Punctuated lesions and floating teeth are seen in-

Ans. is 'b' i. e., Osteitis fibrosa Osteitisfibrosacystica o Also known as osteitis fibrosa, osteodystrophia fibrosa, and Von Recklinghausen's disease of bone (not to be confused with Von Recklinghausen's disease, neurofibromatosis type I) o It is a skeletal disorder caused by hyperparathyroidism o The hyperparathyroidism can be triggered by a parathyroid adenoma, hereditary factors, parathyroid carcinoma, or renal osteodystrophy. o Surplus parathormone stimulates the activity of osteoclasts o Osteoclastic bone resorption releases minerals, including calcium, from the bone into the bloodstream, o Over-activity of this process results in a loss of bone mass, a weakening of the bones as their calcified supporting structures are replaced with fibrous tissue (peritrabecular fibrosis), and the formation of cyst-like brown tumors in and around the bone. o Radiological evaluation of the head in such patients reveals bilateral destruction of the lamina dura around teeth resulting in a floating teeth appearance associated with marked mandibular and maxillary osteopenia, o The excess of calcium present in the blood stream is deposited in the renal tissues. This is called nephrocalcinosis. Cortical nephrocalcinosis is often detected radiologically as unilateral egg shell calcification: while medullary nephrocalcinosis presents as multiple punctuated calcifications seen within the kidney shadows in bilateral symmetrical fashion. o Thus we know from the above discussion that both floating teeth and punctuated calcification both can be associated with osteitis fibroscystica (secondary hyperparathyroidism, renal osteodystrophy).