The jaws and teeth in Paget's disease of bone.

That Paget's disease of bone may affect the jaws has been known since Moore's (1923) report of a case in which there was a bony tumour of the maxilla together with osteoporosis circumscripta of the frontal region, though until quite recently the disease in this site has been considered rare. Osteoporosis circumscripta itself has now been identified with an early phase of Paget's disease (Sosman, 1927; and others), and a number of cases have since been described in which there has been a coexisting lesion in the maxilla (Kasabach and Gutman, 1937; Elkeles, 1947; Rushton, 1948). It has also been realized that the symptoms arising from the lesions in the jaws may be the first of which the patient complains, leading to detection of lesions in other parts of the skull or in other bones (Novak and Burket, 1944; Jacobs, 1945), or that such lesions may be the only ones present (Thoma, Howe, and Wenig, 1945). The incidence of jaw lesions is uncertain, as most of the published reports concern single cases or relatively small series, with the exception of the report by Stafne and Austin (1938), who found 23 cases with mandibular or maxillary involvement out of 138 cases in which the skull was affected. The maxilla is much more often involved than the mandible; in the series just referred to the mandible was involved in only three of the 23 cases. Instances of mandibular involvement have also been reported by Seldin (1933), Glickman (1943), Jacobs (1945), Thoma et al. (1945), and Stafne (1946). The teeth are often affected in association with the surrounding bone, the principal abnormality being hypercementosis (Fox, 1933). As a result of enlargement of the jaws and of the overgrowth of cementum which may lead to ankylosis of the involved teeth and difficulty in their extraction, it not infrequently happens that the patient with Paget's disease is first seen by the dental surgeon. Thus the specimens which the pathologist receives for histological examination may be teeth or fragments of bone from the jaws, and it is the purpose of this paper to describe the appearances in these tissues when affected by Paget's disease. The materials from which these observations have been made comprise teeth and maxillary bone from six patients who complained of dental symptoms in the first instance.