2. 45/F
pain , swelling in Right side of the upper jaw and halitosis
difficult extraction of the teeth on the same side
Diffuse swelling was present in right maxillary region
Palpation – swelling had diffuse borders and firm
consistency
Intraorally –entire maxillary alveolus was enlarged and
maxillary alveolus extending from canine to second molar
showed necrotic bone exposed into the oral cavity with
inflammation of the surrounding mucosa
Difficulty in walking
Case report
4. Diagnosis ???
• swelling
• a. Lincoln Mark
• >40 years old.
• Waddling gait
• Hypercementosis
• Mosaic pattern
• Cotton wool
• ALP->200
5. Paget's Disease
Paget's Disease is as diseases of bone marked by
repeated episodes of increased bone resorption
followed by excessive attempts at bone formation ,
rustling in weakened and deformed bone of increased
mass
6. Introduction
• Rapid turnover remodeling of bone
• Elderly – older then 50 years
• Men: women = 3:2
• Most commonly affected – spin , femurs, skull, pelvis, sternum ,and Jaws
• Maxilla 2:1 mandible
7. Systemic FINDING
Osteoarthritis may result from changes in bone shape that alter normal skeletal mechanics. For example, bowing of a
femur affected by Paget's
Heart failure (i.e. more than 40% skeletal involvement).
Kidney stones are somewhat more common in patients with Paget's disease.
Nervous system problems may occur in Paget's disease, resulting from increased pressure on the brain, spinal cord, or
nerves, and reduced blood flow to the brain and spinal cord.
• bones of the cranio-facial complex can be affected - Foramina narrowing → cranial nerve neuropathies deafiness
blurring of the vision, head ache
At diagnosis many patients are asymptomatic, although up to 40% of patients initially present with bone pain.
8. DENTAL FINDING
• Generalized hypercementosis which is most advanced
on premolar and molar teeth. ) difficulties in
extraction(
• Diastemas and lingual inclinations because of dental
compensations in response to the slow expansion
• Denture wearer may present with the classic
complaint of a denture that ha s become too small and
may even have had several
• During active disease, pagetoid bone is extremely
vascular with multiple arteriovenous shunts. Oral
surgical procedures during this time can result in
extensive hemorrhage.
• During the later sclerotic phase, the bone is
hypersensitive to inflammation and can develop
osteomyelitis with minimal provocation.
• appliances
9. Radiographic appearance
in early disease stages, the affected bone exhibits
decreased radiodensity and a coarse trabecular pattern.
Particularly in the skull, large circumscribed radiolucencies
may be present (osteoporosis circumscripta).
With progression (late stage ), diffuse sclerosis is seen
radiographically ding the so-called
cotton wool" appearance of confluent nodular
opacifications.
"fluffed, radiodense, cloud-like aggregation"
10. Lincoln beard sign
is one of the signs of Paget disease on the radionuclide
bone scan when the disease involves the mandible
Lincoln sign on bone scintigraphy, increased radiotracer
uptake in the body of mandible. This pattern has also
been described as "black beard" sign.
11. Leontiasis ossea
lion-like facial : is a rare medical condition with
characteristic overgrowth of the facial and cranial
bones.
Maxillary disease produces enlargement of the middle
third of the face and may result in :
• nasal obstruction
• enlarged turbinate
• obliterated sinuses
• deviated septum
12. Treatment and Prognosis
• Mild cases require no treatment.
• Paget discase is currently incurable, but the pain and deformity can be
controlled with treatment.
• Anti-osteoclastic actions of calcitonin or the bisphosphonates. 200-mg oral
dose of Disodium Etidronate may be given twice daily.
• Edentulous patients -- may require new and larger dentures periodically to
compensate for progressive enlargement of the alveolar processes.