Paget's Disease

• Chief Complaint: Denture tightening (due to arch expansion)
• Fractures: Chalk-stick fractures
• Facial Feature: Leontiasis ossea (lion-like facies)
• Radiology: Cotton wool appearance
• Histology: Jigsaw puzzle pattern
• Clinical: Bone warm to touch (↑ vascularity)
• Laboratory: ↑ Alkaline phosphatase (>250 Bodansky units)
• Other Signs: Osteoporosis circumscripta, platybasia
• Memory Aid: "Paget's Patients Prefer Tight Dentures"

Osteopetrosis

• Radiographic Sign: Rugger Jersey Spine (classic)
• Fractures: Chalk-stick fractures

Fibrous Dysplasia

• Facial Feature: Leontiasis ossea
• Histology: Chinese script pattern
• Radiology:
  • Ground glass appearance
  • Rind sign, orange peel appearance
• Bone Deformity: Hockey stick/Shepherd's crook deformity (femur)
• Key Feature: Lesional bone fused with normal bone (vs COF)
• Memory Aid: "Fibrous Faces Feel Funny"

Cemento-Ossifying Fibroma (COF)

• Histology: Chinese script pattern
• Facial Feature: Leontiasis ossea
• Difference: NOT fused with normal bone (vs Fibrous Dysplasia)

Hyperparathyroidism

• Radiology: Ground glass appearance (brown tumor)
• Histology: Numerous giant cells, vascular stroma, hemosiderin deposits

Cherubism & Central Giant Cell Granuloma

• Histology: Same as hyperparathyroidism (giant cells + vascular stroma + hemosiderin)
• Note: Cherubism previously called "Familial fibrous dysplasia"
• Memory Aid: "Giant Cells Have Three Homes" (Hyperparathyroidism, Cherubism, CGCG)

Juvenile Ossifying Fibroma

• Aggressiveness: More aggressive than Cemento-ossifying fibroma
• Types:
  • Trabecular type: Common in jaws
  • Psammomatoid type: Involves base of skull

Non-epithelial cysts (not true cysts)

Solitary bone cyst

Radiology

The solitary bone cyst appears as a well-defined but non-corticated radiolucency. Typically, it has little effect
on adjacent structures and 'arches' up between the roots of teeth .

The inferior dental canal may not be displaced, but the cortical margins of the canal may be lost where it overlies the lesion. Expansion is rare.

Pathology

The cyst is lined by fibrovascular tissue that often includes haemosiderin and multinucleate giant cells.

Aneurysmal bone cyst

Radiology

The aneurysmal bone cyst typically presents as a fairly well-defined radiolucency. Sometimes it has a multilocular appearance because of the occurrence of internal bony septa and opacification. Marked expansion is a feature.

Pathology

The predominant feature of an aneurysmal bone cyst is the presence of blood-filled spaces of variable size lying in a stroma rich in fibroblasts, multinucleate giant cells and haemosiderin. Deposits of osteoid are also seen
 

• Gingivitis - Immune Cells: Neutrophils are the predominant immune cells present in the first stage of gingivitis.

• Acute Necrotizing Ulcerative Gingivitis (ANUG): Involved papillae show punched out, crater-like necrotic areas covered by grayish pseudomembrane.

• Drug-Induced Gingival Enlargement: Never seen in edentulous areas, as there is no plaque in these areas for the drug to interact with.

• Papillon-Lefèvre Syndrome:

  • Cause: Mutation of the cathepsin C gene located on chromosome 11q14.

  • Result: Impaired chemotaxis and phagocytosis, leading to severe periodontitis and palmar/plantar hyperkeratosis.

• Bull Neck: Seen in Diphtheria and Ludwig's Angina.

• Bull's Eye Lesion / Target Lesions: Characteristic of Stevens-Johnson Syndrome and Erythema Multiforme.

• Bull's Teeth: Refers to Taurodontism.

• Circus Rubber Man: Clinical appearance associated with Ehlers-Danlos Syndrome (due to hypermobility and skin elasticity).

• Claw Hands: A physical deformity seen in advanced Scleroderma.

• Coup de Sabre: A linear depression or groove resembling a "saber cut" seen in Facial Hemiatrophy (Parry-Romberg Syndrome) and localized Scleroderma (linear scleroderma).

• CREST Syndrome: A limited form of Scleroderma, characterized by:

  • Calcinosis

  • Raynaud's phenomenon

  • Esophageal dysfunction

  • Sclerodactyly

  • Telangiectasias

• Crowe's Sign: Axillary or inguinal freckling seen in Neurofibromatosis Type 1.

• Frog Facies: A characteristic facial appearance seen in Crouzon Syndrome (due to midfacial hypoplasia and exophthalmos).

• Gorlin Sign: The ability to touch the tip of the nose with the tongue, seen in Ehlers-Danlos Syndrome (due to increased joint laxity).

• Hockey Stick Deformity of Femur and Shepherd's Crook Sign: Radiographic findings typically associated with Fibrous Dysplasia.

• Parrot's Beak Nose: A nasal deformity seen in Crouzon Syndrome.

• Red Strawberry Tongue and Pastia's Lines: Clinical signs characteristic of Scarlet Fever.

• Rodent Facies: A facial appearance often associated with Thalassemia.

• Simian Stance: A stooped posture, reminiscent of an ape, seen in Paget's Disease of Bone.

• Snail Track Ulcers: Serpiginous, grayish-white lesions on mucous membranes, characteristic of Syphilis (mucous patches in secondary syphilis).

• Socks Feet and Mitten Hands: Refers to syndactyly (fusion of digits) appearing like a sock or mitten, seen in Apert's Syndrome.

• Parrot Beak Shaped Nails: A nail deformity (onychogryphosis) seen in Congenital Syphilis.

• Pioneer bacteria invade dentinal tubules before clinical signs
• Tubules contain pure forms:
  • One tubule → cocci
  • Adjacent tubule → bacilli or threads
• No mixed forms within a single tubule

• Hypogeusia Treatment: Zinc sulfate supplements above the usual recommended daily dose appear beneficial.

• Arsenic Poisoning: Characterized by "rain drop pigmentation" on the skin.

• Quincke's Edema: Commonly known as Angioneurotic Edema.

• Internal Resorption: Also known as Pink Tooth of Mummery or Odontoclastoma.

• Mercury Intoxication: Also known as Pink Disease.

• Lead Poisoning (Plumbism):

  • "Lead line" / "Burtonian line": A gray/bluish-black line of sulfide pigmentation occurring in the gingiva.

  • Peripheral neuritis: Produces a characteristic wrist drop/foot drop.