Introduction:
Condensing osteitis is a dental condition that manifests as a bony radiopacity (observed radiographically), usually in the lower jaw, either adjacent to or in the surrounding area of a tooth that has a large restoration or needs endodontic treatment. The inflammation is said to arise when a tooth is affected by pulpitis. Pulpitis is caused when there are large carious lesions or deep restorations that may over time cause pulpal pressure and pulpal cell death or necrosis. The condition of condensing osteitis occurs in every possible age group, primarily in individuals infected with pulpitis. According to the global incidence of condensing osteitis, it can be considered a relatively uncommon condition, comprising approximately two percent of dental conditions diagnosed during routine X-ray or dental radiographic examinations (according to global studies published in Dentomaxillofacial Radiology).
What Are the Characteristic Features of Condensing Osteitis?
According to research studies conducted by the Brazilian Oral Research Association, the age range for condensing osteitis can be anywhere between 30 and 70 years of age. However, these patients often do not experience the typical tooth pain associated with deep restorations or caries involving the pulp. This unique characteristic sets condensing osteitis apart as a dental lesion. There is a predilection for young patients, and the condition specifically occurs in the premolar or molar region of the mandible or lower jaw. Clinically, no bony plate expansion is visible upon examination by the dentist. However, upon radiographic examination of the affected tooth, a moderate to large area of opacification is observable surrounding the apex of the inflamed tooth. This confirms the diagnosis of pulpitis.
The inflamed tooth does not exhibit any radiolucent rims which helps in distinguishing it from a similar condition called focal cemento-osseous dysplasia. The radiographic appearance also reveals widened periodontal ligaments. The lower posterior molars, specifically the mandibular molars, are the most commonly affected teeth with patients being unaware of any clinical symptoms typically associated with a painful tooth, such as in cases of decayed teeth or chronic pulpitis lesions. The asymptomatic nature of condensing osteitis is also linked to the fact that there is increased bone deposition or density at the base or apex of the tooth root, unlike the bone wearing out in infectious tooth lesions. As a result, patients may rarely report any symptoms and only receive a diagnosis from the dentist during a routine examination of the affected tooth. Clinical research demonstrates that condensing osteitis lesions indeed stimulate jaw bone growth in the mandibular molar or premolar region, which is the cause of the increased bone density or radiopacification observed in this condition.
What Are the Histopathological Findings of Condensing Osteitis?
Histologically, condensing osteitis exhibits very dense bone with minimal or no inflammation at all. This has led dental researchers to conclude that this condition may be a bony reaction to a low-grade inflammatory stimulus that typically arises from the adjacent tooth that is infected or has a large restoration. When there is no tooth associated with this lesion either radiographically or histologically, then this condition is also referred to as idiopathic osteosclerosis, bone scar lesions, or dense bone islands, as determined by histopathological examination.
How Is the Dental Diagnosis Done for Condensing Osteitis?
The use of diagnostic X-ray equipment is always beneficial so that dental professionals such as dentists or oral surgeons can clearly assess the bony areas infected without performing a biopsy every time. However, for confirmatory diagnosis of uncommon lesions or cancers, a dentist may also perform a biopsy, especially in cases of chronic or severe lesions affecting the tooth and jaw bone. During regular dental checkups, a routine X-ray or OPG (full mouth X-ray, also known as an orthopantomogram) will assist the dentist in accurately diagnosing the pulpal condition of all teeth. Any bone growth in the jaw, whether in the upper jaw (maxilla) or the lower jaw (mandible), typically appears as opaque lesions on routine radiography. Any local bone destruction would appear as transparent lesions causing oral pain and discomfort, sometimes even difficulty during swallowing or drinking water.
Many dentists consider condensing osteitis to be primarily a radiographic diagnosis. It is a commonly diagnosed condition through dental two-dimensional (2D) or three-dimensional (3D) radiography, where the dentist identifies an area of radiopacity in the bone adjacent to the infected tooth during routine examination. The infected tooth may have a large carious lesion, which the patient may be asymptomatic or it may have a large restoration that is exerting pressure on the pulp and has led to pulpal necrosis. The diagnosis of this condition is largely dependent on the dentist's radiographic and histologic observations, as it is typically asymptomatic clinically.
How Can Condensing Osteitis Be Managed?
Treatment for condensing osteitis primarily relies on the elimination of the underlying tooth infection. The dentist will address the odontogenic infection primarily through endodontic therapy. In cases where endodontic treatment has a higher chance of failure or if the tooth is in poor or hopeless condition, the dentist may choose to extract the infected tooth as the final option. After the infection is eliminated, the patient can experience relief from the tooth infection either partially or completely over time. Endodontists or root canal therapists always focus on preventive restorative and endodontic therapy as the first line of treatment. Proper root canal therapy and obturation performed by the dentist can eliminate the possibility of future infections recurring in the affected teeth. However, when a root canal-treated tooth has a recurring bone infection surrounding or adjacent to it, the prognosis of the lesion would be considered poor, requiring surgical removal or extraction. Failed root canal therapy or improper dental obturation can also contribute to the development of condensing osteitis.
Endodontists or root canal therapists always prioritize preventive restorative and endodontic therapy as the first line of treatment. Proper root canal therapy and obturation performed by the dentist can eliminate the possibility of future infections recurring in the affected teeth. However, if a root canal-treated tooth continues to have a recurring bone infection surrounding or adjacent to it, the prognosis of the lesion would be considered poor, and surgical removal or extraction may be necessary. Failed root canal therapy or improper dental obturation can also contribute to the development of condensing osteitis.
Conclusion:
Although the lesions of condensing osteitis may be asymptomatic in individuals, it is still important for preventive measures and diagnosis. The treatment modality should be implemented by the dentist only if there is pulpal pain, discomfort, or any other persistent dental issue. Dental infections can not only lead to cysts but can also contribute to the formation of benign or malignant jaw tumors under aggravating or predisposing factors. Therefore, it is always important to follow regular dental checkups every six months to a year and be aware of the importance of oral healthcare. This holds even more significance in the current scenario of increasing global burden of oral and maxillofacial diseases.
