Condensing osteitis
DESCRIPTION: Condensing osteitis is a reaction to infection. It differs from other periapical inflammatory diseases in that there is a bone production rather than bone destruction. The result is a radiopaque lesion. This sclerotic reaction is apparently brought about by good patient resistance coupled with a low degree of virulence of the offending bacteria. It is more commonly seen in the young and seems to show special predilection for the periapical region of lower molars. The associated tooth is carious or contains a large restoration. We are reluctant to state the reaction of the tooth to pulp testing because of lack of sufficient personal experience and paucity of published information. Theoretically, the results should be abnormal. Current level of knowledge suggests that the pulp is irreversibly inflamed. Uncommonly, condensing osteitis occurs as a reaction to periodontal infection rather than dental infection.
ETIOLOGY: Infection of periapical tissues by organisms of low virulence.
TREATMENT: Vitality of the overlying tooth should be investigated. If the pulp is inflamed or necrotic, endodontics or extraction are the options.
PROGNOSIS: In those cases in which the offending tooth is extracted, the area of condensing osteitis may remain in the jaws indefinitely, and is termed osteosclerosis or bone scar.
DIFFERENTIAL DIAGNOSIS: Idiopathic osteosclerosis and cementoblastoma. An abnormal result with pulp testing strongly suggests condensing osteitis and tends to rule out osteosclerosis and cementoblastoma.
