Image taken from Clinical Guide to Oral Diseases.
A 62-year-old man came with a complaint of difficulty in wearing his upper partial denture that had caused him serious eating problems.
His complaint began one year ago after a difficult extraction of his upper left second molar, but worsened over the last four months, and since then the patient had three unsuccessful readjustments of his upper denture.
Hypercholesterolemia and diabetes type II were his main health problems and treated with low fat and sugar diet and drugs such as atorvastatin and metformin respectively.
Oral examination revealed an enlarged, diffuse, asymptomatic bony expansion of his upper jaw that was particularly prominent towards the hard palate.The overlying mucosa was thin with normal color, apart from an erythematous area where the upper denture was situated. The denture’s supporting teeth did not show any evidence of pulp necrosis, and their surrounding gingivae were soft, swollen but recessed, especially where the denture clasps were applied. No other growths were found in his mandible or in other bones; nor were other similar lesions reported among his close relatives. Skull X-rays revealed an enlarged maxilla with a cotton-wool like appearance. Blood tests did not reveal any anemia, and the calcium,phosphorus, urea and creatinine were within normal levels. However, increased serum alkaline phosphatase up to four times higher than normal was measured.
What is the main cause of his badly fitted denture: Paget’s disease (monostotic)
Paget’s disease of the bone is characterized by a chronic bone remodeling, leading to this deformity (enlargement) and weakness of one or more bones that is associated with pain, fractures or arthritis of associated joints.