oral medicine

1. Florid Osseous Dysplasia
• It is also called as ‘chronic sclerosing osteomyelitis’, ‘sclerosing
osteitis’, ‘multiple enostosis’ and ‘sclerotic cemental masses’
• Robinson defined it as an abnormal reaction of bone to irritation or
stimulation and the term florid osseous dysplasia includes chronic
diffuse sclerosing osteomyelitis and sclerotic cemental masses.
• It is inherited as an autosomal dominant trait. In florid osseous
dysplasia, the normal bone is replaced by fibrous tissue and
mineralized structure like cementum, bone or both

2. Clinical Features:
• Age and sex—females are exclusively affected. Most common age is middle age,
with a mean age 42 years with predilection for blacks.
• Sites—the lesion is restricted to the jaw bone with mandible being most commonly
affected.
• Symptoms—there is a painless expansion of the alveolar process of mandible.
Patients may complain of intermittent poorly localized pain in the affected bone area,
with or without an associated bony swelling.
• Signs—if the lesion secondarily infected features of osteomyelitis may develop.
Mucosal ulceration with fistulous tract may be present. Teeth in the involved bone are
vital

3. Radiographic Features :
• Location—lesions of florid osseous dysplasia present bilaterally in both the jaws.
Lesions occur above the inferior alveolar nerve canal. It involves all four quadrants.
• Radiodensity—it varies from an equal mixture of radiolucent and radiopaque
region to almost complete radiopaque.
• Size—individual lesions do not exceed 2-3 cm in diameter. The lesions may extend
into the mandibular ramus or into the maxillary sinus.
• Margins—margins are fairly regular and well defined. Each lesion is surrounded
by a radiolucent capsule and a cortical rim.

4. • Radiolucent stage—in this stage, well defined radiolucent area are superimposed
over the apical area of adjacent tooth.
• Mixed stage—in this stage radiolucent cavity, partially filled with one or more
dense radiopaque masses. As lesions mature, the radiopacities increase. This stage
also shows target appearance with central calcified masses in the radiolucent
lesion.
• Radiopaque stage—this shows multiple radiopacity continuous with the
surrounding bone, but they were separated from adjacent teeth periodontal
ligament space. In this stage cotton wool appearance (lobular or lump shaped and
soft radiopaque characters like that of cotton wool) is seen.
• Active hypercementosis—hypercementosis of tooth in the affected area is seen.
There is an also wide periodontal ligament space.

5. Differential Diagnosis :
• Paget’s disease
• Chronic sclerosing osteomyelitis
• Osteopetrosis
Diagnosis
• Clinical diagnosis—painless expansion in
four quadrant of jaw.
• Radiological diagnosis—radiopaque,
mixed lesion in all four quadrants with
active hypercementosis will diagnose this
condition
Management
• Effective oral hygiene
• Recontouring—patients with more severe form of the disease has superficial lesions
which are located near the crest of alveolar ridge, these may require recontouring to
accommodate the denture or to prevent ulceration

6. Cemento-ossifying Fibroma
• It is a benign neoplasm that is osteogenic (non-odontogenic), well defined
and rarely encapsulated, consisting of fibrous tissue with variable amounts
of mineralized material similar to bone and/ or cementum
• Clinical Features
• Age and sex distribution—it predominantly occurs in females in third or
fourth decades of life.
• Bones affected—it can arise from any part of the facial skeleton and skull
with over 70% of cases arising in the head and neck region.
• Symptoms—there is occasional facial asymmetry is seen in some of the
cases.
• Signs—there may be associated exophthalmos, with visual disturbances,
depending on the extent of compression of its orbital content by the tumor.

7. • Giant ossifying fibroma—large lesions increasing in size to over 80 mm
in their greatest diameter have been termed ‘giant ossifying fibroma’
• Teeth—the lesion is slow growing and in some cases, there is
displacement of teeth.
• Cortex—bony cortex and covering mucosa remain intact

8. Radiographic Features
• Periphery—the borders of cemento-ossifying fibroma lesions usually are well defined. A
thin radiolucent line, representing a fibrous capsule, may separate it from surrounding
bone
• Internal structure—it is a mixed radiolucent/ radiopaque density with a pattern that
depends on the amount and form of the manufactured calcified material
Diagnosis
• Clinical diagnosis—not so specific. Facial asymmetry is seen.
• Radiological diagnosis—mixed radiopaque radiolucent lesion seen with sclerotic border.
Displacement of teeth can also be seen
• Laboratory diagnosis—large number of fibroblasts, with flat elongated nuclei is present
within the network of interlacing collagen fibers. Chinese letter shaped islands of bone or
calcification is also seen

9. Differential Diagnosis
• Post extraction socket and residual
cyst
• Primordial cyst
• Ameloblastoma
• Periapical cemental dysplasia
• Adenomatoid odontogenic tumor
• Calcifying epithelial odontogenic
tumor
• Osteoid osteoma
• Osteoblastoma
• Osteosarcoma
• Enucleation—small, clinical
encapsulated lesions are treated by
conservatively enucleation.
• Resection—it is recommended if there
is involvement of inferior border,
extension into maxillary sinus occurs.
Management

10. Peripheral Ossifying Fibroma
• It presents as a tumor like growth of the oral soft tissues and is often
associated with sharp teeth, rough restoration, and ill- fitting
dentures.
Clinical Features
• Even though cemento-ossifying fibroma is considered as an
intraosseous lesion, affects the gum and soft tissue have also been
described.

11. Radiographic Features
• In edentulous patients, there
may appear to be some superficial
erosion of the underlying bone on
radiographs.
• Intra-oral films taken with low
penetration may show varying
amounts of calcification within the
lesion.
Diagnosis
• Clinical diagnosis—not so
specific.
• Radiological diagnosis—erosion
of underlying bone below the
lesion with calcification will give
clue to diagnosis