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Specialist referral may be indicated if the Practitioner feels:
Many diseases of, or in, the jaws present asymptomatically, as radiolucencies, radio-opacities or with mixed appearances on radiographs. Other presentations are as swellings, pain or sometimes fracture or disturbance of tooth eruption (displaced, missing or loose teeth). Swellings that appear to originate from the jaws may arise from subcutaneous tissues or bones. The mnemonic MINT aids diagnosis: Malformations, eg tori and fibro-osseous lesions.
Inflammatory conditions, eg odontogenic infections, osteomyelitis, actinomycosis, tuberculosis, or syphilis.
Neoplasms and cysts (see below).
Trauma causing subperiosteal haematomas.
Investigations largely involve imaging, and serum calcium, phosphate, and alkaline phosphatase levels but histopathology is almost invariably required.
Some jaw conditions are ‘pseudo-diseases’, including: unerupted teeth, tori (Figures 1–3), bone marrow defects, traumatic bone cyst, Stafne bone defect (static bone cyst), osteosclerosis, pseudocyst of maxillary sinus, or sub-pontic osseous hyperplasia.
A number of bone diseases may also affect the jaws.
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