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. Whether or not the pulp is irreversibly diseased is not known. 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: General protocol is to treat only those cases which are symptomatic. This is done by endodontic therapy or extraction. In those cases which are asymptomatic in which there is no obvious caries in the associated tooth, we follow them with periodic x-ray examination.
Prognosis: In those cases in which the offending tooth is extracted, the area of condensing osteitis may remain in the jaws indefinitely.
Differential diagnosis: Idiopathic osteosclerosis and cementoblastoma. An abnormal result with electric pulp testing strongly suggests condensing osteitis and tends to rule out osteosclerosis and cementoblastoma.