Diseases Of Bone And Joints Oral Pathology Essay Question And Answers

Diseases Of Bone And Joints Important Notes

1. Fibrous Dysplasia Definition: It is an idiopathic condition, in which an area of normal bone is gradually replaced by abnormal fibrous connective tissue, which then again undergoes osseous metaplasia, and eventually the bone is transformed into a dense lamellar bone.
   • Fibrous Dysplasia Classification:
     • Monostotic – Only one bone is involved
     • Polyostotic – More than one bone is involved
       • Jaffe’s type -Polyostotic along with cafe-au-lait-skin pigmentation
       • Albright syndrome – characterized by polyostotic fibrous dysplasia, cafe-au-lait skin pigmentation, and endocrine disturbances
   • Diseases Of Bone And Joint Features
     • Cafe au lait pigmentation of skin
     • Unilateral swelling of the jaw
     • Precocious puberty
     • Egg crackling of the cortex of the bone is present
     • Later ground glass appearance is seen
     • Maxillary lesions causes obliteration of maxillary sinus
     • Spindle-shaped fibroblasts are arranged in a whorled pattern
2. Paget’s disease
   • It is characterized by excessive and abnormal remodeling of bone
   • Affects the adult skeleton
   • Patients suffer from deafness, blindness, and facial paralysis
   • There is a progressive enlargement of the skull and maxilla because of which the patient has to change the hats and dentures frequently
3. Cherubism
   • Manifests by the age of 3-4 years
   • Painless symmetric swelling of the mandible or maxilla occurs
   • Results in chubby face appearance
   • The deciduous teeth shed prematurely and numerous teeth are absent
   • X-ray shows numerous unerupted teeth floating in cyst-like spaces
4. Cleidocranial dysplasia
   • it is characterized by abnormalities of the skull, shoulder girdle, jaws, and teeth
   • Skull – delayed closure of sutures and wormian bones
   • Shoulder – partial or complete absence of clavicles
   • Teeth – prolonged retention of deciduous and delayed eruption of permanent
   • Numerous supernumerary teeth are found in the mandibular premolar and incisor areas
5. Blue sclera Is seen In
   • Osteogenesis imperfecta
   • Marfan syndrome
   • Cherubism
   • Ehlers Danlos syndrome
   • Osteopetrosis
   • Fetal rickets
   • Normal infants
6. Marfan’s syndrome
   • Long thin extremities
   • Hyperextensibility of joints
   • Spidery fingers
   • Arachnodactyly
   • Bifid uvula
   • CVS complications
7. Albright’s syndrome
   • Precocious puberty
   • Polyostotic fibrous dysplasia
   • Cafe-au- lait pigmentation
8. Down syndrome
   • It occurs due to trisomy 21
   • Features
     • Hypermobility
     • Macroglossia
     • Flat face
     • Large anterior fontanelle
     • Sexual underdevelopment
     • Cardiac abnormalities
9. Cotton wool appearance is seen in
   • Paget’s disease
   • Chronic sclerosing diffuse osteomyelitis
   • Fibrous dysplasia
   • Cemento-osseous dysplasia
10. Radiographic features in different disease
    
    Serum affine phosphatase is elevated In  
    • Malignancy
    • Abscess of Ihrer
    • Amyloidosis
    • Leukemia
    • Sarcoidosis
11. Pierre Robin syndrome
    • Features
      • Micrognathia
      • Geffc palate
      • Glossoprosis
12. Diseases with cafe-Au lait spots are
    • Albright syndrome
    • Yon Recklinghausen neurofibromatosis
    • Bloome’s syndrome
    • Fanconi’s syndrome
    • Cowden’s syndrome
    • Tuberculosis sclerosis
    • Watson’s syndrome
    • Ataxia telangiectasia

Diseases Of Bone And Joints Short Question And Answer

Question 1. Classify the diseases of TMJ. Write etiology and clinical features of ankylosis
Answer:

Classification of Diseases of Temporomandibular Joint:

1. Disorders due to extrinsic factors
   • Masticatory muscle disorders
     • Myofunctional pain dysfunction syndrome
     • Myositis
   • Problems due to trauma
     • Traumatic arthritis
     • Fracture
     • Internal disc derangement
     • Tendonitis
2. Disorders due to intrinsic factors
   • Trauma
     • Dislocation
     • Fracture
   • Internal disc displacement
     • Anterior disc displacement with reduction
     • Anterior disc displacement without reduction
   • Arthritis
     • Osteoarthritis
     • Rheumatoid arthritis
     • Juvenile arthritis
     • Infantile arthritis
   • Developmental defects
     • Agenesis
     • Hypoplasia
     • Hyperplasia
   • Ankylosis
   • Neoplasm
     • Benign
     • Malignant

Read And Learn More: Oral Pathology Questions and Answers

Ankylosis: Ankylosis means stiff joint

Ankylosis Etiology:

• Trauma
• Congenital
• Infections- osteomyelitis
• Inflammation- Osteoarthritis
• Systemic diseases-typhoid
• Measles
• Prolonged trismus

Ankylosis Types:

• False or true ankylosis
• Extra articular or intra articular
• Fibrous or bony
• Unilateral or bilateral
• Partial or complete

Ankylosis Clinical Features:

1. Unilateral ankylosis
   • Deviation of the chin on the affected side
   • The fullness of the face on the affected side
   • Flatness on the unaffected side
   • Crossbite
   • Angle’s class 2 malocclusion
   • Condylar movements absent on the affected side
2. Bilateral ankylosis
   • Inability to open mouth
   • Neck chin angle reduced
   • Class 2 malocclusion
   • Protrusive upper incisors
   • Multiple carious teeth

Question 2. Enumerate bone disorders affecting the jaws. Describe the pathogenesis, clinical features, radiographic appearance, and histopathology of fibrous dysplasia.
Answer:

Bone Disorders Affecting the Jaws:

• Osteogenesis imperfecta
• Osteopetrosis
• Fibrous dysplasia
• Cheruhism
• Mandibulofaci dysostosis
• Pierre Robin malformation
• Achondroplasia
• Chondroectodermal dysplasia
• Cleidocranial dysplasia
• Down’s syndrome
• Marfan syndrome
• Infantile cortical hyperostosis

Fibrous Dysplasia:

• Fibrous dysplasia is a skeletal developmental anomaly of the bone-forming mesenchyme that manifests as a defect in osteoblastic differentiation and maturation

Fibrous Dysplasia Pathogenesis:

Fibrous Dysplasia Types:

• Monostotic form
• Polyostotic form
• Jaffe’s type
• Albright syndrome

Fibrous Dysplasia Clinical Features:

• Age- Occurs in the first and second decade of life
• Sex- common in females
• Site involved
  • Skull
  • Facial bones
  • Clavicles
  • Pelvic bones
  • Long bones-femur, tibia, humerus
• Skeletal lesions
  • Unilateral distribution of lesions
  • Swelling on the affected side
  • Recurrent bone pain
  • Cessation of growth
  • Pathological fractures
• Skin lesions
  • Cafe-au- Jail pigmentations
  • It consists of irregularly, pigmented, light brown, flat, melanotic spots
• Oral manifestations
  • Slow enlarging, painless, unilateral swelling of the jaw
  • Facial deformity
  • Expansion and distortion of cortical plates,
  • Displacement of regional teeth
  • Disturbances in teeth eruption
  • Severe malocclusion
  • Maxillary lesions lead to Exophthalmos, proptosis, and nasal obstruction
  • Mandibular protuberance
• Precocious puberty
  • Premature vaginal bleeding
  • Breast development
  • Presence of axillary and pubic hairs at the age of 2-3 years

Fibrous Dysplasia Radiographic Features:

• Initially, it produces unilocular or multilocular radiolucent areas in bone
• Expansion and distortion of cortical plates occurs
• Displacement of teeth
• The egg-cell crackling of the cortex of the bone is present
• Later a classical ground glass or orange peel appearance of bone is seen
• The margin of the lesion blends with the surrounding normal bone
• Mandibular lesions cause bulging of the US inferior border
• Narrowing of periodontal ligament
• Thinning of lamina dura
• Maxillary lesions causes obliteration of maxillary sinus

Fibrous Dysplasia Histopathology:

1. Monostatic fibrous dysplasia
   • Consists of proliferating fibroblasts in the stroma of interlacing collagen fibers
   • Trabeculae of bone are multiple, coarse, irregular, and immature
   • This produces a Chinese letter pattern
   • Spheroidal areas of calcification are seen
   • Presence of giant cells
   • At the margin, the lesion blends with the surrounding bone
   • Gradually the amount of cellularity decreases and the amount of bone tissue increases
   • There is remodeling of woven bone
2. Polyostotic fibrous dysplasia
   • Areas of fibrous metaplasia within flat and tubular bones
   • Well defined lesions
   • Rich in spindle-shaped fibroblasts arranged in a whorled pattern
   • Presence of giant cells
   • Collagen fiber bundles lack orientation

Question 3. Enumerate the osteodystrophies. Write in detail about Paget’s disease of bone.
Answer:

Osteodystrophies: Osteodystrophies are disorders of bone other than neoplastic and inflammatory conditions

Osteodystrophies Classification:

1. Fibro-osseous lesions
   • Fibrous dysplasia
   • Periapical cementitious dysplasia
   • Focal cementitious dysplasia
2. Giant cell lesions
   • Cheru be
   • Central giant cell granuloma
   • Peripheral giant cell granuloma
3. Developmental disorders of bone
4. Metabolic disorders of bone
   • Brown’s tumor
5. Miscellaneous
   • Rickets
   • Osteomalacia

Paget’s Disease: It is a bone disorder characterized by excessive, tin- coordinated phases of bone resorption and subsequent deposition of new bone in the same area

Paget’s Disease Clinical Features:

• Age- fifth, sixth, seventh decade of life
• Sex- common in males
• Sites involved
  • Weight-bearing areas- vertebral column, femur
  • Skull
  • Pelvis
  • Sternum
  • Common in maxilla than mandible
• Present as deep and aching bone pain
• Bilateral swelling of the involved bone
• Bowing deformity of weight-bearing areas
• Results in monkey-like stance
• Waddling gait
• Involvement of facial bones is referred to as dementia- sis ossa
• Headache
• Deafness, blindness
• Facial paralysis
• Enlargement of skull
• Bowing of legs
• The increased localized temperature of the skin

Paget’s Disease Histopathology:

• The initial stage shows osteoclastic bone resorption
• Bone is replaced by highly vascularised cellular connective tissue
• Osteoclasts are larger and multinucleated
• The later stage shows the deposition of new lamellar bone by osteoblast cells
• Fatty bone marrow is replaced by fibrous stroma
• Bone resorption and deposition produce prominent reversal and resting lines
• The irregular pattern of such lines produces a jigsaw- puzzle or mosaic pattern
• The affected bone is thick, sclerotic
• Obliteration of the medullary cavity occurs
• Chronic inflammatory cells and dilated blood capillaries are present

Paget’s Disease Radiographic Features:

• Initially, there is the presence of radiolucent areas in the affected bone
• In the next stage, involved bone shows haphazardly arranged newly formed bone in radiolucent areas
• This produces the cotton wool appearance
• The radiopacity of lesions increases due to increased osteosclerosis
• Prognathic and pagetoid mandible
• Obliteration of maxillary sinus
• Hypercementosis of tooth
• Loss of lamina dura
• Obliteration of periodontal ligament space
• Root resorption

Question 4. Clinical features of monostotic fibrous dysplasia
Answer:

Monostotic Fibrous Dysplasia: It is a form of fibrous dysplasia that involves single-bone

Monostotic Fibrous Dysplasia Clinical Features:

• Common in children and young adults
• Painless swelling of the jaw
• Common in mandible
• The protuberance of its inferior border
• Misalignment or displacement of regional teeth
• The overlying mucosa is intact
• Maxillary lesions involve the maxillary sinus, the floor of the orbit, and the zygomatic process
• There is a bulging of canine fossa

Question 5. Cleidocranial dysplasia
Answer:

Cleidocranial dysplasia

It is a hereditary disorder characterized by abnormal growth of the bones in the face, skull, and clavicles with a tendency for the failure of tooth eruption

Cleidocranial dysplasia Clinical Features:

• Absence or hypoplasia of one/ both clavicles
• Hypermobility of shoulder joints
• Elongated frontal and occipital skull plates
• Underdeveloped entire mid-face
• Delayed closure of fontanelles
• High and narrow arched palate
• Underdeveloped paranasal sinuses
• Photophobia
• Multiple unerupted and impacted teeth

Cleidocranial dysplasia Radiographic Features:

• Open sutures
• Open fontanelles
• Partial/complete loss of clavicles
• Multiple impacted teeth
• Thin roots of teeth

Question 6. Etiopathogenesis and Histopathology of cherubism
Answer:

Cherubism: It is a rare benign hereditary condition characterized by bilaterally symmetrica] enlargement of the mandible

Cherubism Etiopathogenesis:

• It results due to
  • Anomalous development of bone
  • Latent hyperparathyroidism
  • Hormone dependent neoplasm
  • Trauma
  • Disturbance in the development of bone-forming mesenchyme

Cherubism Histopathology:

• The presence of numerous multinucleated giant cells
• Stroma consists of a large number of spindle-shaped fibroblasts
• Numerous small vessels and capillaries are present
• They are lined by endothelial cells and perivascular cuffing
• Advanced lesions show
• Increase in fibrous tissue
• Decrease in giant cells
• Formation of new bone

Question 7. MPDS
Answer:

MPDS

• It is a disorder characterized by facial pain limited to mandibular function, muscle tenderness, joint sounds, absence of significant organic and pathologic changes in TMJ
• It may be due to functional derangement of dental articulation, psychological state of mind, or physiological state of the joint
• Coined by Laskin

MPDS Etiology:

1. Extrinsic factors
   • Occlusal disharmony
   • Trauma
   • Environmental influences
   • Habits
2. Intrinsic factors
   • Internal derangement of TMI
   • Anterior locking of disc
   • Trauma

MPDS Features:

• Unilateral preauricular pain
• Dull constant sound
• Muscle tenderness
• Clicking noise
• Altered jaw function
• Absence of radiographic changes
• Absence of tenderness in ext. auditory meatus

MPDS Management:

1. Reassurance
2. Soft diet
3. Occlusal correction: 7 ‘R’s
   • Remove-extract the tooth
   • Reshape grind the occlusal surface
   • Reposition orthodontically treated
   • Restore conservative treatment
   • Replace by prosthesis
   • Reconstruct TMJ surgery
   • Regulate control habits
4. Isometric exercises
   • Opening and closing of mouth 10 times a day
5. Medicaments
   • Aspirin: 0.3-0.6 gm/ 4 hourly
   • NSAIDS: for 14-21 days
   • Pentazocine: 50 mg/ 2-3 times a day
6. Heat application
   • It increases circulation
7. Diathermy
   • Causes heat transmission to deeper tissues
8. LA injections
   • 2% lignocaine into trigger points
9. Steroid injection
   • As anti-inflammatory
10. Anti-anxiety drugs
    • Diazepam-2-5 mg * 10 days
11. TENS
12. Acupuncture

Question 8. Cherubism
Answer:

Cherubism

It was described by Jones in 1933

Cherubism Classification:

• Based on the severity and location of the lesion
  • Grade 1- Affects Minus of the mandible
  • Grade 2- Affects ramous and body of the mandible and maxillary tuberosity
  • Grade 3 – after maxilla ami mandible entirely

Cherubism etiology:

• Autosomal dominant trail latent hyperparathyroidism
• Trauma
• Disturbance in bone-forming mesenchymal

Cherubism Clinical Features:

• Age and sex- 2-3 years males are affected
• Site-angle of mandible bilaterally
• Bilateral, painless, symmetrical swelling giving a chubby appearance
• Swelling is firm to hard in consistency
• Maxillary swelling causes pressure over the floor of the orbit
• Due to this, pupils turn upwards giving a “heavenward look”
• Difficulty in speech, deglutition, mastication, and respiration
• Limited jaw movements
• Expansion and widening of alveolar ridge
• Flattening of palatal vault
• Chronic lymphadenopathy
• Malocclusion

Question 9. Osteogenesis Imperfecta
Answer:

Osteogenesis Imperfecta

It is a genetically transmitted disease of bone characterized by defective matrix formation and lack of mineralization

Osteogenesis Imperfecta Clinical Features:

Osteogenesis Imperfecta Oral Manifestations:

• Large head
• Frontal bossing
• Maxillary hypoplasia
• Bulbous crowns of teeth
• Class 3 malocclusion
• Severe attrition of deciduous teeth
• Multiple impacted permanent teeth
• Increased incidence of osteomyelitis

Question 10. Osteopetrosis
Answer:

Osteopetrosis

• It is also known as marble disease
• It is a rare bone disorder characterized by increased bone density

Osteopetrosis Clinical Features:

• Decreased bone marrow activity leading to anemia, leukopenia, and pancytopenia
• Hepatosplenomegaly
• Deafness, blindness, and facial paralysis due to narrowing of cranial foramina
• Defective enamel formation
• Short roofs
• Pathological fractures
• Increased incidence of osteomyelitis

Question 11. Blue sclera
Answer:

Blue sclera

• Blue sclera is due to unusually transparent or thin sclera which causes increased visibility of choroids
• It is seen in
  • Osteogenesis imperfecta
  • Marfan syndrome
  • Cherubism
  • Ehlers-Danlos syndrome
  • Osteopetrosis
  • Fetal rickets
  • Normal infants

Question 12. Leontiasis ossa
Answer:

Leontiasis ossa

The involvement of facial bones in Paget’s disease is known as leontiasis ossa

Leontiasis ossia Features:

• Progressive enlargement of the maxilla
• Widening of alveolar ridges
• Loosening of teeth
• Flattening of palate
• Mouth remains open
• In edentulous patients, there is difficulty in wearing dentures

Question 13. Albright’s syndrome
Answer:

Albright’s syndrome Features:

• Common in females
• It is a severe form of fibrous dysplasia involving nearly all the bones in the body
• It is accompanied by pigmentations of the skin and endocrine disorders
• Endocrine disorders
  • Precocious puberty
  • Goitre
  • Hyperthyroidism
  • Hyperparathyroidism
  • Cushing’s syndrome
  • Acromegaly
• Skin lesions
  • These are coffee with milk color spots
  • There is an irregular flat area of increased skin pigmentation
• Vaginal bleeding occurs
• Long bones are frequently affected

Question 14. Marfan’s syndrome
Answer:

Marfan’s syndrome

It is a hereditary syndrome

Marfan’s Syndrome Clinical Features:

• Long, thin extremities resembling spider fingers
• Hyperextensibility of joints
• Habitual dislocations
• Kyphosis
• Aortic regurgitation
• Cardiac aneurysm
• Mitral valve prolapse
• Myopia, cataract
• Retinal detachment
• Psychological trauma

Marfan’s Syndrome Oral Manifestations:

• Long and narrow face
• High arched palate
• Bifid uvula
• Presence of multiple odontogenic cysts
• Malocclusion
• Temporomandibular joint dysarthrosis

Question 15. Mandibulofacial dysostosis
Answer:

Mandibulofacial dysostosis

It is a hereditary- disease characterized by defects in structures derived from 1st and 2nd branchial arches

Mandibulofacial dysostosis Clinical Features:

• Malformation of the external ear- the absence of an external auditor canal, deformity in the middle and internal ear
• Antimongoloid palpebral fissures
• Coloboma of the outer portion of lower eyelids
• Hypoplasia of the mandibular body and zygoma
• Narrow face and depressed cheek
• Results in bird-face appearance
• Crowding and malocclusion of teeth
• High arched palate
• Atypical hair growth
• Parotid hypoplasia
• Narrowing of larynx and trachea
• Difficulty in speech and respiration

Question 16. Serum alkaline phosphatase
Answer:

Serum alkaline phosphatase

• Alkaline phosphatase occurs in many tissues of the body, especially in osteoblasts
• It is elevated in
  • Malignancy
  • Abscess of liver
  • Amyloidosis
  • Leukemia
  • Sarcoidosis

Question 17. Pierre Robin syndrome
Answer:

Pierre Robin syndrome

It is a hereditary disease

Pierre Robin syndrome Features:

• Mandibular micrognathia giving bird face appearance
• Downward and backward placement of tongue
• Difficulty in breathing, airway maintenance, feed- ind and speech
• Malocclusion of teeth
• Presence of multiple missing teeth or supernumerary teeth
• Absence of TMJ
• Mongolism
• Congenital heart defects
• Hydrocephaly, microcephaly
• Mental retardation
• Psychological trauma

Question 18. Cotton wool appearance
Answer:

Cotton wool appearance

• Cotton wool appearance is a radiographic feature of Paget’s disease
• In the later stage of the disease, new bone is formed in the present radiolucent areas
• It results from thickened, disorganized trabeculae which lead to areas of sclerosis in previously lucent areas of bone
• These areas are poorly calcified

Question 19. Peaud orange radiographic appearance
Answer:

Peaud orange radiographic appearance

• It is seen in the later stage of fibrous dysplasia
• Initially, there is the presence of unilocular or multi-locular radiolucent areas
• Later quite opaque areas develop due to delicate trabeculae
• This results in a proud orange or orange peel appearance
• It is not well-circumscribed
• Its margins blend with the surrounding bone

Question 20. Down syndrome
(or)
Trisomy 21
Answer:

Down syndrome

• Down’s syndrome/trisomy 21/mongolism affects approximately 1 in 1000 births.
• It is the most common chromosomal disorder and is the commonest cause of mental retardation.

Down syndrome or Trisomy 21 Etiology:

• Late maternal age
• Nondisjunction of chromosome 21 during an early stage of embryogenesis.

Down Syndrome or Trisomy 21 Clinical Features:

• Epicanthal folds and flat facial profile,
• Slanting eyes produce a mangoloid appearance.
• Hands are short with a transverse single palmar crease.
• Abnormalities of ears, trunk, pelvis, and phalanges
• Cardiac malformations
• Congenital malformations are common and quite disabling
• Risk of developing acute leukemia, especially megakaryocytic leukemia.

Down syndrome or Trisomy 21 Oral Manifestation:

• Deficient maxilla- class 3 relation,
• Open mouth,
• Large tongue,
• Caries free teeth due to excess salivation.

Question 21. Brown tumor
Answer:

Brown tumor

• The brown tumor is also known as hyperparathyroidism
• It is an endocrine disorder occurring due to an excess of circulating parathyroid hormone

Brown tumor Types:

• Primary hyperparathyroidism
• Occurs due to tumour of glands
• Secondary hyperparathyroidism
• Occurs in response to hypocalcemia
• Tertiary hyperparathyroidism
• Occurs after long-standing secondary hyperparathyroidism

Brown Tumour Clinical Features: Age and sex- common in middle-aged women

1. Classic triad
   • Kidney stones
   • Bone resorption
   • Duodenal ulcers
2. Renal symptoms
   • Renal calculi
   • Hematuria
   • Back pain
3. Psychological symptoms
   • Emotionally unstable
4. GIT symptoms
   • Anorexia
   • Nausea, vomiting
5. Skeletal
   • Bone pain
   • Pathologic fractures
   • Bone deformities
   • Hypercalcaemia
6. Generalised symptoms
   • Muscle weakness
   • Fatigue
   • Weight loss
   • Insomnia
   • Headache
   • Polydipsia and polyuria
7. Oral manifestations
   • Intraoral and extraoral swelling
   • Gradual loosening of teeth
   • Drifting and loss of teeth
   • Malocclusion

Question 22. Philadelphia chromosome
Answer:

Philadelphia chromosome

• Philadelphia chromosome is the translocation of chromosomal material from chromosome 22 to chromosome 9
• It is seen in leukemic patients

Question 23. Cafe au lait spots
Answer:

Cafe au lait spots

• Cafe-au-lait spots are pigmented macules
• They are arranged in linear or segmental patterns near the midline of the body

Diseases with Cafe-Au-Lait Spots are:

• Albright syndrome
• Von Recklinghausen’s neurofibromatosis
• Bloome’s syndrome
• Fanconi’s anaemia
• Cowden’s syndrome
• Tuberculosis sclerosis
• Watson’s syndrome
• Ataxia telangiectasia

 

Diseases Of Bone And Joints Viva Voce

1. Pathognomic feature of osteogenesis imperfecta is blue sclera
2. Ankylosis means stiff joint
3. Cotton wool appearance is seen in Paget’s disease
4. Ground glass appearance is seen in monostotic fibrous dysplasia
5. Mosaic bone and jigsaw puzzle appearance is seen in Paget’s disease
6. Chinese letter appearance is seen in Monostotic fibrous dysplasia
7. The brown tumor occurs due to an excess of circulating parathyroid hormone
8. Philadelphia chromosome is the translocation of chromosomal material from chromosome 22 to chromosome 9