it is also known as keratocystic odontogenic tumor ( KOT)
also known as osteogenic sarcoma
A 35-year-old man presents with gross loosening of both his lower left premolar teeth. The gingiva around them looks swollen and is purple–brown in colour. A radiograph shows irregular bone destruction to the apices. Incisional biopsy shows multinucleated osteoclast-like giant cells in a haemorrhagic fibrous stroma.
- Which investigations should now be performed?
The serum calcium level should be measured and radiographs reviewed to exclude hyperparathyroidism.
- If these prove negative, what treatment should be undertaken?
The lesion should be treated by local removal with curettage.
- Which other lesions in the jaws contain multinucleate giant cells of this type?
Osteoclast-like giant cells are found in
- giant-cell granuloma
- brown tumour of hyperparathyroidism
- Pagetʼs disease of bone
- aneurysmal bone cyst
- some fibro-osseous lesions, particularly cherubism.
Concepts of Health & Disease
Health is a basic human need and better health improves your quality of life.
There are various changing concepts of Health . Absence of disease being the traditional concept – Biomedical concept . Health is perceived in different ways nowadays giving rise to following concepts:
1. Biomedical concept
2.Ecological concept : Health is perceived as balance between man and his environment and one who cannot adjust is not fit to be called healthy.
3. Psychosocial concept : Health is also influenced by social, psychological , cultural , economic and political factors of the people concerned.
4.Holistic concept : is an integrated approach towards wellbeing of the human being.
This was keypoints about concepts of Health. I hope it helps .
A 60-year-old man has been treated for a T2N0M0 squamous-cell carcinoma by radical radiotherapy. He has a history of chronic alcoholism and was a heavy smoker. Six years after treatment, he develops a painful ulcer in the alveolar mucosa in the treated area following minor trauma. His pain worsens and the bone became progressively exposed. He is treated by a partial mandibular resection with graft.
- What diagnosis is most likely?
The features suggest osteoradionecrosis. Recurrent carcinoma is possible but less likely.
- How does radiotherapy damage tissues and what structural features might be seen in the bone?
Radiotherapy damages tissues by producing free radicals. DNA damage may prevent cell division and repair. Endoarteritis obliterans results in reduced vascular supply to the tissues. Bone may become necrotic, showing osteocyte death, sequestration and breakdown of the matrix. Infection may result in osteomyelitis
- What changes may arise in irradiated connective tissues 10 years after exposure?
Mutations and other genetic damage may lead to neoplasia in irradiated tissues. Osteosarcoma can arise in this way.
A 58-year-old woman noticed that her front teeth had become spaced and seeks advice from her dentist. On entering the surgery, the dentist notices that she has difficulty in walking and does not respond to his questions. She has become increasingly deaf and her vision has also deteriorated. On examination, the maxilla and zygoma are enlarged and there is enlargement of the forehead.
1. What diagnosis would you suspect?
Pagetʼs disease of bone results in enlargement of cranial bones and deformation of weight- bearing bones. The cranium is usually expanded in thickness and symptoms may arise from cranial nerve compression.
2. What information might be gained from oral radiographs and blood tests to support this diagnosis?
Radiographs of the jaws may show hypercementosis, cemental masses, abnormal trabeculation and a cotton-wool appearance in the jaws. The alkaline phosphatase level is markedly raised.
3. What are the principal histological features of this disorder?
Disordered bone remodelling is seen; larger osteoclasts are present and the trabeculae show a scalloped outline. Numerous resting and reversal lines, resulting in a mosaic pattern, are seen and the vasculature may be increased. Globular cementum-like masses are seen in the jaws.
- Head is tilted backwards
- Anterior open bite
- Increased overjet/ Proclined anterior teeth
- Crowding seen in anterior segment
- Supra erupted posterior
- Posterior crossbite
- Narrow maxilla and deep palatal vault
- Xerostomia = prone to caries
- Gingival recession
- Bleeding from gums
- Narrow nasal passages
- used for mesiodistal tooth movement.
- Active arm is 12 mm and retentive tag is 3-5mm.
- Placed along long axis of the tooth which has to be moved.
- If tooth is to be moved mesially, direction of helix will be distal
- The finger spring is activated by moving the active arm towards the teeth intended to be moved. This is done as close to the coil as possible.
- Activation of upto 3 mm is considered
- High frenal attachment
- Tooth are procline
- Tooth material arch length discrepancy
- Midline pathology
- How to correct midline diastema?
- Composite restoration
- Finger springs = draw
- Fixed appliance = keychain
- Permanent retention