osteomas. Genetic counseling is indicated.
Aneurysmal bone cyst Treatment: Aneurysmal bone cysts of the jaws usually are treated by curettage or enucleation, sometimes supplemented with cryosurgery
Patients under 30 years, no sex predilection Histo: characterized by blood-filled spaces of varying size. These blood-filled spaces lack an endothelial or epithelial lining.
Dentin dysplasia type II Treatment: The deciduous teeth in dentin dysplasia type II can be approached in a manner similar to that described for dentinogenesis imperfecta. The success of full coverage is best in teeth with crowns and roots that exhibit close to a normal shape and size. Overlay dentures placed on teeth that are covered with fluoride-releasing glass ionomer cement have been used with success in some cases.
Taurodontism Treatment: Patients with taurodontism require no specific therapy. Coronal extension of the pulp is not seen; therefore, the process does not interfere with routine restorative procedures.
Syphilitic hypoplasia Treatment: Restore function/esthetics (composite, crown, veneer)
Can also affect posterior teeth (mulberry molars)
Osteoma Treatment: Small, asymptomatic osteomas may not require treatment but should be observed periodically. Conservative excision is appropriate for large or symptomatic osteomas of the mandibular body.
Histo - normal appearing bone with dense marrow
Dilaceration Treatment: Patients with minor dilaceration of permanent teeth frequently require no therapy. Those teeth that exhibit delayed or abnormal eruption may be exposed and orthodontically moved into position. Extractions and endodontic therapy are more difficult.
Periapical granuloma Treatment: Endodontic therapy and appropriate restoration.
Most are asymptomatic, but pain and sensitivity can develop if acute exacerbation occurs. Typically, the involved tooth does not demonstrate mobility or significant sensitivity to percussion. The tooth does not respond to thermal or electric pulp tests unless the pulpal necrosis is limited to a single canal in a multirooted tooth. Histologically, consists of inflamed granulation tissue surrounded by a fibrous connective tissue wall
Osteosarcoma Treatment: The treatment of choice for osteosarcoma of the jaws is wide surgical resection. The additional use of chemotherapy and/or radiotherapy for gnathic osteosarcomas is controversial but may be considered in some cases (e.g., tumors of questionable resectability, surgical margins positive for tumor, and recurrent tumors).
Mean age is 33-39 years Swelling and pain are the most common clinical findings Histo shows direct production of osteoid by malignant mesenchymal cells
Osteoblastoma Treatment: Most osteoid osteomas and osteoblastomas of the jaws are treated by local excision or curettage.
85% occur before age 30 Slight female predominance Dull pain, tenderness, and swelling are common presenting features Histo - centrally exhibit irregular trabeculae of osteoid or woven bone, which are surrounded by numerous osteoblasts and scattered osteoclasts
External resorption Treatment: Identification and elimination of any accelerating factor.
Stafne defect Treatment: No treatment is necessary for patients with Stafne defects, and the prognosis is excellent. Biopsy may be done to rule out other pathologic lesions.
A striking male predilection is observed, with 80% to 90% of all cases seen in men
Multiple myeloma Treatment: Chemotherapy
Adult males Average diagnosis at 60-70 years 2x more frequent in Black people Bone pain, particularly in the lumbar spine, is the most characteristic presenting symptom. Bence Jones proteins found in urine of 30-50% of patients. Histologically, see diffuse, monotonous sheets of neoplastic, variably differentiated, plasmacytoid cells that invade and replace the normal host tissue.
Talon cusp Treatment: Patients with talon cusps on mandibular teeth often require no therapy; talon cusps on maxillary teeth frequently interfere with occlusion and should be removed. Pulp exposure and loss of vitality are risks with rapid removal.
Plasmacytoma Treatment: Plasmacytomas are usually treated with radiation therapy, and typically a dose of at least 40 Gy is delivered to the tumor site.
Adult males - average diagnosis at 55 years No evidence of plasma cell infiltration
Hyperdontia Treatment: Early diagnosis and treatment often are crucial in minimizing the aesthetic and functional problems of the adjacent teeth. Complications created by anterior supernumerary teeth tend to be more significant than those associated with extra teeth in the posterior regions.
Most frequently occurs in maxillary anterior or third molar region
Cleidocranial dysplasia Treatment: The preferred treatment involves removal of primary and supernumerary teeth followed by exposure and orthodontic extrusion of permanent teeth. Orthognathic surgery also may be considered after growth completion.
Dentinogenesis imperfecta Treatment: In dentinogenesis imperfecta, the entire dentition is at risk because of numerous problems. The root canals become threadlike and may develop microexposures, resulting in periapical inflammatory lesions. In spite of the risk of enamel loss and significant attrition, the teeth often are not good candidates for full crowns because of cervical fracture. The success of full coverage is best in teeth with crowns and roots that exhibit close to a normal shape and size. Overlay dentures placed on teeth that are covered with fluoride-releasing glass ionomer cement have been used with success in some cases.
Metastatic tumors to jaws Treatment: Although a solitary metastatic focus may be treated by excision or radiation therapy, jaw metastasis almost always is associated with widely disseminated disease. Management depends on the specific underlying tumor type and often is palliative in nature. Administration of bisphosphonates may help to slow progression of bone metastases, decrease bone pain, and reduce the risk for pathologic fracture.
Clinical signs and symptoms may include pain, swelling, tooth mobility, trismus, and paresthesia Most radiographically appear as ill-defined or "moth-eaten" radiolucencies.
Fibrous dysplasia Treatment: Patients with minimal cosmetic and functional disturbances may not require surgical treatment. For young patients with significant problems due to large or extensive lesions, surgical contouring, shaving, or other debulking procedures may be performed. However, subsequent regrowth may require additional surgery.
Predilection for maxilla, posterior Painless, unilateral swelling "ground glass" opacification, bucco-lingual expansion Histo - The abnormal bony trabeculae tend to be thin and disconnected, with curvilinear shapes likened to Chinese character
Microdontia Treatment: Treatment of the dentition is not necessary unless desired for aesthetic considerations. Maxillary peg laterals often are restored to full size by porcelain crowns.
Ankylosis Treatment: Recommended therapy for ankylosis of primary molars is variable and often is determined by the severity and timing of the process. When an underlying permanent successor is present, extraction of the ankylosed primary molar should not be performed until it becomes obvious that exfoliation is not proceeding normally or adverse occlusal changes are developing. After extraction of an ankylosed molar, the permanent tooth will erupt spontaneously in the majority of cases. In permanent teeth or primary teeth without underlying successors, prosthetic buildup can be placed to augment the occlusal height. Severe cases in primary teeth are treated best with extraction and space maintenance.
Periapical cyst Treatment: A periapical cyst is treated in the same manner as a periapical granuloma (endo and restoration)
Patients typically have no symptoms unless there is an acute inflammatory exacerbation. Root resorption is common. Most frequently associated with molar teeth. Histo - lined by stratified squamous epithelium. Lumen may be filled with fluid or cellular debris.
Simple bone cyst Treatment: Surgical exploration necessary for diagnosis (empty cavity with shiny bony walls). Simple bone cysts of the jaws typically are managed by surgical exploration and curettage.
Young patients (2nd decade) No epithelial lining
Nasopalatine duct cyst Treatment: Nasopalatine duct cysts are treated by surgical enucleation. Biopsy is recommended because the lesion is not diagnostic radiographically; other benign and malignant lesions have been known to mimic the nasopalatine duct cyst.
Most common in 4th-6th decades of life. Male predilection.
Erosion Treatment: In patients affected by dental erosion, preventive interventions should attempt not only to reduce acid exposure but also to improve the oral cavity's ability to resist the effects of acid. Patients should be informed of the potential for loss of tooth structure associated with the overuse of acidic foods and drinks, chronic regurgitation, and improper oral hygiene techniques. Restoration indicated for strong esthetic concerns, dental sensitivity or progressive/uncontrollable wear.
Amelogenesis imperfecta Treatment: Patients with generalized thin enamel hypoplasia demonstrate minimal normal enamel associated with rapid attrition. These variants require full coverage as soon as is practical. In those patients without sufficient crown lengths, full dentures (overdentures in some cases) often become the only satisfactory approach. The other types of amelogenesis imperfecta demonstrate less rapid tooth loss, and the aesthetic appearance often is the prime consideration. Many less severe cases can be improved by the placement of full crowns or facial veneers on clinically objectionable teeth.
Attrition Treatment: Intervention only required for cases that create a pathologic degree of tooth loss. Immediate therapy should be directed toward resolution of tooth sensitivity and pain, but identifying the causes of tooth structure loss and protecting the remaining dentition also are important goals.
Hypercementosis Treatment: Patients with hypercementosis require no treatment.
Paget disease Treatment: Asymptomatic patients with limited disease do not require treatment. Patients with symptomatic or extensive disease typically receive bisphosphonate therapy.
Up to 40% of patients present with bone pain Older patients, male predilection Skull involvement generally causes a progressive increase in head circumference. Alveolar enlargement may cause spacing between teeth, and edentulous patients may complain that their dentures feel too tight. Teeth may exhibit generalized hypercementosis Elevated serum alkaline phosphatase levels
Internal resorption Treatment: The treatment of internal and external resorption centers on the removal of all soft tissue from the sites of dental destruction. Internal resorption can be stopped consistently if endodontic therapy successfully removes all vital pulp tissue before the process perforates into the PDL. Once perforation occurs, therapy becomes more difficult and the prognosis is poor.
Intraosseous vascular malformation Treatment: Vascular malformations of the jaws are potentially dangerous lesions because of the risk of severe bleeding, which may occur spontaneously or during surgical manipulation. Needle aspiration of any undiagnosed intrabony lesion before biopsy is a wise precaution to rule out the possibility of a vascular malformation. The management of venous malformations depends on the size, location, and associated complications of the lesion. Small, stable malformations may not require treatment. Larger, problematic lesions may be treated with a combination of sclerotherapy and surgical excision, The treatment of arteriovenous malformations is more challenging and also depends on the size of the lesion and degree of involvement of vital structures. For cases that require resection, radiographic embolization often is performed 24 to 48 hours before surgery to minimize blood loss.
More common in females, mandible A bruit or pulsation may be apparent on auscultation and palpation. Channels resemble vessels of origin.
Dens invaginatus Treatment: Depending on severity of invagination, may need endodontic therapy or periapical surgery. Large and extremely dilated invaginations often have abnormal crowns and need to be extracted.
Turner hypoplasia Treatment: Restore function/esthetics (composite, crown, veneer)
Most frequent in permanent bicuspids (caries) or maxillary incisors (trauma)
Residual cyst Treatment: Because any number of odontogenic and nonodontogenic cysts and tumors can mimic the appearance of a residual periapical cyst, all of these cysts should be excised surgically.
Florid cemento-osseous dysplasia No treatment necessary
Middle age black females
Dentin dysplasia type I Treatment: Primarily preventive care. Perhaps as a result of shortened roots, early loss from periodontitis is frequent. In addition, pulp vascular channels extend close to the dentinoenamel junction; therefore, even shallow occlusal restorations can result in pulpal necrosis. Meticulous oral hygiene must be established and maintained.
Papillon-Lefevre syndrome Treatment: Skin lesions in these patients have been treated most successfully using systemic retinoids, such as etretinate, acitretin, and isotretinoin (refer to dermatologist). Rigorous oral hygiene, chlorhexidine mouth rinses, frequent professional prophylaxis, and periodic appropriate antibiotic therapy are necessary for long-term maintenance.
The extensive loss of osseous support often results in teeth that radiographically appear to be floating in soft tissue. By age 15, all of the permanent teeth have been lost in most affected individuals.
Abrasion Treatment: Low-abrasive toothpaste and professional guidance to prevent inappropriate, overzealous, or too frequent toothbrushing may assist in reducing associated abrasion. Active restorative therapy is premature in the presence of ongoing tooth wear and should be postponed until the patient expresses strong aesthetic concerns, exhibits dental sensitivity that is nonresponsive to conservative interventions, or demonstrates progressive and uncontrollable wear. Once indicated, the minimum treatment necessary to solve the problem should be implemented.
Langerhans cell histiocytosis Treatment: Accessible bone lesions, such as those in the maxilla and mandible, are usually treated by curettage. Low doses of radiation may be used for less accessible bone lesions, although the potential for induction of malignancy secondary to this treatment is a concern in younger patients. If multiple organ systems involved, refer for chemotherapy.
40-60% associated with BRAF mutation More than 50% of cases seen younger than age 15 The jaws are affected in 10% to 20% of all cases. Dull pain and tenderness often accompany bone lesions. Ulcerative or proliferative mucosal lesions or a proliferative gingival mass may develop if the disease breaks out of bone Histologically, the bone lesions show a diffuse infiltration of large, pale-staining mononuclear cells that resemble histiocytes.
Concrescence Treatment: Patients with concrescence often require no therapy unless the union interferes with eruption; then surgical removal may be warranted.
More frequent in posterior maxillary regions.
Focal cemento-osseous dysplasia No treatment necessary - biopsy may be needed to confirm diagnosis.
Middle age females
Periapical cemento-osseous dysplasia No treatment necessary
Middle age black females
Section 2
(16 cards)