PDL Space Widening — MFDS Part 1 MCQ

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ModerateRadiologyPDL Space WideningMFDS Part 1

A 48-year-old woman has Raynaud phenomenon, progressive tightening of the facial skin and reduced mouth opening. Periapical radiographs show generalised, relatively uniform widening of the periodontal ligament spaces, most marked around the posterior teeth. The teeth are vital, there is no fremitus, and she has never received orthodontic treatment. Which underlying condition best explains this radiographic pattern?

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Correct answer: B — Systemic sclerosis

The correct answer is **A, systemic sclerosis**. Generalised periodontal ligament widening, often most marked around posterior teeth, is a recognised oral radiographic manifestation. Raynaud phenomenon, taut facial skin and reduced mouth opening provide the decisive systemic clues. Primary hyperparathyroidism more characteristically produces loss of the lamina dura and altered jaw trabeculation. Paget disease causes bone enlargement, coarse trabeculation and mixed or “cotton-wool” sclerosis. Craniofacial fibrous dysplasia usually presents as an expansile, poorly defined ground-glass lesion rather than uniform ligament-space widening. Osteosarcoma can widen the periodontal ligament space, but this is usually irregular and localised, with other aggressive features such as bone destruction or periosteal reaction. Periodontal ligament widening is therefore not diagnostic in isolation and must always be correlated clinically.

Reference: Mortazavi H, Baharvand M. Review of common conditions associated with periodontal ligament widening. Imaging Science in Dentistry. 2016;46(4):229-237. https://pubmed.ncbi.nlm.nih.gov/28035300/