RADIOGRAPHIC INTERPRETATION OF

SYSTEMIC DISEASES MANIFESTED IN THE

JAWS

DRG. SHANTY CHAIRANI

HYPERPARATHYROIDISM
Loss of bone mineralization (osteoporosis)
because of increased PTH secretion
(primary) or increased demand for serum
calcium (secondary) , resulting in multiple
systemic complications, loss of alveolar
bone architecture, and occasionally giant
cell tumor ("brown tumor").
The increased secretion of parathyroid
hormone causes generalized bone
resorption (osteopenia), bone pain,
pathological fractures and raises the serum
calcium levels.

 Clinical Features:
Enlargement of one or more parathyroid
glands
Female dilection, middle aged adults
Elevated serum parathyroid hormone and
blood calcium levels.
The serum alkaline phosphatase level may
also be elevated.
Symptoms and signs : renal calculi,
psychiatric problesms, bone and joint
paint.
There may be gradual loosening, drifting
and loss of teeth

 Radiographic Features:
Well defined unilocular or multilocular
radiolucency
Loss of lamina dura around the associated
teeth
The trabecular pattern becomes very fine
(ground glass appearance).
Granular-appearing bone in skull.
Reduction in cortical bone density and
thinning of the cortical border of the
mandible.
In a late stage, localized cyst-like
radiolucencies may occur (brown tumors).
After treatment the appearance becomes
normal again.

HYPERPITUITARISM
Results from hyperfunction of the anterior
lobe of the pituitary gland, increased
production of growth hormone.
Excess of growth hormone causes
overgrowth of all tissues in the body.
Clinical features :
If the abnormality occurs in childhood, generalized
overgrowth of most tissues occurs. It terms as
gigantism.
If it occurs in adult, it is called acromegaly.
Overgrowth of the bones, including the jaw
In acromegaly, there is excessive growth of the
mandible

 Radiograph features :
Enlarged of jaw, especially mandible in acromegaly.
Lengthening of the condylar processes and ascending
ramus of the mandible.
May also be an increase in the thickness and height of the
alveolar processes

HYPOPHOSPHATASIA
A genetic metabolic disorder of bone
mineralization caused by a deficiency in
alkaline phosphatase in serum and tissues;
characterized by skeletal defects resembling
those of rickets.
Odontohypophosphatasia - children and
adults who have only dental problems
(premature loss of teeth).
Clinical Features:
Skeletal changes may present in infants, children,
or may be delayed until adulthood
Premature loss of teeth is common in children
and adults and delayed eruption of the permanent
dentition

 Radiographic Features:
Excessive amount of unmineralized osteoid tissue
Generalized lucency of the maxilla and mandible
Reduced enamel thickness and enlarged pulp
chambers and pulp canals
The cortical bone and lamina dura is thin and the
alveolar bone may be deficient

HISTIOCYTOSIS X
Also known as Langerhans Cell Histiocytosis and
Eosinophilic Granuloma
A probable neoplastic proliferation of Langerhans
type of histiocytic cells with a wide spectrum of
biological behavior ranging from a single lesion of
the mandible to diffusely distributed bone lesions in
combination with organ and other soft tissue
lesions.
There are 3 clinical forms of histiocytosis X :
Eosinophilic granuloma of bone
Hand-Schuller-Christian disease (chronic disseminated
histiocytosis X)
Letterer-Siwe disease (acute disseminated histiocytosis X)

Frequently the oral changes are the first clinical

signs of the disease.

 Clinical Features:
Letterer-Siwe disease
Aggressive, in infants or young children
Widespread disease: skin and mucosal lesions,
visceral, and bone involvement

Hand-Schuller-Christian disease
Typically begins in childhood
Exophthalmos, diabetes insipidus, osteolytic
skull lesions (characteristic triad)
Hepatosplenomegaly and skin and mucosal
lesions
Oral symptoms

 Eosinophilic Granuloma disease

Solitary localized bone destruction
Most often in older children and young adults.
Swelling and pain
More often in mandible, usually in posterior
regions
Loosening of the teeth
The sockets of teeth lost to the disease
generally fail to heal normally.

Radiographic Features:
Solitary or multiple punched-out radiolucent
lesion
Lesion margins are usually well-defined but not
corticated (punched-out).
Teeth may appear "floating in space
No expansion of the surrounding bone.

OSTEOPOROSIS
A deficiency of bone tissue, per unit volume of
bone.
There are 2 types of osteoporosis : primary
osteoporosis which associated with aging and
secondary osteoporosis which associated with
abnormal or iatrogenic circumstances such as
corticosteroid therapy or conditions such as
malnutrition.
Clinical features :
The most common type of metabolic bone disease.
Generalized, gradual decrease in bone mass.
Histologically, the bone is normal.
Most common in postmenopausal women. High risk
for pathologic fractures.

 Radiographic features :
Generalized osteopenia.
Thinning of bone cortices
A reduction in the density and thickness of the
inferior mandible cortex

A. Normal bone in a 12 year old boy

B. Osteoporosis in a 60 year old male

OSTEOMALACIA AND RICKETS

These abnormalities are caused by a
nutritional deficiency of vitamin D
In these diseases, osteoid builds up in
excessive amounts because of its failure to
mineralize properly.
Clinical features :
Rickets in children and osteomalacia in
adults.
Usually bone pain and muscle weakness.
Children with rickets usually have short stature
and deformity of the extremities. Development of
the dentition is delayed and the eruption rate of
the teeth is retarded.

 Radiographic features :
Generalized osteopenia.
Thinning of cortical cortex.
Pathological fractures.

THALASSEMIA
Inherited, chronic condition affecting
the red blood cells. The red blood cells
have a shortened life expectancy.
The hematopoietic system responds
with proliferation of bone marrow, at
the expense of the cancellous bone, in
order to produce more red blood cells.
Clinical features :
The face develops prominent cheekbones
and a protrusive premaxilla

 Radiographic changes:

Hair-on-end calvarium
Widening of the diploic space
Enlarged marrow spaces in all bones
Generalized osteoporosis
Enlargement of jaws
Thinning of all cortical structures (especially the
lower border of the mandible)
Dense, irregular, and coarse trabeculation.
Thinning of lamina dura
Shortened tooth roots.

SICKLE CELL ANEMIA

Inherited condition affecting the red
blood cells. Due to abnormal
hemoglobin the red blood cells become
sickle-shaped under conditions of
hypoxia. They have decreased capacity
to carry oxygen to the tissues.
The hematopoietic system responds
with the proliferation of bone marrow,
at the expense of the cancellous bone,
in order to produce more red blood
cells.

 Clinical features :
It affects mainly black populations.
It occurs mostly in children and
adolescents.

Radiographic changes:
Hair-on-end calvarium
Widening of the diploic space
Enlarged marrow spaces in all bones
Generalized osteoporosis
Thinning of all cortical structures (such as
the skull cortex).