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RADIOGRAPHIC INTERPRETATION OF

SYSTEMIC DISEASES MANIFESTED IN THE
JAWS

DRG. SHANTY CHAIRANI

HYPERPARATHYROIDISM
• Loss of bone mineralization (osteoporosis)
because of increased PTH secretion
(primary) or increased demand for serum
calcium (secondary) , resulting in multiple
systemic complications, loss of alveolar
bone architecture, and occasionally giant
cell tumor ("brown tumor").
• The increased secretion of parathyroid
hormone causes generalized bone
resorption (osteopenia), bone pain,
pathological fractures and raises the serum
calcium levels.

bone and joint paint. – There may be gradual loosening. – Symptoms and signs : renal calculi. middle aged adults – Elevated serum parathyroid hormone and blood calcium levels.• Clinical Features: – Enlargement of one or more parathyroid glands – Female dilection. psychiatric problesms. – The serum alkaline phosphatase level may also be elevated. drifting and loss of teeth .

– Reduction in cortical bone density and thinning of the cortical border of the mandible. .• Radiographic Features: – Well defined unilocular or multilocular radiolucency – Loss of lamina dura around the associated teeth – The trabecular pattern becomes very fine (ground glass appearance). – After treatment the appearance becomes normal again. localized cyst-like radiolucencies may occur (brown tumors). – In a late stage. – Granular-appearing bone in skull.

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– Overgrowth of the bones. including the jaw – In acromegaly. • Clinical features : – If the abnormality occurs in childhood. • Excess of growth hormone causes overgrowth of all tissues in the body. it is called acromegaly. generalized overgrowth of most tissues occurs.HYPERPITUITARISM • Results from hyperfunction of the anterior lobe of the pituitary gland. increased production of growth hormone. – If it occurs in adult. It terms as gigantism. there is excessive growth of the mandible .

– May also be an increase in the thickness and height of the alveolar processes .• Radiograph features : – Enlarged of jaw. – Lengthening of the condylar processes and ascending ramus of the mandible. especially mandible in acromegaly.

children and adults who have only dental problems (premature loss of teeth).HYPOPHOSPHATASIA • A genetic metabolic disorder of bone mineralization caused by a deficiency in alkaline phosphatase in serum and tissues. children. or may be delayed until adulthood – Premature loss of teeth is common in children and adults and delayed eruption of the permanent dentition . characterized by skeletal defects resembling those of rickets. • Clinical Features: – Skeletal changes may present in infants. • Odontohypophosphatasia .

• Radiographic Features: – Excessive amount of unmineralized osteoid tissue – Generalized lucency of the maxilla and mandible – Reduced enamel thickness and enlarged pulp chambers and pulp canals – The cortical bone and lamina dura is thin and the alveolar bone may be deficient .

• There are 3 clinical forms of histiocytosis X : – Eosinophilic granuloma of bone – Hand-Schuller-Christian disease (chronic disseminated histiocytosis X) – Letterer-Siwe disease (acute disseminated histiocytosis X) • Frequently the oral changes are the first clinical signs of the disease.HISTIOCYTOSIS X • Also known as Langerhans Cell Histiocytosis and Eosinophilic Granuloma • A probable neoplastic proliferation of Langerhans type of histiocytic cells with a wide spectrum of biological behavior ranging from a single lesion of the mandible to diffusely distributed bone lesions in combination with organ and other soft tissue lesions. .

and bone involvement – Hand-Schuller-Christian disease • Typically begins in childhood • Exophthalmos. in infants or young children • Widespread disease: skin and mucosal lesions. diabetes insipidus. visceral. osteolytic skull lesions (characteristic triad) • Hepatosplenomegaly and skin and mucosal lesions • Oral symptoms .• Clinical Features: – Letterer-Siwe disease • Aggressive.

usually in posterior regions • Loosening of the teeth • The sockets of teeth lost to the disease generally fail to heal normally. – Teeth may appear "floating in space“ – No expansion of the surrounding bone. • Swelling and pain • More often in mandible. . • Radiographic Features: – Solitary or multiple punched-out radiolucent lesion – Lesion margins are usually well-defined but not corticated (punched-out).– Eosinophilic Granuloma disease • Solitary localized bone destruction • Most often in older children and young adults.

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OSTEOPOROSIS • A deficiency of bone tissue. gradual decrease in bone mass. – Generalized. – Most common in postmenopausal women. . per unit volume of bone. High risk for pathologic fractures. the bone is normal. • Clinical features : – The most common type of metabolic bone disease. • There are 2 types of osteoporosis : primary osteoporosis which associated with aging and secondary osteoporosis which associated with abnormal or iatrogenic circumstances such as corticosteroid therapy or conditions such as malnutrition. Histologically.

Normal bone in a 12 year old boy B.• Radiographic features : – Generalized osteopenia. – Thinning of bone cortices – A reduction in the density and thickness of the inferior mandible cortex A. Osteoporosis in a 60 year old male .

. – Children with rickets usually have short stature and deformity of the extremities. • Clinical features : – “Rickets” in children and “osteomalacia” in adults. osteoid builds up in excessive amounts because of its failure to mineralize properly. Development of the dentition is delayed and the eruption rate of the teeth is retarded. – Usually bone pain and muscle weakness.OSTEOMALACIA AND RICKETS • These abnormalities are caused by a nutritional deficiency of vitamin D • In these diseases.

– Pathological fractures.• Radiographic features : – Generalized osteopenia. – Thinning of cortical cortex. .

THALASSEMIA • Inherited. at the expense of the cancellous bone. The red blood cells have a shortened life expectancy. in order to produce more red blood cells. • The hematopoietic system responds with proliferation of bone marrow. • Clinical features : – The face develops prominent cheekbones and a protrusive premaxilla . chronic condition affecting the red blood cells.

irregular. . and coarse trabeculation. – Thinning of lamina dura – Shortened tooth roots.• Radiographic changes: – – – – – – “Hair-on-end” calvarium Widening of the diploic space Enlarged marrow spaces in all bones Generalized osteoporosis Enlargement of jaws Thinning of all cortical structures (especially the lower border of the mandible) – Dense.

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They have decreased capacity to carry oxygen to the tissues. • The hematopoietic system responds with the proliferation of bone marrow. . Due to abnormal hemoglobin the red blood cells become sickle-shaped under conditions of hypoxia. at the expense of the cancellous bone.SICKLE CELL ANEMIA • Inherited condition affecting the red blood cells. in order to produce more red blood cells.

– It occurs mostly in children and adolescents.• Clinical features : – It affects mainly black populations. • Radiographic changes: – “Hair-on-end” calvarium – Widening of the diploic space – Enlarged marrow spaces in all bones – Generalized osteoporosis – Thinning of all cortical structures (such as the skull cortex). .