Oral Pathology

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