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By Naglaa S.

El Kilani

Because systemic disorders affect the


entire body, the radiographic changes
manifested in the jaws are generalized.
The general changes include the following:
1. A change in size and shape of the bone
2. A change in the number, size, and
orientation of trabeculae
3. Altered thickness and density of cortical
structures
4. An increase or decrease in overall bone
density

Naglaa S.El kilani

Changes to teeth and associated structures


include the following:
1. Accelerated or delayed eruption
2. Hypoplasia
3. Hypocalcification
4. Loss of a distinct lamina dura

Naglaa S.El kilani

Parathyroid function:
Parathyroid hormone
preserves blood
calcium by several
major effects:
Enhancing absorption
of calcium from the
small intestine
Suppression of calcium
loss in urine
Mobilization of calcium
from bone.
Naglaa S.El kilani

Clinical Features
Women are two to three times more
commonly affected.
Age incidence :30 to 60 years of age.
Most patients have renal calculi
Peptic ulcers, psychiatric problems.
Bone and joint pain.
Hypercalcemia.
Naglaa S.El kilani

Main radiographic features:


Osteopenia of the skull vault producing a fine

stippled pattern .
Localized radiolucent cyst-like giant cell lesions
(Osteitis fibrosa cystica ).
Brown tumors occur late in the disease and in
about 10% of cases.
Pathologic calcifications in soft tissues in the
kidneys and joints.
The entire calvarium has a granular appearance
Naglaa S.El kilani

Naglaa S.El kilani

Evidence in the jaws of:


- Osteopenia (in mandible and maxilla)
producing a very fine trabecular pattern (
ground glass)
- Loss of the lamina dura surrounding all the
teeth
Thinning or loss of the normal thick cortical
bone of the lower border of the mandible

Naglaa S.El kilani

Naglaa S.El kilani

Naglaa S.El kilani

Hyperpituitarism results from


hyperfunction of the anterior lobe of the
pituitary gland, which increases the
production of growth hormone.
Classification:
1. Gigantism ( before puberty)
2. Acromegaly (after puberty)

Naglaa S.El kilani

This is a disturbance of bone growth


caused by hypersecretion of growth
hormone (GH) usually as the result of a
pituitary adenoma developing after
puberty.

Naglaa S.El kilani

Characteristic clinical features


Renewed growth of certain bones, particularly the
jaws, hands and feet.
The supraorbital ridges and the underlying frontal
sinus are enlarged.
Hypertrophy of some soft tissues as the lips,
tongue, nose.

Naglaa S.El kilani

Naglaa S.El kilani

Naglaa S.El kilani

Main radiographic features :


Evidence in the skull of:
- Thickening of the bones of the skull vault.
- Enlargement and distortion of the pituitary
fossa.
Evidence in the jaws of:
- Enlargement of the mandible, it to become
prognathic (classIII) .
- Enlargement of the inferior dental canal
- Thickening of the alveolar bone with spacing
and fanning out of the teeth, particularly
anteriorly, resulting in an open bite.
- Hypercementosis of posterior teeth .
Naglaa S.El kilani

Naglaa S.El kilani

Hyperthyroidism is a syndrome that involves


excessive production of thyroxin in the
thyroid gland.
Clinical features:
A generalized increase in the metabolic rate
of all body tissues
Tachycardia
Increased blood pressure
Sensitivity to heat, and irritability.

Naglaa S.El kilani

Radiographic Features

In infants:
Early eruption of the primary teeth
Premature loss.
In adults :
A generalized decrease in bone density.

Naglaa S.El kilani

Cushing's syndrome arises from an excess of


secretion of glucocorticoids by the adrenal
glands.

The increased level of glucocorticoid results


in a loss of bone mass from reduced
osteoblastic function and either directly or
indirectly increased osteoclastic function
Naglaa S.El kilani

Clinical Features

Females three to five more than males.


Usually seen in the third or fourth decade.
Often show obesity (which spares the
extremities).
kyphosis of the thoracic spine "buffalo
hump"
Muscle Weakness
Hypertension
Concurrent diabetes.
Naglaa S.El kilani

Naglaa S.El kilani

Radiographic Features
Generalized osteoporosis, a granular bone
pattern.
Pathologic fractures.
The skull can show diffuse thinning with a
mottled appearance.
Premature eruption of teeth.
Partial loss of the lamina dura may occur.
Naglaa S.El kilani

Normally bone remodeling processes are tightly coordinated


Osteoporosis occurs when bone resorption exceeds
formation.
Collagen as well as mineral is lost from bone resulting in a
generalized decrease in bone mass.
Naglaa S.El kilani

Naglaa S.El kilani

Occurs with the aging process of bone

Bone mass normally increases from


infancy to about 35 to 40 years of age.

At this time there begins a gradual and


progressive decline, occurring at the rate
of about 8% per decade in women and 3%
per decade in men.
Naglaa S.El kilani

Secondary osteoporosis:
Nutritional deficiencies
Hormonal imbalance
Inactivity
Corticosteroid
Heparin therapy.

Naglaa S.El kilani

Clinical Features
Postmenopausal women.
Fracture.
The most common locations are the distal
radius, proximal femur, ribs, and vertebrae.
Bone pain.

Naglaa S.El kilani

Radiographic Features
An overall reduction in the density of bone.
Thinning of cortical boundaries such as the
inferior mandibular cortex.
Accurate assessment of bone mass loss is
difficult but may be done with dual energy
photon absorption (DEXA) or quantitative
computed tomography (QCT) programs.
Naglaa S.El kilani

They result from inadequate serum and


extracellular levels of calcium and phosphate
minerals.

Both abnormalities result from a defect in


the normal activity of the metabolites of
vitamin D, especially 1,25(OH)2D, required for
resorption of calcium in the intestine.
Naglaa S.El kilani

Such defect may occur due to:


1. Lack of exposure to ultraviolet light required
for conversion of provitamin D3
2. Lack of conversion of vitamin D3 to 25(OH)D
in the liver.
3. Lack of metabolism of 25(OH)D2 to
1,25(OH)2D by the kidney .
4. A defect in the intestinal target cell response
to 1,25(OH)2D or inadequate calcium supply.
Naglaa S.El kilani

Clinical Features
Rickets:
In the first 6 months of life:
Tetany or convulsions resulting from the
hypocalcemia of rickets.
Later in infancy:
Deformity of the extremities.
Delayed development of the dentition
Retarded eruption rate of the teeth.
Naglaa S.El kilani

Osteomalacia:

Bone pain.
Muscle weakness of varying severity.
Peculiar waddling or "penguin" gait,
Tetany
Bone fractures.

Naglaa S.El kilani

Radiographic Features
General radiographic features:
In rickets:
A characteristic bowing of the femur and tibia.
Greenstick fractures (an incomplete fracture).
In osteomalacia:
T he cortex of bone may be thin.
Pseudofractures may also be present
Naglaa S.El kilani

Radiographic features of the jaws:


Within the cancellous portion of the jaws, the
trabeculae become reduced in density, number,
and thickness.
Radiographic changes associated with the teeth:
In Rickets : Hypoplasia of developing dental
enamel.
The lamina dura and the cortical boundary of
tooth follicles may be thin or missing.
Osteomalacia does not alter the teeth
Naglaa S.El kilani

Naglaa S.El kilani

Osteopetrosis is a disorder of bone that results from a


defect in the differentiation and function of
osteoclasts.

The lack of normally functioning osteoclasts results in


abnormal formation of the primary skeleton and a
generalized increase in bone mass.

Obliteration of the marrow compromises


hematopoiesis and compresses cranial nerves.
Naglaa S.El kilani

Clinical Features
Progressive loss of the bone marrow .
A severe increase in bone density.
Hydrocephalus
Blindness, deafness, vestibular nerve
dysfunction, and facial nerve paralysis.
Bone pain .
Osteomyelitis that is more common in the
mandible.
Naglaa S.El kilani

Radiographic Features
General radiographic features:
Increased bones density, which is bilaterally
symmetric.
The trabecular patterns of the medullary cavity
may not be visible.
Radiographic features of the jaws:
The increased radiopacity of the jaws so that
even the roots of the teeth may not be
apparent.
Naglaa S.El kilani

Naglaa S.El kilani

Radiographic features associated with the


teeth:
Delayed eruption, early tooth loss, missing
teeth, malformed roots and crowns.
The lamina dura and cortical borders may
appear thicker than normal.

Naglaa S.El kilani

Naglaa S.El kilani

Sickle cell anaemia

Thalassaemia (Cooley's
anaemia)

Hereditary, chronic, haemolytic


blood disorder

Hereditary ,chronic
haemolytic anaemia

affects principally
black populations

mainly affects people from the


Mediterranean

Abnormal hemoglobin called


hemoglobin S. A genetic error
makes the hemoglobin molecules
stick together in long, rigid rods
after they release oxygen. These
rods cause the red blood cells to
become hard and sickle-shaped,
unable to squeeze through tiny
blood vessels causing a blockage
that deprives the body's cells and

The rate of production of certain


hemoglobins is decreased leading to
an imbalance of globin chains
available for hemoglobin dimer
construction.
This results in the formation of
abnormal amounts of structurally
normal (normal amino acid
sequence) hemoglobins.

tissues of blood and oxygen.

Naglaa S.El kilani

Sickle cell anaemia

Thalassaemia (Cooley's
anaemia

Evidence in the skull vault of:


- Thickening of the frontal and parietal
bones
-Widening of the diploic space
-Thinning of the inner and outer tables
-Generalized osteoporosis
-The hair-an-end appearance

Evidence in the skull vault of:


- Widening of the diploic space
-Thinning of the inner and outer tables
-Remodeling of the trabeculae to give
sparse lines which may
radiate outwards from the inner table
producing the hair-on-end

Evidence in the jaws of:


A generalized coarse trabecular pattern
-Fewer trabeculae are evident
- Enlargement of the maxillae, with
protrusion and separation of
the upper anterior teeth
Osteosclerotic areas resulting from the
infarcts
- Usually normal teeth with normal lamina
dura.

Evidence in the jaws of :


-Generalized coarse trabecular pattern
-Thinning of all cortical structures
- Expansion, which lead to
encroachment on, and subsequent
obliteration of the maxillary antra
-No evidence of bone infarcts.
- Apparent spike-shaped or shortened
tooth roots

Naglaa S.El kilani

Sickle cell anaemia


Naglaa S.El kilani

Naglaa S.El kilani

Thalassaemia
Naglaa S.El kilani

Naglaa S.El kilani