Sclerotic lesions in the maxilla and mandible are seen in a variety of well-characterized conditions including florid osseous dysplasia, Gardner's syndrome, and others. When these are eliminated, there remains localized, self-limiting sclerotic lesions of unknown origin that have been recognized by a variety of names including idiopathic osteo-sclerosis, dense bone islands, bone whorl, enostosis, and others. Surveys of dental radiographs reveal an incidence of about 5%. Osteosclerosis is discovered on radiographs taken for other reasons and is always asymptomatic. The most common location is the mandible and the majority is seen in the cuspid-bicuspid region. Osteo-sclerotic lesions may be seen in children but most are recognized in young adults. Radiographically they appear as a uniform dense lesion that sharply abuts on adjacent bone without a radiolucent halo. The size ranges from a few millimeters to several centimeters. In tooth-bearing areas, osteosclerosis may envelop a portion of the tooth root and appear to be attached. Alternately, they may partially fill the space between teeth or occupy an edentulous area. Even large lesions do not expand the jaw. The history will provide no explanation regarding cause, as there is no common denominator. Some lesions may be of developmental origin, whereas others are the result of overzealous bone repair after oral surgery or from past infections. Clinicians whose responsibilities include the jaws should be familiar with osteosclerosis, the range of its appearance, and harmless behavior.
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