Jaw bone disaese

Jaw bone Disease
Mazen Abood Bin Thabit MD.FICPath
. Associate Prof .of Pathology
.Senior lecturer of Oral pathology and oral histology

Classification of bone disease
1. Inflammatory bone disease.
2. Hereditary bone disease .
3. Metabolic bone disease .
4. Disease of unknown etiology .
a. Paget’s disease .
b. Fibro-osseous disease
5. Bone tumors .

Normal bone histology

Haversian system

Inflammatory disease of jaw bone
Bone infection ( Oteomyelitis) Chronic osteomyelitis with
can be classified into : proliferative periostitis
1. Suppurative : ( Garr’s disease)
Acute osteomyelitis Alveolar ostitis .
Chronic osteomyelitis . Special types
2. Granulomatous a Osteoradionecrosis .
3. Non suppurative b. Chemical osteomyelitis
Chronic sclerosing O c. Osteomyelitis of newborn
a. Focal and infant ( Neonatal
maxillitis)
b. Diffuse
d. Chronic periostitis

Osteomyelitis
• Is an inflammation of the medullary portion of
the jaw bone which extends to involve the
periosteum of the affected area

Acute osteomyelitis
• Rare disease .
• An infection of bone follow an infection
associated with teeth
• The potential source of infection is
1. Periapical infection .
2. Periodontal pocket’s .
3. Acute gingivitis .
4. Penetrating and contaminated injuries
5. Tooth extraction .

Acute osteomyelitis
Predisposing factors :
Local:
1. Fracture .
2. Radiation
3. Paget’s disease
4. Osteoporosis .
5. Vascular disease

Acute osteomyelitis
Systemic:
1. Immunodeficiency .
2. Immunosuppressant .
3. Malignancy .
4. Poorly controlled D.M
5. Chronic alcoholism and malnutrition

Acute osteomyelitis
• Clinical feature:
• More common in adult with
mnadibular infection
• Osteomyelitis of Maxilla more
common in neonate .
• Sever throbbing pain , deeply sited
pain .
• Swelling ,malaise and pyrexia
• Gingiva red swollen and tender
• Involved teeth tender and mobile .
• Intra and extra-oral pus discharge
• Regional L.N enlargement
• Paresthesia of lower lips .
• Trismus

Acute osteomyelitis
Radiography:
1. Normal in early stages.
2. In 10-14 days, sufficient
bone resorption occurs
to produce irregular,
moth-eaten areas of osteomyelitis

radiolucency.
3. Sequestra may be seen.

Etiopathogensis
Micro-organism • Pathogenesis :
1. Aerobic bacteria:
. Staphylococcus aureus .
. Haemolytic streptococcus .
2. Anaerobic bacteria :
.Pigmented bacteroids
.Anaerobic streptococcus .
.Perphyromonas
. Pervotella

Acute osteomyelitis
• Histopathology:
• Acute inflammatory changes
• Bone trabeculae shows scalloping.
• Bone necrosis with degeneration of
osteoblast and osteocytes .
• Sequestrum.

Chronic suppurative osteomyelitis
Low grade inflammation • Causes :
with associated with bone
1. Inadequate treatment of acute
destruction , granulation
tissue formation with little osteomyelitis.
suppuration 2. Infection by weak bacteria .
3. Infection of avscular bone .
4. Irradiation .

Chronic suppurative osteomyelitis
Clinical feature: Radiography:
• Molar area mostly affected . • Mouth eating radiolucent area
• Mild dull pain . • Multiple radio-opaque area
• Jaw swelling . represent sequstra .
• Sinus tract formation , pus
discharge and shedding of
squestra
• Sequestra can be felt by probe .

( Alveolar ostitis ( Dry socket
• Localized inflammation of
bone following either failure
of blood clot to form in
socket, or premature loss or
disintegration of clot.

Unpredictable complication of tooth Improper healing
(.extraction (~1-3%

• Etiology: 2. Premature loss of blood
1. Failure of blood clot clot may be due to:
formation due to Poor blood . Excessive mouth rinsing.
supply as in: . Fibrinolysis byproteolytic
. Paget’s disease. bacteria.
. Osteopetrosis.
. Following radiotherapy.
. Excessive use of vasoconstrictor

in local anesthesia.

Clinical picture :
1. Intense pain .
2. Most frequently seen in :
. 3rd molar extraction
. Difficult extraction with trauma
. Smoker .
3. tooth socket appears empty and dry
4. jaw bone is visible in the tooth socket
5. Bad breath and Unpleasant taste .
6. Swollen of regional lymph node .

• Histopathology:
Histological section of
socket wall reveal formation
of necrotic bone containing
empty lacunae

Chronic osteomyelitis with proliferative
periostitis
• Represent areactive sub-
periosteal new bone
formation in response to
low grade periapical
infection , perifolliculitis or
trauma

Garr’s disease
Periostitis

Chronic osteomyelitis with
proliferative periostitis
1. Young adult of both sexes.
2. Exclusively lower 1st
permanent molar
3. Mild pain .
4. Non tender , smooth and
hard bony swelling .

:X-Ray
Smooth , focal subperiosteal bony growth on the
outer surface of cortex

Chronic osteomyelitis with proliferative
periostitis
• Histopathology:
Fibro-osseous microscopic
feature

Chronic sclerosing osteomyelitis
I. Chronic focal Sclerosing O :
Uncommon nonsuppurative
inflammation with bone reaction
( Osteosclerosis) around the root apex
of nonvital tooth.

It is a local repose to low grade pulpal
inflammation or high tissue resistance to
infection

1. Young adult .
2. Commonly related to permanent
mandibular 1st molar
3. Rare mandibular 2nd molar or
premolar
4. Asymptomatic
5. Some time dull pain
6. Large carious lesion , non vital
pulp
7. Rare may associated with non
vital tooth

• Radiography:
well defined radio-opaque
up to 3 cm below the apex
with intact lamina dura

Focal sclerosing osteomyelitis

Histopathology

Chronic diffuse sclerosing osteomyelitis
• Represent a proliferative bone
reaction ( Osteosclerosis) of the jaw
bone to low grade inflammation , the
source of infection here is through the
PDL

1.Propionibacterium Acnes
2.Peptostreptoccocus

Chronic diffuse sclerosing osteomyelitis

• Clinical Feature:
1. Black Elderly .
2. More in female.
3. Mandible and edentulous .
4. Usually asymptomatic .
5. Vague dull pain .
6. Exacerbation may occur with
mild pain , suppuration and
fistula

Histopathology: Diffuse or nodular sclerosis
Pagetoid ( Mosaic) pattern resembling cotton wool

(Radiation osteomyelitis ( Osteoradionecrosis
• Bone necrosis follow
irradiation of oral malignancy

Endarteritis obliterans and thrombosis
of inferior dental artery
Osteo-radionecrosis

Bone sterile and more susceptible for
infection

Specific osteomyelitis
• Neonatal Maxillatitis • Chemical osteomyelitis
• Rare type of osteomyelitis • Rare condition .
• Infection during delivery • Incorrect use of
or breast feeding . medicaments .
• Red , swollen , painfull • Paraformaldehyde
maxilla with multiple sinus • Phosphorus or mercury
.
• Sequestration of
developing teeth

Fibro-osseous disease
• Group of disorder • Classification :
characterized histologically 1. Fibrous dysplasia :
by replacement of the normal
a. Monostatic .
bone by fibrous tissue
b. Polystatic .
within which trabeculae of
nonfunctional osseous 2. Cemento-osseous dysplasia.
structure or metaplastic bone a. Periapical –cemental dysplasia
b. Focal cemento-osseous dys
c. Florid cemento –osseous dysp.
3. Fibro-osseous neoplasm.
4. Cherubism

Fibrous dysplasia
• A self limiting disease
characterized by fibrous
replacement of medullary
bone by metaplastic woven
bone that eventually
replaced by dense lamellar
bone

1. Monostatic
2. Polystatic

Fibrous dysplasia
• Monostatic :
1. More common 70%.
2. Any bone affected
3. In the Jaw bone maxilla is more
affected
4. Start in childhood .
5. Slow growing painless, smooth ,
rounded bony swelling with
facial asymmetry .
6. Enlarge to make dysfunction with
malocclusion and displacing
teeth and some time prevent it’s
eruption
Monostatic fibrous dysplasia

Fibrous dysplasia
7. No pain on palpation
8. Maxillary lesion may cause
exophthalmos , proptosis and
nasal obstruction .
9. Mandibular lesion occur in
molar and premolar region
10. Protuberance and increase the
depth of jaw

Fibrous dysplasia
• Polystatic:
1. Rare .
2. Several bone .
3. More common in female.
4. 5% in the head and neck .
5. ( Albright syndrome) Patchy
pigmentation Café au lait
with precocious puberty and
oth endocrine dysfunction.
6. Jaffe syndrome when these is
absence of endocrine
abnormalitis
Café au lait

Fibrous dysplasia
• Histopathology:
1. Normal bone replaced by loose
cellular fibrous tissue .
2. Newly formed bony trabeculae
are delicate and irregular
(likened to Chinese characters).
3. Spherical areas of calcification
Fibrous stroma with
resembling cemetum may be
metaplastic bone
present.
4. At the margins, lesional bone
fuses with normal bone .
5. With age fibrous tissue decrease
and bone formation increase with
remodeling to lamellar bone

Fibrous dysplasia
• Radiography:
. Radiolucent area with
fine orange peal textures
. Borders are difficult to
define because of gradual
transition to normal.
. Initially resemble cyst-
like radiolucencies
containing faint bony
trabeculae

1. The disease is self limiting
2. Large lesion surgical ecountring

Cemento-osseous dysplasia
• A disease of jaw bone of • Cemento-osseous dysplasia of
unknown etiology with three types:
reactive and dysplastic 1. Periapical Cemento-osseous
process characterized dysplasia .
microscopically by the 2. Focal Cemento-osseous dysplasia .
replacement of normal 3. Florid Cemento-osseous dysplasia
bone with a collagenous
matrix containing
trabeculae of immature
bone and, in some
instances,cementum-like
mater

• Periapical Cemento-osseous
dysplasia .
1. Mandibular incisor
2. More than one teeth is affected .
3. Tooth vital
4. More common in black female .
5. Middle age ( around 40) and rare
before 20 .
6. Asymptomatic , typical discovered
on routine radiographic examination

A mixture of benign fibrous tissue
, trabeculae of bone and
cemnentum like material

. Periapical Cemento-osseous dysplasia

• Radiography:
1. Early lesion appears as
rounded radiolucent area
related to the apex and
continue with PDL.
2. Later produce solid radio-
opaque mass

Early Late

When not associated with a tooth apex
called as focal cementoosseous, dysplasia

• Florid cemento-osseous
dysplasia:
1. Gigantiform cementoma
2. Less common .
3. Represent an exuberant and
sever form of periapical type
4. Middle age black women Radio-opaque masses with
5. Typically symmetrical and radiolucent porder at the root
bilateral .
6. Some time all four quadrant
evolved

Cherubim
• Benign and self-limited
hereditary autosomal
dominant disease of the
jaw bone

Chromosome 4pl6.3, which encodes
the SH3-binding protein, SH3 BP2.

Symmetrical jaw bone swelling

Cherubim
1. Young children 2-5 years
2. More common in male .
3. Familial .
4. At birth patient appears normal .
5. Later develop bilateral , painless ,
symmetrical swelling at the angles
of mandible .
6. The swelling grow rapidly for few
years then slow regression untill
childhood and become static at
puberty
7. In sever cases maxilla involved
and give Chubby face.

Cherubim
8. Exhibit fullness of cheek with
widening of alveolar ridges and flat
palatal vault
9. Premature exfoliation of deciduous
teeth
10. Malocclusion .
11. Difficulty in mastication ,
swallowing and speech
12. Sever maxillary lesion produce
pressure at the orbit floor result in
upward turn of the pupils
( Heavenward look) with an angelic
appearance .
13. Enlargement of submandibular
L.Ns may occur .

Cherubim
• Radiography:
1. Well defined multilocular
cyst like radiolucent areas
2. Expansion and thinning
of the cortical plates

Multilocular cyst like radiolucent

Cherubim
• Histopathology
1. Highly cellular and vascular
connective tissue arrange in
whorls.
2. Large number of multinucleated
giant cells .
3. Eosinophilic peri-vascular cuffing
of collagen fibers .
4. Extravassated RBCs
5. Variable amount of metaplastic
bone trabeculae

Jaw bone disaese

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