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2016 self-study course two course The Ohio State University College of Dentistry is a recognized provider for ADA CERP credit. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at www.ada.org/cerp. The Ohio State University College of Dentistry is approved by the Ohio State Dental Board as a permanent sponsor of continuing dental education. This continuing education activity has been planned and implemented in accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between The Ohio State University College of Dentistry Office of Continuing Dental Education and the Sterilization Monitoring Service (SMS). ABOUT this COURSE… FREQUENTLY asked QUESTIONS… . READ the MATERIALS. Read and Q: Who can earn FREE CE credits? review the course materials. COMPLETE the TEST. Answer the A: EVERYONE - All dental professionals eight question test. A total of 6/8 in your office may earn free CE questions must be answered correctly credits. Each person must read the contact for credit. course materials and submit an online answer form independently. SUBMIT the ANSWER FORM ONLINE. You MUST submit your answers ONLINE at: Q: What if I did not receive a confirmation ID? us http://dentistry.osu.edu/sms-continuing-education A: Once you have fully completed your . RECORD or PRINT THE answer form and click “submit” you phone CONFIRMATION ID This unique ID is will be directed to a page with a displayed upon successful submission unique confirmation ID. 614-292-6737 of your answer form. Q: Where can I find my SMS number? ABOUT your A: Your SMS number can be found in toll free the upper right hand corner of your FREE CE… monthly reports, or, imprinted on the 1-888-476-7678 back of your test envelopes. The SMS number is the account number for your office only, and is the same for . TWO CREDIT HOURS are issued for everyone in the office. fax successful completion of this self- study course for the OSDB 2015-2016 Q: How often are these courses 614-292-8752 biennium totals. available? . CERTIFICATE of COMPLETION is A: FOUR TIMES PER YEAR (8 CE credits). used to document your CE credit and e-mail is mailed to your office. [email protected] . ALLOW 2 WEEKS for processing and mailing of your certificate. The Ohio State University College of web Dentistry is an American Dental dentistry.osu.edu/sms Association (ADA) Continuing Education Recognized Provider (CERP). Page 1 Bone Pathology: A Guide to 2016 Differential Diagnosis course Learning Objectives: one 1. Be able to determine most likely diagnosis from clinical and radiographic information 2. Recognize radiographic pathology and be able to produce a reasonable differential 3. Recognize when radiographic findings warrant systemic work up 4. Use the radiographic and clinical features to determine when to treat or watch 5. Differentiate between lesions that are quickly and slowly progressing This is a OSDB Category B – Supervised self-instruction course. INTRODUCTION This course serves as a review of bone lesions seen on panoramic radiographs and periapical films. The radiographic appearance of a lesion or condition provides features that help to narrow down the differential diagnosis of a lesion. Systemic disorders can present as abnormal changes in the jaw obligating dentists to recognize the written by presentation before other symptoms arise. Location and extent of Ashleigh Briody, DDS disease process can be helpful to guide a clinician to the correct differential diagnosis and necessary treatment (or negate the need for further treatment). Lesions above the inferior alveolar canal on the edited by mandible and in proximity to the teeth of both the mandible and maxilla Ross White, BS could be pathology of odontogenic origin (most likely) or other origin such Jon Strasbourg, BA as bone. Lesions within the alveolar canal are most likely neural (nerve tissue) or vascular (blood vessel) in origin. Changes below the inferior release date alveolar canal or not in close association with teeth on a panoramic radiograph could be bone pathology (more likely), odontogenic, or other May 2, 2016 (7:30 AM EST) entities such as salivary gland. It is prudent to note that depending on the angulation of the radiation source, lesions may appear more superior or last day to take the inferior on a two-dimensional image. Well-defined lesions are typically course at no charge benign, as the well-defined margin shows that the surrounding bone has June 6, 2016 (3:30 PM EST) had time to react to the process. Ill-defined margins suggest rapid processes such as infection and malignancy. This course focuses not on odontogenic cysts and neoplasms that occur in the bone but bone last day course is pathology itself. available for credit December 31, 2018 Page 2 CASE 1 CASE 2, continued.. A 52 year old male presents with chief concern of A 9 year old male was referred to OSU College bone pieces extruding from the gingiva since of Dentistry for evaluation of a 3 month history of extractions 3 months prior. One week prior to his a swelling in the area of teeth #6-8. Tooth #7 appointment he reports seeing a dentist who was displaced distally and #6 was unerupted and referred him to OSU College of Dentistry. The in a similar location to the contralateral canine. patient stated that he attempted to extract a Clinically, the lesion was expansile, firm and maxillary tooth on his own. He reports pain and tender to palpation. The differential diagnosis numbness of the chin. Clinical exam revealed poor included adenomatoid odontogenic tumor (AOT), dentition, left facial swelling and an area of central giant cell granuloma, and dentigerous exposed bone. Radiographically, the left mandible cyst. The panoramic radiograph showed a shows diffuse moth-eaten radiolucencies. The poorly circumscribed intrabony radiolucency. On remaining root tips from the maxillary and cone beam computed tomography (CBCT) mandibular teeth are noted many of which are images, a thin cortex of bone surrounded the associated with periapical radiolucencies. The expansile mass. The lesion showed a close patient denied history of bisphosphonate use and association with #6, so an odontogenic lesion radiation therapy. A biopsy was performed and a could not be ruled out. The patient underwent diagnosis of chronic osteomyelitis was rendered. general anesthesia, the lesion was aspirated, The patient was prescribed systemic antibiotics, and an incisional biopsy was performed. The chlorhexidine and pain medications. Definitive pathologic diagnosis rendered was a central treatment in this case involves resection and giant cell granuloma. Intraoperatively, tooth #7 reconstruction of the jaw. was encased, had no bony support and was subsequently extracted. Tooth #8 expressed CASE 2 class II mobility but was spared along with the canine. Several weeks later the patient underwent excisional biopsy which showed a hybrid bone lesion showing central giant cell granuloma and ossifying fibroma. Page 3 CASE 3 Periapical Radiopacities Condensing osteitis: Tooth #18 tested nonvital. The bone surrounding the apices exhibits increased density (radiopacity). Picture on the left was before root canal therapy. Picture on the right was 6 years post endodontic therapy. (Courtesy of Dr. Kitrina Cordell, LSUHSC School of Dentistry) A 67 year old man presented with chief concern Condensing osteitis is an increased bone of pain in the right posterior mandible. He density in response to periapical disease. The reported that the day after the extraction of #28 radiograph of this lesion reveals a thickened and #29, he was admitted to the hospital for two periodontal ligament (PDL) in association with a weeks following a gastrointestinal biopsy uniform radiopacity adjacent to the apex of the procedure. After his hospital discharge, he diseased tooth. No expansion of the bone noticed that the pain was now intermittent and should be present. The treatment of this felt numbness along the right mandible and chin. condition involves eliminating the source of Clinically, there was significant expansion of the infection. In most cases, the radiopacity will right mandible, although the extraction sites return to normal radiodensity. Persistence of a appeared to be healing without incident. A radiopacity in the area after definitive resolution panoramic radiograph was taken and revealed of the source of infection is termed bone scar. an ill-defined radiolucency in the right mandible, The clinical significance of a bone scar is posterior to #27. The margins appeared ragged potential root resorption in an orthodontic patient and a biopsy was performed. The diagnosis if the scar is in the path of tooth movement. rendered was diffuse large B-cell Lymphoma. Follow up revealed that the pathology of the Idiopathic osteosclerosis: mandibular lesion was consistent with that of the mass in the colon and the patient began chemotherapy treatment. Radiopacity noted between the roots of #20 and #21. The lesion has blended borders with the surrounding bone. Both teeth are vital. (Courtesy of Dr. Kitrina Cordell, LSUHSC School of Dentistry) Page 4 Idiopathic osteosclerosis, continued… Cemento-osseous dysplasia, continued… Idiopathic osteosclerosis is an asymptomatic Cemento-osseous dysplasia (COD) is a benign benign process that results in increased bone fibro-osseous process that presents in several density. Age of onset ranges from 20 to 40 years ways. As the name suggests, there is a soft old and is more common in the posterior tissue “fibro” component (radiolucent) and a hard mandible. Radiographically, this presents as a tissue “cemento-osseous” component singular or multiple well-defined radiopacities.
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