Idiopathic osteosclerosis

It is usually painless and is detected on routine radiographs. It appears as a radiopaque (white) area around a tooth, usually a premolar or molar. There is no evidence of inflammation of the pulp and/or tissues surrounding the tooth.

It is quite common and affects 5% of the population, the average age at which it manifests itself is 20 to 40 years. It is usually asymptomatic and is a radiographic finding. Shapes range from round to linear striae to angular forms.

It may appear as a reaction to previous trauma or infection, but in some cases it is difficult to determine.

What is idiopathic osteosclerosis?

Idiopathic osteosclerosis is an area of increased bone production. In the mandible it usually appears around the roots of the teeth with a round, elliptical or irregular and radiopaque shape. According to the literature, although this disorder is sometimes described as dense bone island, bone scar, focal periapical osteopetrosis or enostosis, idiopathic osteosclerosis is often preferred because of its unknown origin.

These types of lesions can be accepted as developmental intraosseous anatomic variations and should be classified separately from cases of inflammatory origin or systemic disease. These asymptomatic lesions are usually discovered as incidental findings on radiographs taken for other reasons.

On radiographic evaluation, idiopathic osteoscleroses can be detected in various sizes, ranging from 2 or 3 mm to 1 or 2 cm in diameter, or the lesions can be very large, spanning almost the entire height of the mandibular body. They may appear at the root apices, between the roots or in a separate location from the teeth, mainly in the premolar/molar region and with a predilection for the mandibular arch.

Lesions can arise at any age, with no gender predilection, and usually do not require specifictreatment. The lesions can usually remain for years, and surgical intervention is not recommended.

To be sure that the clinical diagnosis is correct, periodic follow-up of the lesions is necessary. Although rare, if associated root resorption occurs over time, endodontic treatment or extraction of the affected tooth may be necessary.

Causes of idiopathic osteosclerosis

Some of the causes of osteosclerosis may be:

• Excessive jaw tension or prolonged mechanical stimulation.
• Previous trauma.
• Reaction to an infection.

There is also hereditary idiopathic osteosclerosis. This is more likely to occur in the cranial vault.

In hereditary idiopathic osteosclerosis, craniofacial anomalies develop progressively during childhood or adolescence (between 12 and 20 years of age).

There may be no change in general condition, as the person is otherwise healthy. However, in some cases there may be loss of sensation in the facial nerve and/or hearing loss.

Osteosclerosis can be seen on X-rays and CT scans. The bone is denser and appears more opaque (whiter on the X-ray). In addition, the sinuses are sometimes invisible because they are almost filled with bone.

Symptoms of idiopathic osteosclerosis

It is an asymptomatic lesion. The lesion is not pathogenic and has been defined by different terms such as osteopetrosifocal and thickened bone island; microscopically, it consists of normal dense lamellar bone.

The lesion should be distinguished from osteomas, which is a slow-growing benign neoplasm consisting of dense lamellar bone tissue. The radiographic appearance is of a radiopaque area with well-defined margins.

Treatment of idiopathic osteosclerosis

Periapical foci of idiopathic osteosclerosis do not require treatment, but these lesions should be differentiated from other processes such as condensing or sclerosing osteitis. Invasive measures, such as bone biopsies, are not indicated when the diagnosis is evident.

Periodic check-ups are recommended, initially in the form of annual radiological controls to confirm the diagnosis.