• Mosaic / Cotton Wool Bone → Paget’s Disease
• Orange Peel / Ground Glass → Monostotic Fibrous Dysplasia
• Salt & Pepper Bone → Thalassemia
• Phantom Bone / Massive Osteolysis → Bone disappearance
• Drill / Rider’s / Exercise Bone → Myositis Ossificans
• Brittle Bone → Osteogenesis Imperfecta
• Wormian Bones → Cleidocranial Dysplasia
• Coarse Woven Bone → Fibrous Dysplasia

• Chemotherapy Acute Changes: The two common acute changes are hemorrhage and mucositis.

• Radiosensitivity of Glands: Serous type of glands exhibit more radiosensitivity compared to mucous and mixed glands.

Osteoradionecrosis

Clinical features

A reduction in vascularity, secondary to endarteritis obliterans, and damage to osteocytes as a consequence of ionising

Radiotherapy can result in radiation-associated osteomyelitis or Osteoradionecrosis. The mandible is much more  commonly affected than the maxilla, because it is less vascular. Pain may be severe and there may be pyrexia. The overlying oral mucosa often appears pale because of radiation damage. Osteoradionecrosis in the jaws arises most often following radiotherapy for squamous cell carcinoma.
 

Scar tissue will also be present at the tumour site, often in close relation to the necrotic bone.

Radiology
 

Osteoradionecrosis appears as rarefying osteitis within which islands of opacity (sequestra) are seen. Pathological

fracture may be visible in the mandible.

Pathology
The affected bone shows features similar to those of chronic osteomyelitis. Grossly, the bone may be cavitated

And discoloured, with formation of sequestra.
Acute inflammatory infiltrate may be present on a background of chronic inflammation, characterized by formation

Of granulation tissue around the non-vital trabeculae.

Blood vessels show areas of endothelial denudation and obliteration of their lumina by fibrosis.

Small telangiectatic vessels lacking precapillary sphincters may be present.

Fibroblasts in the irradiated tissues lose the capacity to divide and often become binucleated and enlarged.

Management

Prevention of Osteoradionecrosis is vital. Patients who  require radiotherapy for the management of head and

neck malignancy should ideally have teeth of doubtful prognosis extracted at least 6 weeks prior to treatment.

The dose of radiation,
The area of the mandible irradiated and
the surgical trauma involved in the dental extractions.
Surgical management of Osteoradionecrosis is similar to osteomyelitis.

• Cheiloscopy: The examination of lip prints.

• Gustafson's Method for Age Estimation: Includes assessment of:

  • Amount of occlusal attrition

  • Secondary dentine deposition (coronal)

  • Periodontal attachment loss

  • Cementum apposition at root apex

  • Root resorption at apex

  • Dentine translucency

• Bacteria adhere to acquired pellicle
• Coaggregation enables biofilm complexity
• Sucrose → lactic acid → pH drops → Hydroxyapatite dissolves

Key Enzymes Recap:

• Invertase → splits sucrose
• GTF → forms sticky glucans for adhesion
• FTF → synthesizes fructans for biofilm scaffolding

Mnemonics Flashcards