Systemic Diseases Manifested in Jaw l Oral radiology MCQs for dental students 

Important points to remember in systemic diseases manifested in jaw

1. Diabetes mellitus: Polyuria, polydipsia (excessive intake of water), polyphagia, nocturia and rapid weight loss are present. Radiograph shows discontinuity or blurring of the cortex of the alveolar crest, wide destruction of the lamina dura, thickening of periodontal membrane, and horizontal and vertical bone loss.
2. Hyperthyroidism: Process of eruption of permanent teeth is advanced. Radiodensity of jawbone, particularly in the mandible, is reduced.
3. Hypothyroidism: Patient is having expressionless face with scanty hair and retarded development of the teeth. There is presence of wormian bones in skull and periodontal disease which may lead to early loss of teeth.
4. Hyperparathyroidism: It is due to hypercalcaemia; symptoms include polyuria, polydipsia, renal colic, lethargy, anorexia, nausea, dyspepsia and peptic ulceration. On radiograph there is granular or ground-glass appearance, osteitis fibrosa generalisata, brown tumours and demineralisation of skull.
5. Hypoparathyroidism: Spasm of wrist and ankle joints, and tingling sensation around the circumoral area are present. On radiograph there is decreased density of enamel due to enamel hypoplasia.
6. Hyperpituitarism: There is generalised overgrowth occurring in the individual. Radiograph shows enlargement (ballooning) of sella turcica and enlargement of paranasal sinuses, especially frontal sinus.
7. Hypopituitarism: Patients show dwarfism, delayed tooth eruption and retarded jaw growth. On radiograph jaws are small and mandible is sometimes more affected than maxilla resulting in retrusion of the chin.
8. Cushing syndrome: Weight loss, menstrual irregularity, hirsutism, muscle weakness, hypertension and buffalo hump appearance are present. The primary radiographic feature of Cushing syndrome is generalised osteoporosis.
9. Rickets: An excess of osteoid produces frontal bossing and squared appearance of head. Deformation of chest results in ‘rachitic rosary’ and ‘pigeon chest’. On radiograph there is widening and fraying at the epiphyses of long bones. Bowing in the bone is the characteristic deformity seen in weight-bearing bones.
10. Osteomalacia: The most striking feature is bone pain which is severe in nature. On radiograph there are marked
11. changes in the structure of bones, with gross alteration of the shape.
12. Osteoporosis: There is gradual loss of height and chronic back pain. On radiograph there is generalised rarefaction of bone without any change in size, possibly due to increased porosity of compact bone and loss of trabeculae in cancellous bone.
13. Osteopetrosis: It is also known as marble bone disease. Bone is subjected to fracture on minor trauma. On radiograph there is narrowing of foramina and increased opacity of cranial base.
14. Histiocytosis X: The three different forms include eosinophilic granuloma of bone, Hand–Schuller–Christian disease and Letterer–Siwe disease. In Letterer–Siwe disease there is skin rash involving the trunk, scalp and extremities. Oral lesion includes ulcerative lesion with gingival hyperplasia. The lesion may occur in jaw and overlying soft tissue. In Hand–Schuller–Christian disease there is classic triad of bone lesion, diabetes insipidus and exophthalmos.
15. Radiographic features of histiocytosis X: The skull is commonly involved and lesion may be solitary or multiple. Jaw lesion of eosinophilic granuloma is usually seen as area of pure osteolysis close to the alveolar process. The lesion in the jaws has fairly discrete borders, which are rarely hyperostotic. Thus, they have punched-out appearance.
16. Hypophosphatasia: The infant shows bowed legs and marked deficiency of skull ossification. Skull shows poor
17. calcification and beaten-silver appearance.
18. Sickle cell anaemia: During the crisis state, there is severe abdominal, muscle and joint pain and high temperature and circulatory collapse may result. Orally there is paleness of mucosa. On radiograph ‘hair-on-end appearance’ is seen. Another typical feature of sickle cell anaemia is ‘stepladder defect’. This occurs due to horizontal alignment of trabeculae.
19. Thalassaemia: Orally there is bimaxillary protrusion which results in malocclusion of teeth. There is proclination of anterior maxillary teeth with spacing. All these features give rise to ‘chipmunk’ facies. Thalassaemia also shows ‘hair-on-end’ appearance.