Etiology • Chronic, low-grade, dentoalveolar infection • Resultant bony inflammation extends to the periosteum, pro-
ducing a reduplication of the cortex (“onion skin” effect).
Clinical Presentation • Usually an asymptomatic, unilateral, mandibular, bony hard
asymmetry • Limited to children and young adults
Radiographic Findings • Medullary mottling with (lucent and opaque) ill-defined margins • Periosteal-cortical expansion • Occlusal radiograph shows concentric or parallel layering of
cortex
ducing a reduplication of the cortex (“onion skin” effect).
Clinical Presentation • Usually an asymptomatic, unilateral, mandibular, bony hard
asymmetry • Limited to children and young adults
Radiographic Findings • Medullary mottling with (lucent and opaque) ill-defined margins • Periosteal-cortical expansion • Occlusal radiograph shows concentric or parallel layering of
cortex
Diagnosis • Carious mandibular tooth, usually first permanent molar • Radiographic features • Biopsy results showing periosteal osteoblastic reaction, mini-
mally inflamed fibrous marrow
Differential Diagnosis • Ewing’s sarcoma • Langerhans cell disease (histiocytosis X) • Osteosarcoma • Fibro-osseous lesion • Metastatic disease
Treatment • Elimination of the infected focus (carious tooth to be extracted
or filled) • Antibiotic administration early in treatment phase
Prognosis • Good