Clinical Presentation

The maxilla and mandible are more usually affected by disease arising from closely related structures such as the teeth, oral mucosa and salivary glands and, in the case of the maxilla, the maxillary sinus, the orbit or the infratemporal fossa, rather than from primary bone disease. Many of these conditions are described elsewhere; primary diseases of the odontogenic apparatus and jawbones will be considered here.

Disease of the teeth presents as pain, mobility or swelling although some conditions are detected as incidental findings at radiographic examination. Caries and periodontal disease are painless until advanced destruction of tissue has occurred. A draining sinus opening onto mucosa or facial skin may accompany dental abscesses but others may present with soft tissue swelling of the face and other signs of spreading infection. Gingival bleeding is often the only sign of chronic marginal periodontal disease until increased tooth mobility or the drainage of pus from between gingiva and tooth occur. Developmental cysts, odontogenic hamartomas and neoplasms are often painless but may present with bony swelling, facial asymmetry or a failure of teeth to erupt. Discolouration of teeth, rapid wear or abnormal morphology are features of the hereditary developmental tooth disorders such as dentinogenesis imperfecta or amelogenesis imperfecta; usually all the teeth will be affected.

Primary disease of the jawbones presents as bony swellings that may or may not involve overlying mucosa or adjacent teeth.

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