Which is not a marker of bone resorption?

A. Hydroxyproline

B. Alkaline Phosphatase (ALP)

C. N and C terminal telopeptides

D. TRAcP 5b (tartrate resistant acid phosphatase)

E. BSP (bone sialoprotein)

B. Alkaline Phosphatase (ALP)

- it is a marker of bone formation

Developmental defect of submandibular salivary gland on the lingual aspect of the mandible; neither a cyst nor a pseudocyst.

Stafne's bone "cyst"

aka

Static bone "cyst"

aka

Latent bone "cyst"

What type of Odontogenic cyst is generated by cystic degeneration of enamel organ?

Primordial cyst

What type of Odontogenic cysts arise from the dental lamina (epithelial rests or glands of Serres)?

Odontogenic keratocyst

some developmental lateral periodontal & gingival cysts

What type of odontogenic cysts does the Reduced enamel epithelium give rise to?

dentigerous cyst

eruption cyst

paradental cyst

What type of Odontogenic cysts do the Rests of Malassez generate?

Radicular cysts

&

residual cysts

What are "ghost cells" and in what type of lesion are they found?

Ghost cells are small spherical keratinized epithelial cells with missing nuclei, that often undergo calcification.

They are found in the epithelium of COCs (calcifying odontogenic cysts), along with ameloblasts and stellate reticulum.

- these cysts are rare

Most common sites for dentigerous cysts?

mandibular third molars

&

maxillary canines

What related odontogenic cysts are thought to develop as the result of fluid accumulationi between enamel and reduced enamel epithelium?

Dentigerous cysts

&

Eruption cysts

(eruption cysts are extra-alveolar dentigerous cysts formed during tooth eruption)

Which of the following does not have the potential to enlarge considerably?

A. Odontogenic keratocyst

B. Calcifying odontgenic cyst

C. Unicystic ameloblastoma

D. Hyperplastic follicle

E. Dentigerous cyst

D. Hyperplastic follicle

- unlikely to exceed 5 mm

Most common sites for lateral periodontal cysts?

Mandibular canine and premolar areas

What percent of oral cancers arise from odontogenic cysts?

1-2%

Which type of odontogenic cyst is most likely to undergo malignant transformation?

Second most likely?

Least likely?

Radicular cyst most likely

Dentigerous cysts make up 25%

Lateral periodontal cyst rarely

What kind of tumor am I?

I am benign & encapusulated

2F:1M gender predilection

I mostly occur in 20's

I occur in anterior jaws, 2x as often in the maxilla

Unilocular radiolucency, sometimes w/ calcified flecks

Enucleate and curettage me!

Adenomatoid Odontogenic Tumor (AOT)

- most cases involve crown of unerupted canine

- flecks may differentiate from dentigerous cyst

A middle aged black female presents with a slight bony expansion of her mandible and radiographs showing multiple, confluent, cotton wool opacities in 2 quadrants.

What does she have?

What do you do?

Florid osseous dysplasia

Don't biopsy! Don't extract involved teeth!

- periodontal health must be maintained (and unecessary invasive procedures avoided) in order to prevent secondary osteomyelitis

What is the treatment for a Solitary central giant cell lesion of the jaw?

Attempt to shrink before surgery by:

corticosteroid injection for 6 weeks

Calcitonin injection or nasal spray for 12 months

Interferon alpha-2a

then surgical resection with peripheral margin & curetage

- prognosis is good if excised with adequate borders

Solitary unilocular well-defined radiolucencies occuring in young people?

Central Giant Cell lesion

(teenagers and young adults)

Central ossifying fibroma (early)

(mostly in young adult females)

Langerhans cell disease

(children and young adults)

Apical radiolucency: Cementoblastoma (early) & Traumatic Bone cyst & Langerhans

Ameloblastomas are aggressive but benign tumors of the jaw. How do they present microscopically?

They resemble enamel organs microscopically;

Islands of epithelium consist of a single layer of ameloblasts surrounding a central area of stellate reticulum.

What is a periapical scar?

What type of tissue would be found here?

How is it removed?

Surgical removal of a periapical granuloma (chronic apical periodontitis) may cause resolution by scarring =

periapical scar.

You would find fibrous connective tissue here.

Surgical removal usually requires perforation of both lingual and cortical plates. Will remain radiolucent.

The most common type of odontogenic cyst?

Radicular cyst

aka

Periapical cyst (as most develop at the apex)

What type of jaw cyst am I?

- lined by nonkeratinized SSE

- supporting fibrous connective tisse w/ inflammatory cells

- hyaline Rushton bodies may be present

Radicular cyst

occurrence:

Anterior maxilla>posterior maxilla>posterior mandible

>anterior mandible

- most common type of odontogenic cyst

What type of jaw cyst am I?

- I arise from dental lamina

- my epithelial lining has a parakeratinized corrugated surface

- Satellite cysts may occur in my FCT wall

- I have a high recurrence rate

Odontogenic Keratocyst

- clear or cheesy aspirate

- treatment is removal with peripheral ostectomy and/or cautery/cryosurgery

- monitor & regular long-term follow ups

Where might you see Giant cells, besides a giant cell lesion?

Brown tumor

&

Langerhans

&

Cherubism

In what jaw lesions would you likely find spindled cells?

Odontogenic myxoma

- along with loose myxoid fibrous connective tissue

Ameloblastic fibroma

- as components of the dense fibrous connective tissue

Adenomatoid Odontogenic tumor

- swirled around tubules

A multilocular version of a lateral periodontal cyst?

Botryoid odontogenic cyst

You'd be most likely to find denticles in a ________.

Compound Odontoma

Gemination and fusion both refer to double teeth. Which one is associated with a reduced number of teeth?

Fusion

- associated with missing tooth if counted as one

- gemination has normal tooth count when double tooth counted as one

On which tooth is a coronal dens invaginatus most likely to occur?

A dens evaginatus?

dens invaginatus - max lateral incisor

(also most common tooth for talon cusps)

dens evaginatus - mand premolar

What is increased apico-occlusal dimension of pulp chamber called?

In what syndromes is it found?

Taurodontism

- found in Klinefelters and Down syndrome

(not necessarily associated with these - can occur in isolated cases or in families)

What is perimyolysis?

Loss of tooth structure due to chemical erosion

Which of the following disorders can include anodontia?

A. Gardner's syndrome

B. Hereditary ectodermal dysplasia

C. Cleidocranial dysplasia

B. Hereditary ectodermal dysplasia

- other 2 disorders associated with hyperdontia

(supernumerary teeth)

Polyposis coli is a malignant change in the colon that can occur in what disorder having prominent dental stigmata?

Gardner Syndrome

ORAL STIGMATA:

In which type of Dentinogenesis Imperfecta would you see "shell teeth" and large pulp chambers?

In which type would you see short roots and a pulp chamber obliterated by irregular dentin?

Type III - shell teeth and large pulp chamber

Types I and II - short roots and obliterated pulp

In what disease does the patient exhibit normally shaped and colored crowns, but has obliterated pulp chamber and shortened roots due to abnormal dentin formation?

Dentin Dysplasia type 1 (radicular type)

- teeth can be mobile with tooth loss

In what defect of tooth mineralization do "ghost teeth" appear?

Regional Odontodysplasia

- teeth in region or quadrant have poorly mineralized enamel and dentin

- teeth fail to erupt or have rough discolored surface

- short roots, enlarged pulps, open apical foramina

- affects primary and secondary teeth

- etiology unknown

Hyperphosphaturia and Hypophosphatemia occur in this disease also known as "Phosphate Diabetes".

Familial Hypophosphatemic Rickets

- high pulp horns result in exposures

Cemental hypoplasia leading to exfoliation is a consequence of this autosomal recessive disorder.

Hypophosphatasia

- lack of alkaline phosphatase w/ increased urinary phosphoethanolamine

- shell teeth, lack of alveolar bone

Chronic disseminated type of what disease has the rare triad of map cranium, exophthalmos, and diabetes insipidus?

Langerhans Cell Disease

- occurs between 5 years and adolescence

- on xray teeth look like they're "floating in space"

U-shaped radio-opaque halo beyond widened PDL

Condensing Osteitis

- can look similar to chronic focal sclerosing (condensing) osteomyelitis - near root apex of tooth that has suffered some infection or inflammation

In which non-odontogenic jaw pathology, primarily affecting children, would you see new bone trabeculae perpendicular to periosteum, with or without chronic inflammatory cells, and marrow occupied by collagenous tissue?

(Radiographically you would see mottled trabelculae and new periosteal bone deposition)

Periostitis Ossificans

Multiple odontogenic keratocysts occur in what syndrome affecting young people?

Nevoid Basal Cell Carcinoma Syndrome

 - aka "Gorlin Syndrome"

- absence of functional PTCH gene

Overgrowth of epiphiseal cartilage and excessive osteoid production occur in what metabolic/nutritional/inherited disorder?

Vitamin D deficiency Rickets

Increased PTH causes _______ phosphate in the urine.

Increased phosphate in urine

(hyperphosphaturia)

Wide uncalcified osteoid seams around trabeculae occur in _____________.

Osteomalacia

- Hyperphosphaturia & Hypophosphatemia also occur

*Narrow osteoid seams present in Osteoporosis

What enzyme do zolendronic acid and alendronate both inhibit?

both are nitrogenous bisphosphanates that inhibit

farnesyl diphosphate synthase

- cause osteoclast death by apoptosis

- decrease VEGF

True or False?

Fibrous dysplasia can go through stages of radiolucency, mixed lucent-opaque, and radioopaque.

True

- poorly defined in all cases