Idiopathic Osteosclerosis — MFDS Part 1 MCQ

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ModerateRadiologyIdiopathic OsteosclerosisMFDS Part 1

A 32-year-old asymptomatic patient undergoes routine panoramic radiography. A solitary, well-defined, homogeneous radiopaque focus is present within the cancellous bone of the mandibular first molar region. It has no radiolucent rim and causes no cortical expansion. The adjacent teeth are vital and show no caries, large restorations or evidence of apical inflammation. What is the most likely diagnosis?

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Correct answer: D — Idiopathic osteosclerosis

The diagnosis is idiopathic osteosclerosis, also termed a dense bone island or enostosis. It is usually an incidental, asymptomatic, homogeneous radiopacity within cancellous bone, most commonly in the mandibular premolar–molar region. The absence of expansion and of an inflammatory cause in the adjacent vital teeth supports this diagnosis. Osteosarcoma usually has aggressive features such as ill-defined destruction, periosteal bone formation or a mixed appearance. Metastatic disease is generally destructive or multifocal rather than a stable, sharply defined bone island. Paget disease causes more extensive jaw enlargement and mixed or cotton-wool change. Fibrous dysplasia characteristically produces diffuse, blending ground-glass opacity rather than a discrete homogeneous focus.

Reference: Ñahuincopa López PM, Romero Rodríguez LM. An updated review of idiopathic osteosclerosis of the jaws. Rev Cient Odontol (Lima). 2021;9(1):e050. https://pubmed.ncbi.nlm.nih.gov/38464409/