Idiopathic Osteoslerosis

This patient presents as a 30 year old, white female. Asymptomatic tooth #19 was identified in a routine radiographic exam. Clinical findings: normal to thermal testing, normal to percussion, normal to probing, slight pain to biting on lingual cusps. DX: Normal pulp & periapex

The radiopacent area on the mesial root is noted and diagnosed as an idiopathic osteosclerosis. As a quick review, this is a designation for a uniformly radiopacent lesion that cannot be attributed to any inflammatory, dysplastic or neoplastic source. They may also be found in other locations. Most commonly found in patients between 20 & 40 years old and may have a female predilection. Also appears more commonly in black population. 90% of cases are seen in the mandible, usually in the 2nd premolar/molar area.

No treatment is indicated. Little change is usually seen in these lesions.

Another term that is often used interchangably is condensing osteitis or focal chronic sclerosing osteomyelitis. While looking identical, these lesions are associated with necrotic pulps and are believed to be a result of chronic, low grade inflammation. The interchangable use of these terms can be somewhat confusing. However, accurate pulpal diagnosis will help determine whether the radiolucent lesion is the result of inflammation caused by a necrotic pulp (condensing osteitis) or truly idiopathic (unknown) origin (idiopathic osteosclerosis).

(Source: Neville, Damm, Allen & Bouquot. Oral & Maxillofacial Pathology, 445-446, 1995)