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.

• Clinical Features:– Enlargement of one or more parathyroid

glands– Female dilection, middle aged adults– Elevated serum parathyroid hormone and

blood calcium levels. – The serum alkaline phosphatase level may

also be elevated.– Symptoms and signs : renal calculi,

psychiatric problesms, bone and joint paint.

– There may be gradual loosening, drifting and loss of teeth

• 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). – Granular-appearing bone in skull. – Reduction in cortical bone density and

thinning of the cortical border of the mandible.

– In a late stage, localized cyst-like radiolucencies may occur (brown tumors).

– After treatment the appearance becomes normal again.

HYPERPITUITARISM• Results from hyperfunction of the anterior

lobe of the pituitary gland, increased production of growth hormone.

• Excess of growth hormone causes overgrowth of all tissues in the body.

• Clinical features :– If the abnormality occurs in childhood,

generalized overgrowth of most tissues occurs. It terms as gigantism.

– If it occurs in adult, it is called acromegaly.– Overgrowth of the bones, including the jaw– In acromegaly, there is excessive growth of the

mandible

• Radiograph features :– Enlarged of jaw, especially mandible in acromegaly.– Lengthening of the condylar processes and ascending

ramus of the mandible.– May also be an increase in the thickness and height of the

alveolar processes

HYPOPHOSPHATASIA• A genetic metabolic disorder of bone

mineralization caused by a deficiency in alkaline phosphatase in serum and tissues; characterized by skeletal defects resembling those of rickets.

• Odontohypophosphatasia - children and adults who have only dental problems (premature loss of teeth).

• Clinical Features:– Skeletal changes may present in infants, children,

or may be delayed until adulthood – Premature loss of teeth is common in children

and adults and delayed eruption of the permanent dentition

• 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

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.

• 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.

• Clinical Features:– Letterer-Siwe disease

• Aggressive, in infants or young children• Widespread disease: skin and mucosal lesions,

visceral, and bone involvement– Hand-Schuller-Christian disease

• Typically begins in childhood• Exophthalmos, diabetes insipidus, osteolytic

skull lesions (characteristic triad)• Hepatosplenomegaly and skin and mucosal

lesions• Oral symptoms

– Eosinophilic Granuloma disease• Solitary localized bone destruction• Most often in older children and young adults.• Swelling and pain• More often in mandible, usually in posterior

regions• Loosening of the teeth• The sockets of teeth lost to the disease

generally fail to heal normally.• Radiographic Features:

– Solitary or multiple punched-out radiolucent lesion

– Lesion margins are usually well-defined but not corticated (punched-out).

– Teeth may appear "floating in space“– No expansion of the surrounding bone.

OSTEOPOROSIS• A deficiency of bone tissue, per unit volume of

bone.• 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.

• Clinical features :– The most common type of metabolic bone disease. – Generalized, gradual decrease in bone mass.

Histologically, the bone is normal. – Most common in postmenopausal women. High risk

for pathologic fractures.

• Radiographic features :– Generalized osteopenia.– Thinning of bone cortices– A reduction in the density and thickness of the

inferior mandible cortex

A.Normal bone in a 12 year old boyB.Osteoporosis in a 60 year old male

OSTEOMALACIA AND RICKETS• These abnormalities are caused by a

nutritional deficiency of vitamin D• In these diseases, osteoid builds up in

excessive amounts because of its failure to mineralize properly.

• Clinical features :– “Rickets” in children and “osteomalacia” in

adults. – Usually bone pain and muscle weakness. – Children with rickets usually have short stature

and deformity of the extremities. Development of the dentition is delayed and the eruption rate of the teeth is retarded.

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

THALASSEMIA• Inherited, chronic condition affecting

the red blood cells. The red blood cells have a shortened life expectancy.

• The hematopoietic system responds with proliferation of bone marrow, at the expense of the cancellous bone, in order to produce more red blood cells.

• Clinical features :– The face develops prominent cheekbones

and a protrusive premaxilla

• 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, irregular, and coarse trabeculation.– Thinning of lamina dura– Shortened tooth roots.

http://ddmfr.ath.cx/DentalExpertBi/upload/images/diseases/thalassaimiaacta.jpg

SICKLE CELL ANEMIA• Inherited condition affecting the red

blood cells. Due to abnormal hemoglobin the red blood cells become sickle-shaped under conditions of hypoxia. They have decreased capacity to carry oxygen to the tissues.

• The hematopoietic system responds with the proliferation of bone marrow, at the expense of the cancellous bone, in order to produce more red blood cells.

• Clinical features :– It affects mainly black populations. – It occurs mostly in children and

adolescents.• 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).