Pathology · patient case question
Each of the following is associated with a systemic disease of bone EXCEPT one. Which is the EXCEPTION?
Patient case: Bulbous root form on a recall radiograph
Patient: Male, 61 years old
Chief complaint: “Nothing hurts — I'm here for my cleaning.”
History: Hearing aid fitted last year. Reports his hat size has increased. Takes no regular medications.
Findings: Periapical radiographs show generalised bulbous, club-shaped root enlargement with the periodontal ligament space and lamina dura following the enlarged outline. The bone shows a patchy, cotton-wool trabecular pattern. Teeth are vital.
Show answer and explanation
Correct answer: A. A diet high in glucose
- A. CORRECT as the exception. Dietary sugar intake is a CARIES risk factor. It has no established role in the metabolic bone diseases — Paget disease, fibrous dysplasia, hyperparathyroidism, osteopetrosis — whose drivers are genetic, endocrine or idiopathic remodelling defects.
- B. A raised alkaline phosphatase reflects osteoblastic activity and is the standard biochemical marker of Paget disease. It is genuinely associated.
- C. Bilateral symmetric jaw enlargement is characteristic of several bone diseases, cherubism and Paget among them.
- D. Cranial nerve compression from bony overgrowth at skull-base foramina is a recognised feature of both Paget disease and osteopetrosis — hearing loss, visual loss and facial palsy.