Bone Pathology of the Jaws

Fibro-osseous and related lesions

Lesion	Who and where	Radiograph and management
Fibrous dysplasia	Children and teens; maxilla more than mandible; GNAS mutation; McCune-Albright when polyostotic with café-au-lait spots and endocrine disease	Ground-glass, blends into normal bone; usually stops at skeletal maturity; contour only if needed
Cemento-osseous dysplasia (periapical, focal, florid)	Middle-aged women, often Black women; mandibular incisors (periapical), posterior mandible (focal), several quadrants (florid)	Lucent → mixed → opaque at VITAL teeth; no treatment; avoid surgery and extractions in the area (infection risk)
Ossifying fibroma	Young adults; mandible	Well-defined, expansile, mixed; enucleate
Paget disease of bone	Older adults; maxilla enlarges (dentures get tight)	Cotton-wool opacities, hypercementosis, raised alkaline phosphatase

Condition	Key points
Condensing osteitis	Opacity at the apex of a tooth with pulpitis or necrosis; may regress after endodontic treatment
Idiopathic osteosclerosis (dense bone island)	Opacity near a VITAL tooth without expansion or symptoms; no treatment
Acute and chronic osteomyelitis	Pain, swelling, moth-eaten bone, sequestra; debridement plus antibiotics
Proliferative periostitis (Garré)	Young patient, mandibular molar infection, layered 'onion-skin' periosteal bone; treat the tooth
Medication-related osteonecrosis of the jaw (MRONJ, AAOMS 2022)	Exposed bone (or bone probed through a fistula) for more than 8 weeks with current or past antiresorptive or antiangiogenic therapy and no jaw radiation or metastatic disease
Osteoradionecrosis	Irradiated bone that fails to heal; lifelong risk after head and neck radiation; prevention is key
Central giant cell granuloma	Under age 30, anterior mandible, multilocular; check calcium and PTH because a brown tumor of hyperparathyroidism looks identical
Cherubism	Bilateral painless posterior mandibular swelling in children (SH3BP2); regresses after puberty
Osteosarcoma	Painful swelling, paresthesia, symmetric PDL widening, sunburst periosteal bone

Pick an answer to see right away whether it is correct and why.

Which radiographic feature best distinguishes fibrous dysplasia from ossifying fibroma?
An older man's maxilla is enlarging, his dentures no longer fit, alkaline phosphatase is high and radiographs show cotton-wool opacities. Diagnosis?
Exposed bone in the mandible for 10 weeks in a patient on IV zoledronic acid with no history of jaw radiation meets the criteria for:
A multilocular lesion in the anterior mandible of a 16-year-old shows giant cells on biopsy. The next test is:
An opacity at the apex of a mandibular first molar with irreversible pulpitis is most likely:

0 of 5 answered

Answer key: 1 A · 2 A · 3 B · 4 C · 5 A