Dental MCQ
Fibro-osseous and bone disease · Oral Pathology · INBDE Patient Cases

Bone & Jaw Pathology INBDE Patient Cases

By Dr. Isaac Sun, DDS

8 ADA INBDE-format patient cases on bone & jaw pathology. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

8 patient cases40 linked questionsADA INBDE formatFull distractor explanations

Eight ADA INBDE-format patient cases on bone and jaw pathology: medication-related osteonecrosis of the jaw (MRONJ) prevention in a patient on intravenous antiresorptive therapy, osteoradionecrosis after an extraction in a previously irradiated jaw, fibrous dysplasia with its ground-glass texture and the McCune-Albright association, periapical cemento-osseous dysplasia on vital teeth and the trap of unnecessary endodontics, jaw osteomyelitis with a sequestrum in a diabetic patient, osteosarcoma with a sunburst pattern and symmetric periodontal ligament widening, Paget disease with cotton-wool bone and elevated alkaline phosphatase, and the numb chin sign signaling jaw metastasis. Topics include the fibro-osseous and dysplastic lesions, giant cell and metabolic bone disease, osteomyelitis, osteoradionecrosis and MRONJ prevention, and the benign and malignant bone tumors.

Case Coverage Map
What each case is testing
An extraction in a patient on bone medication:
MRONJ risk with antiresorptives, higher risk with IV/cancer-dose and extractions, pre-therapy dental fitness, and the eight-week definition.
Exposed bone after an extraction in an irradiated jaw:
Osteoradionecrosis, the hypovascular irradiated bone, pre-radiation clearance, hyperbaric oxygen, and conservative post-radiation care.
A painless, slowly growing cheek fullness:
Fibrous dysplasia and its ground-glass texture, McCune-Albright, monitoring over resection, and the contrast with ossifying fibroma.
Apical opacities on healthy front teeth:
Periapical cemento-osseous dysplasia on vital teeth, pulp testing first, avoiding unnecessary endodontics, and the florid form demographic.
Deep jaw pain and swelling after an extraction:
Jaw osteomyelitis, the sequestrum, the role of diabetes, drainage and antibiotics, and hyperbaric oxygen for refractory disease.
Rapid jaw swelling with a loosening tooth:
Osteosarcoma, the sunburst and symmetric PDL widening, paresthesia as a red flag, and urgent imaging, biopsy, and referral.
A denture that no longer fits:
Paget disease, the cotton-wool bone and elevated alkaline phosphatase, hypercementosis, the osteosarcoma risk, and referral.
New numbness of the lower lip and chin:
The numb chin sign as a malignancy red flag, jaw metastasis (most common jaw malignancy), and urgent workup.
Patient case: An extraction in a patient on bone medication
0 of 5 answered, 0 correct
Patient
Female, 71 years old
Chief Complaint
"I need a tooth out, and I get an infusion for my bones."
Background and/or Patient History
  • Receives intravenous antiresorptive therapy for cancer-related bone disease
  • Has a non-restorable molar that is being considered for extraction
  • No prior jaw radiation
  • Generally frail
Allergies
NKDA
Medications
  • Intravenous bisphosphonate / denosumab
Current Findings
  • A non-restorable molar; no current exposed bone
  • Otherwise intact oral soft tissues
  1. Question 1
    Moderate
    The complication this patient is at risk for with an extraction is:
  2. Question 2
    Moderate
    Her risk of MRONJ is considered higher because she is on:
  3. Question 3
    Moderate
    Ideally, invasive dental work like extractions should be:
  4. Question 4
    Moderate
    Since she is already on therapy and needs the tooth out, the appropriate approach is to:
  5. Question 5
    Hard
    MRONJ is typically defined in part by exposed bone persisting for about:

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Patient case: Exposed bone after an extraction in an irradiated jaw
0 of 5 answered, 0 correct
Patient
Male, 64 years old
Chief Complaint
"After my tooth was pulled, the bone is showing and won't heal."
Background and/or Patient History
  • Treated with head and neck radiation for an oropharyngeal cancer two years ago
  • Had a mandibular molar extracted recently
  • The socket has not healed; bone is exposed
  • Pain and a bad taste
Allergies
NKDA
Medications
  • None relevant
Current Findings
  • Exposed, non-healing necrotic bone at the extraction site in the irradiated mandible
  • No antiresorptive drug history
  1. Question 1
    Moderate
    Exposed, non-healing bone after an extraction in a previously irradiated jaw is:
  2. Question 2
    Hard
    The irradiated bone heals poorly because it is:
  3. Question 3
    Moderate
    How could this complication most likely have been prevented?
  4. Question 4
    Moderate
    An adjunctive treatment sometimes used for established osteoradionecrosis is:
  5. Question 5
    Moderate
    For future dental needs in this irradiated patient, the team should:

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Patient case: A painless, slowly growing cheek fullness
0 of 5 answered, 0 correct
Patient
Female, 15 years old, accompanied by parent
Chief Complaint
Parent: "One side of her face has slowly gotten fuller, but it doesn't hurt."
Background and/or Patient History
  • Gradual, painless unilateral maxillary swelling over a couple of years
  • No pain or numbness
  • Found to have a ground-glass bone pattern on imaging
  • Otherwise healthy
Allergies
NKDA
Medications
  • None
Current Findings
  • Painless, unilateral bony-hard maxillary expansion
  • Ground-glass radiographic texture blending into adjacent bone
  1. Question 1
    Moderate
    A painless, slowly enlarging unilateral jaw swelling with a ground-glass pattern in a teenager is most consistent with:
  2. Question 2
    Hard
    If she also had cafe-au-lait skin macules and an endocrine abnormality, the diagnosis would be:
  3. Question 3
    Moderate
    Typical management of fibrous dysplasia is:
  4. Question 4
    Hard
    A feature that distinguishes fibrous dysplasia from a well-circumscribed ossifying fibroma is that fibrous dysplasia:
  5. Question 5
    Moderate
    The most appropriate next step for this lesion is to:

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Patient case: Apical opacities on healthy front teeth
0 of 5 answered, 0 correct
Patient
Female, 48 years old
Chief Complaint
"My x-ray showed spots at the roots of my lower front teeth."
Background and/or Patient History
  • Incidental periapical lesions at the lower anterior teeth on routine radiographs
  • No pain, no swelling, no history of trauma
  • The teeth have no restorations
  • Otherwise well
Allergies
NKDA
Medications
  • None
Current Findings
  • Mixed radiolucent/radiopaque lesions at the apices of the lower incisors
  • All involved teeth test vital
  1. Question 1
    Moderate
    Periapical mixed lesions at the apices of VITAL lower anterior teeth most likely represent:
  2. Question 2
    Moderate
    The single most important step before doing anything is to:
  3. Question 3
    Moderate
    Given vital teeth and an asymptomatic lesion, the correct management is to:
  4. Question 4
    Moderate
    The classic clinical error this case warns against is:
  5. Question 5
    Moderate
    The florid (multiquadrant) form of cemento-osseous dysplasia is most commonly seen in:

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Patient case: Deep jaw pain and swelling after an extraction
0 of 5 answered, 0 correct
Patient
Male, 53 years old
Chief Complaint
"Weeks after a tooth was pulled, my jaw aches deeply and is swollen."
Background and/or Patient History
  • Extraction of a mandibular molar a few weeks ago
  • Persistent deep pain and swelling since
  • Poorly controlled diabetes
  • Now with a draining area and a bad taste
Allergies
NKDA
Medications
  • Metformin
Current Findings
  • Tender mandibular swelling with a draining sinus
  • Radiograph shows a moth-eaten radiolucency with a possible sequestrum
  1. Question 1
    Moderate
    Persistent deep pain and swelling with a moth-eaten radiolucency after an extraction suggests:
  2. Question 2
    Moderate
    The fragment of dead bone that may be seen within the lesion is a:
  3. Question 3
    Moderate
    His poorly controlled diabetes is relevant because it:
  4. Question 4
    Moderate
    Appropriate management of jaw osteomyelitis includes:
  5. Question 5
    Moderate
    If the infection becomes chronic and antibiotics plus debridement are insufficient, an adjunct sometimes considered is:

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Patient case: Rapid jaw swelling with a loosening tooth
0 of 5 answered, 0 correct
Patient
Male, 24 years old
Chief Complaint
"My jaw swelled quickly and a tooth is getting loose and numb feeling."
Background and/or Patient History
  • Rapid swelling of the posterior mandible over weeks
  • A tooth in the area is mobile
  • Altered sensation of the lip developing
  • No history of trauma
Allergies
NKDA
Medications
  • None
Current Findings
  • Radiograph shows a sunburst periosteal reaction and symmetric widening of the periodontal ligament space
  • Firm swelling with paresthesia
  1. Question 1
    Moderate
    A sunburst periosteal reaction with symmetric widening of the periodontal ligament space and rapid growth suggests:
  2. Question 2
    Hard
    The developing lip numbness (paresthesia) in this setting is:
  3. Question 3
    Moderate
    Osteosarcoma is best described as:
  4. Question 4
    Moderate
    The appropriate action by the dentist is to:
  5. Question 5
    Hard
    Symmetric widening of the periodontal ligament space around a tooth, in this context, is:

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Patient case: A denture that no longer fits
0 of 5 answered, 0 correct
Patient
Male, 68 years old
Chief Complaint
"My denture stopped fitting and my jaw seems bigger."
Background and/or Patient History
  • Progressive enlargement of the maxilla over time
  • His upper denture and even his hat feel tighter
  • Mild bone aches
  • No numbness
Allergies
NKDA
Medications
  • None
Current Findings
  • Symmetric enlargement of the maxilla with a cotton-wool radiographic pattern
  • Laboratory testing shows an elevated alkaline phosphatase
  1. Question 1
    Moderate
    An older patient with jaw enlargement, cotton-wool bone, and elevated alkaline phosphatase most likely has:
  2. Question 2
    Moderate
    Why has his denture stopped fitting?
  3. Question 3
    Moderate
    A dental consideration in Paget disease is:
  4. Question 4
    Moderate
    A serious long-term complication of Paget disease to be aware of is:
  5. Question 5
    Moderate
    The appropriate next step is to:

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Patient case: New numbness of the lower lip and chin
0 of 5 answered, 0 correct
Patient
Female, 62 years old
Chief Complaint
"My lower lip and chin have gone numb on one side, with no dental work done."
Background and/or Patient History
  • New, unexplained numbness of the lower lip and chin
  • History of breast cancer treated some years ago
  • No recent trauma or injection in the area
  • A vague ache in the posterior mandible
Allergies
NKDA
Medications
  • None relevant
Current Findings
  • Altered sensation in the mental nerve distribution
  • A poorly defined radiolucency in the posterior mandible
  1. Question 1
    Moderate
    New, unexplained numbness of the lower lip and chin (the numb chin sign) should be regarded as:
  2. Question 2
    Hard
    Given her history of breast cancer, a key consideration is:
  3. Question 3
    Moderate
    The most common malignancy found in the jawbones overall is:
  4. Question 4
    Moderate
    The appropriate action is to:
  5. Question 5
    Moderate
    The broad lesson is that unexplained neurologic changes in the jaw region:

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