Osteopathies (osteodysplasias and osteodystrophies):
Dysplasia:
Malformation or deformation resulting from an abnormality in the development of a tissue or organ, which occurs during the embryonic period or after birth.
Dystrophy:
Any acquired cellular or tissue alteration linked to a “nutritional disorder” (vascular, hormonal, nervous, metabolic).
- Osteodystrophies (quantitative abnormality):
- Definitions:
Are morphological abnormalities of the bone skeleton occurring after embryogenesis
Pathologies of bone structures that can be
Localized
Generalized
- Etiology:
Disruption of bone physiology in the sense of:
Either hyper bone production or hyper bone destruction.
Affecting the elderly more often, they are generalized and develop slowly.
Hypercondensing conditions:
Due to excess production of bone substances or insufficient resorption
Osteolytic disorders:
Due to insufficient production or excess resorption of the bone matrix.
II. Osteodysplasia (qualitative abnormality):
Affecting the young subject more
Are located in rapid evolution.
Classification of osteodysplasia:
- Acquired:
Paget’s disease
Von Recklinghausen’s disease or hyperparathyroidism
Acromegaly (hypersecretion of growth hormone)
Histiocytosis X
- Hereditary:
Cherubism
Infantile cortical hyperostosis
Thalassemia
ACQUIRED OSTEODYSPLASIA:
- Paget’s disease:
Bony swelling of the face
Hypertrophy of a partial or total hemiface
Thickening of the basilar rim with prognathism appearance
Prominent zygomatic arches
Multiple diastemas
Deafness due to stenosis of the internal and external auditory canal
Disturbed phonation and mastication
RX: areas of bone condensation with a pagetoid appearance at the level of the facial bones.
The retroalveolar shows hypercementosis and calcifications.
Biologically: an increase in alkaline phosphatases (30 and 100 IU/L (unit))
Treatment: bisphosphants
Tooth extractions are problematic due to hypercementosis
- Von Recklinghausen’s disease or hyperparathyroidism:
Due to hyperfunction of the parathyroid glands and excessive secretion of parathyroid hormone.
*Role of parathyroid hormone:
– At bone level it mobilizes phosphocalcic reserves
– At the renal level it hinders the resorption of phosphorus by the tubule.
Characterized by:
Severe bone pain
Spontaneous fractures
Bony swellings in the form of often bumpy protrusions
Kidney stones.
Radiologically:
Osteolytic lesions
Metaphyseal geodes
Root and cranial resorptions
Biologically:
-Hypercalcemia: norm/ 2.2 and 2.6 mmol·L-1 of plasma.
– Increased alkaline phosphatases / 30 and 100 IU/L
– Decrease in serum phosphorus / between 25 and 45 mg/L
-Increased serum parathyroid hormone level / 6-50 pg/ml
Treatment: Excision of the adenoma or hyperplastic glands associated with hormone replacement therapy
- Acromegaly (hypersecretion of growth hormone):
Non-congenital hypertrophy of the hands, feet and head
Young adult women are most affected
Protrusion of the brow ridges, cheekbones, chin and mastoids
Lips upturned
Hypertrophied mandible with prognathism
Reverse bite and diastemas
Macroglossia
Melanodermic spots and skin disorders
The radiograph shows widening of the sella turcica, thickening of the cranial vault, increased volume of the sinuses, and hypertrophy of the mandible.
Biologically hypercalcemia and hyperglycemia.
The treatment is the excision of the pituitary adenoma.
- Histiocytosis X:
Disease characterized by the abnormal proliferation and accumulation of Langerhans cells.
It includes:
Eosinophilic granuloma with solitary or multiple maxillary bone involvement.
Hand–Scholler–Christian disease characterized by disseminated bone lesions of the jaws.
Albert-Letterer-Siwie disease with malignant maxillary bone lesions with very significant tooth mobility
HEREDITARY OSTEODYSPLASIAS:
- Cherubism:
Appears around age 4
Bilateral facial swelling with cherub appearance.
The X-ray shows cystic-appearing osteolysis.
The teeth are pushed back or impacted; they appear to float in the air.
Treatment is surgical in severe forms, otherwise therapeutic abstention is necessary because the disease regresses after treatment.
- Infantile cortical hyperostosis:
Appears in children around 18 months with painful swellings in the jaw.
- Thalassemia:
Hereditary anomaly due to a deficit in hemoglobin synthesis :
Maxillary bone hypertrophy
Prognathism of the upper jaw
Multiple diastemas
Osteopathies (osteodysplasias and osteodystrophies)
Untreated cavities can damage the pulp.
Orthodontics aligns teeth and jaws.
Implants replace missing teeth permanently.
Dental floss removes debris between teeth.
A visit to the dentist every 6 months is recommended.
Fixed bridges replace one or more missing teeth.