Oral and maxillofacial lesions in a Thai pediatric population: a retrospective review from two dental schools.

OBJECTIVE: To determine the prevalence of oral and maxillofacial lesions in a Thai pediatric population. MATERIAL AND METHOD: Oral biopsy records from pediatric patients between the ages of 0 and 15 years in the files ofFaculty of Dentistry, Mahidol University, and the files of Faculty of Dentistry, Khon Kaen University were reviewed. The patients were divided into three age groups, including 0 to 5, 6 to 10, and 11 to 15 years. Excluding the diagnosis of normal tissues, the oral and maxillofacial lesions were classified into nine categories. RESULTS: Of 13,050 biopsied oral and maxillofacial lesions, 1,389 cases (10.6%) came from pediatric patients. The largest number of lesions was odontogenic cysts and tumors, followed by inflammatory and reactive lesions, and salivary gland pathology The top ten most prevalent lesions contributed 73% of all oral biopsies. The most common lesion was dentigerous cyst, followed by mucocele and pyogenic granuloma. CONCLUSION: The vast majority of oral diseases in children were benign and related to either developmental or tissue reaction, while malignant lesions were found in a very small proportion of all oral biopsies.

Dentigerous Cysts of Maxillofacial Region- Clinical, Radiographic and Biochemical Analysis.

BACKGROUND: Dentigerous cyst is the second most common type of odontogenic cysts that encloses the crown of an unerupted tooth by expansion of its follicle due to the collection of cystic fluid. In view of the capability of these lesions attaining a marked size if not diagnosed early and treated properly, the present study was done based on the clinical and radiographic presentation of the dentigerous cyst in addition to the analysis of the cystic contents. OBJECTIVE: The present study reported 14 cases of dentigerous cysts (DC) with their incidence and relative distribution of the maxillofacial region along with the clinical and radiographic features and biochemical analysis of cystic fluid. METHOD: The study was conducted at Sri Govind Tricentenary Dental College, Hospital and Research Institute, Gurgaon, Haryana for a period of one year and six months. A detailed case history and thorough clinical examination was done for the patients who were provisionally found to have odontogenic cysts. Necessary radiographs, aspiration of the cystic fluid and incisional biopsy were performed to the 14 patients who were provisionally diagnosed with dentigerous cysts (DC) after obtaining the informed consent and the cystic fluid was subjected to biochemical analysis. RESULTS: Majority of the affected patients with DC were in their second decade and showed more predilection for mandible with a male predominance. The area of predilection was third molar region in the mandible and it is the canine region in maxilla. All the cases were associated with impacted teeth and majority showed expansion of the buccal/labial cortical plate. The various biochemical variables (total protein content, albumin, globulin and albumin: globulin ratio) were also assessed in the present study. CONCLUSION: The awareness of protean features of DC evident through this study is essential for the general as well as specialty practitioners for the accurate diagnosis and proper treatment planning of these non cancerous but potentially destructive lesions and also opens new avenues for further research.

Prevalence of developmental odontogenic cysts in children and adolescents with emphasis on dentigerous cyst and odontogenic keratocyst (keratocystic odontogenic tumor).

OBJECTIVE: To investigate the incidence and prevalence of developmental odontogenic cysts in children and adolescents and compare the features of the two most common types, dentigerous cyst and keratocystic odontogenic tumor (KCOT). STUDY DESIGN: A retrospective review in a series of 369 patients with all histological diagnoses of developmental odontogenic cysts in children (≤12 years) and adolescents (13-18 years) was conducted. RESULTS: Among these, 361 (97.8%) patients were diagnosed as dentigerous cyst (n = 281) and KCOT (n = 80), with the male-to-female ratios of dentigerous cyst and KCOT both being 2:1. The average age of the patients with KCOT was older than that of those with dentigerous cyst (14.7 years vs 11.8 years, p < 0.001). Dentigerous cyst (59.1%) was more common in children, but KCOT (78.8%) was more common in adolescents (p < 0.001). Dentigerous cyst (57.6%) predominantly located on the maxilla, but KCOT (60.3%) predominantly located on the mandible (p = 0.010). CONCLUSIONS: Adolescent patients with lesions located on the mandible would favor KCOT over dentigerous cyst. This study aids in better knowledge of the prevalence of developmental odontogenic cysts in a large pediatric population, and shows that a well-supported early diagnosis is indispensable for a more adequate treatment.

A clinicopathological study of 338 dentigerous cysts.

BACKGROUND: Dentigerous cyst (DC) is one of the most common developmental odontogenic cysts. This hospital-based retrospective study evaluated the clinical and histopathological features of 338 DCs in Taiwanese patients. METHODS: In this study, 338 consecutive cases of DCs were collected from January 1995 to December 2009. The demographic data and clinicopathological features of these DC cases were reviewed and analyzed. RESULTS: The 338 DCs were taken from 332 patients (212 men and 120 women, mean age 33.0 years, range 5-83 years). There was a significant difference in the mean age between male and female patients (P < 0.05). Of the 338 DCs, 122 were found in the maxilla and 216 in the mandible. The most common site for DCs was the mandibular molar region (169 cases) and the most frequently involved tooth was the mandibular third molar (153 cases). Forty-six of the 338 DCs were found to be associated with supernumerary teeth. Microscopically, 317 cysts were lined by stratified squamous epithelium, 9 by mucoepidermoid-typed epithelium, and 12 by ciliated pseudostratified columnar epithelium. Hyaline bodies of Rushton, odontogenic epithelial rests, cholesterol clefts, foamy histiocytes, hemosiderin-laden macrophages, and dystrophic calcifications were discovered in 11, 78, 90, 33, 62 and 45 DCs, respectively. CONCLUSION: Our results indicate that DCs of Taiwanese patients have a male predominance and occur more frequently in patients between 10 and 29 years of age. The most commonly affected site for DCs is the mandibular molar region and the most frequently involved tooth is the mandibular third molar.

Investigation of the transmigrated canine in an orthodontic patient population.

OBJECTIVE: To investigate the prevalence, demographic and clinical characteristics of transmigrated canines in a south Indian orthodontic patient population. DESIGN: Retrospective observational study. SETTING: Manipal University, Manipal, India. SUBJECTS AND METHODS: Panoramic radiographs of 3500 patients were examined and data collected regarding the number and side of transmigrated canines, sex and age of patients, any other associated pathologies and subsequent treatment. Transmigrated canines were classified according to Mupparapu's classification. RESULTS: The prevalence of transmigrated canines in this population was found to be 0.46% of which, seven were males (age: 17-51 years) and nine were females (age: 17-35 years). All transmigrated canines were unilateral and impacted. Eleven canines migrated from the left to the right side, and five migrated from the right to the left. Of the 16 patients, 13 had retained primary canines and 3 had exfoliated primary canines. Eight canines exhibited a type 1 transmigratory pattern, type 2, type 4 and type 5 transmigratory patterns were exhibited by two canines each. One of the canines was classified as type 3. Three canines were associated with dentigerous cyst formation. Four cases were treated by orthodontic traction, while one was removed surgically. Others were observed periodically. CONCLUSIONS: Diagnosis of transmigration at earlier stages is important to prevent more complex occlusal problems.

Analysis of demographic data obtained from pathology records.

INTRODUCTION: Pathologists commonly analyse patient data obtained from pathology records. Such information is useful in that it might provide an indication of changing patterns of disease, or of the aetio-pathogenesis of a disease process, but such data is seldom standardised. AIM: To determine to what extent the lack of standardisation may influence the resultant data and the conclusions drawn. MATERIALS AND METHODS: Pathology reports of all cysts diagnosed from 1994 to 2004 were retrieved. The diagnosis and site of the cyst, and the age, gender and race of patient were analysed. Comparative data from 1958 to 1992 was obtained from the text "Cysts of the oral regions". The data from the different periods was statistically compared. Only the four most common cysts were included: radicular, dentigerous, odontogenic keratocyst and nasopalatine duct cysts. RESULTS: There was no difference in frequency and site of cysts or in age of patients. Statistically significant differences were found in the gender and race comparisons. CONCLUSION: Do the differences reflect a changing pattern of disease or are they due to changes in the demographics of the patient pool from which the surgical specimens were obtained? We favour the latter. Awareness of the fact that data from either survey is not reliable due to lack of standardisation is pertinent to avoid drawing fundamental conclusions from such data.

Primary intraosseous squamous cell carcinoma arising in an odontogenic cyst: a clinicopathologic analysis of 116 reported cases.

PURPOSE: To review the literature on primary intraosseous squamous cell carcinoma (PIOSCC) associated with odontogenic cyst. METHODS: All well-documented cases of PIOSCC published between 1938 and 2010 were collected. Only cases of PIOSCC arising from the lining of an odontogenic cyst, including the keratocystic odontogenic tumor, were selected. Age, sex, signs and symptoms, affected jaw, cyst type, treatment, histopathology, and outcome were recorded. RESULTS: The mean age was 60.2 years (range 1.3-90). There were 80 (69%) men and 36 (31%) women. Mass and pain were the most common presenting symptoms. The mandible was affected in 92 (79%) patients and the maxilla in 24 (21%). It was a residual/radicular cyst in 70 (60%) patients and a dentigerous cyst or a keratocystic odontogenic tumor in the remaining 40%. The histopathology was well-differentiated SCC in 53 (46%) patients and moderately differentiated SCC in 47 (40%) patients. Fifty-three (46%) patients were treated with surgery alone and 44 (38%) with surgery and radiotherapy. Fifty-eight (62%) patients survived 2 years and 36 (38%) survived 5 years. CONCLUSION: PIOSCC has a predilection for men (M/F ratio of 2.22:1), affects mainly adults in their 6-8th decades, occurs most frequently (79%) in the mandible, and is associated mainly with a residual/radicular cyst. Histologically, the well-to-moderately differentiated SCC was the most common. Surgery alone or combined therapy of surgery and radiation was the most common approach. The prognosis is 62% surviving 2 years and 38% 5 years.

Cysts and tumors associated with impacted third molars: is prophylactic removal justified?

PURPOSE: The aim of this retrospective analysis was to determine the frequency and type of cysts and tumors related to impacted third molars (ITMs) in Greek patients. Indications, complications, risks, and benefits of ITM removal are also discussed. PATIENTS AND METHODS: Over a 12-year period, 7,782 third molars were removed in 6,182 patients. RESULTS: Of the 417 specimens submitted for histopathologic examination, 167 cysts (40.04%) and 48 tumors (11.5%) were found. CONCLUSION: Surgical removal of ITMs should only be performed in the presence of specific indications. Our study confirmed that the incidence of pathologic conditions related to ITMs is relatively low (2.77%).

Reclassification of odontogenic keratocyst as tumour. Impact on the odontogenic tumours prevalence.

AIM: The aim of this study was to establish the impact of the redefinition and reclassification of odontogenic keratocyst (OKC) as a tumour on the prevalence of odontogenic tumours (OT). METHODS: We revised 15 435 files of a teaching head and neck histopathology service in the time period from January 1981 to December 2008 and 478 cases of OT were selected. The 342 cases from 1981 to 2004 were classified according 1992 to the World Health Organization (WHO)-classification (excluding keratocystic OT) while the 136 cases from 2005 onwards were classified according to the 2005 WHO-classification (including keratocystic OT). Age and gender were obtained from medical records. The frequency distribution and prevalence of OT from each periods of time were compared. A chi-square test was performed (P < 0.05 95% confidence interval). RESULTS: The prevalence of OT increases 92% in the 2005-2008 period; from 2.6% (1981-2004 period) to 5% (2005-2008 period) (P 0.000).The most frequent OT in the 1981-2004 period was odontoma (45% of all OT) while in the 2005-2008 period was Keratocystic Odontogenicv Tumour (38.9%). CONCLUSIONS: The redefinition of OKC as a tumour produced an increase in the frequency and prevalence of OT.

Relationship between the prevalence of the dentigerous cyst and the odontogenic keratocyst tumor and the current etiologic hypothesis.

Cysts are considered as nonneoplastic benign lesions that, when present for a long period of time, can cause some discomfort, especially related to the treatment form. Among the types of cysts of the maxilla, the dentigerous cyst (DC) presents substances between the dental follicle and the crown of the tooth with high potential for resorption, and the odontogenic keratocyst tumor (OKT) characterizes for its noticed rapid growth pattern and the possibility to develop carcinomas in the lesion wall. The DC is the most common type among the developing odontogenic cystic lesions, while the OKT represents 10% of these lesions. The prevalence of the OKT found in the current study was superior to the DC, opposing data of the evaluated literature, as well as the predominance in relation to the age group. Dentigerous cyst cases were found mostly in younger individuals, whereas the OKT was observed mainly in individuals between the third and fourth decades of life. This fact reflects the fragility of these features while establishing the presumptive diagnosis and insinuates the strong relation with a probable genetic predisposition. In relation to sex and race, the findings in this article were similar to those found in the literature, highlighting the possibility of a hormonal involvement. However, the anatomopathologic examination remains essential to define the main diagnosis of the lesions observed by means of imaging examinations, providing for safer diagnoses to plan the treatment.

Retrospective review of pediatric oral lesions from a dental school biopsy service.

UNLABELLED: This report presents a review of the results from 5457 biopsies of patients, 0-16 years of age, received over 15 years at the University of the Pacific School of Dentistry (Pacific Oral and Maxillofacial Pathology Laboratory). PURPOSE: To carry out the largest and most up to date U.S. survey of oral specimens from children. METHOD: The computerized data was retrieved and compiled for age and diagnoses. The lesions were divided by the MIND classification system into 1) Metabolic 2) Inflammatory 3) Neoplastic and 4) Developmental. RESULTS: Inflammatory lesions formed the largest group of biopsies (2758, 51%) followed by Developmental conditions (1928, 35%) and Neoplasms (734, 13%). Dentigerous cysts were the most common lesions, followed by the mucous retention phenomenon (mucocele). The 15 most frequently occurring lesions accounted for 80% of all biopsies. Eight malignancies and 22 benign aggressive tumors were also included. CONCLUSIONS: 1. Pathoses increase with age. 2. Results from our study are similar to most of the other studies. 3. More serious pathoses occur in some countries where there is limited access to care, resulting in patients seeking care only when symptomatic. 4. Oral malignancies are rare, but as with any malignancy, early diagnosis renders a more favorable prognosis.

Epidemiological study of intraosseous lesions of the stomatognathic or maxillomandibular complex diagnosed by a Reference Centre in Brazil from 2006-2017.

This epidemiological study was designed to find out the incidence and factors associated with the occurrence of intraosseous lesions diagnosed at a Reference Centre in Brazil. We included all patients diagnosed with intraosseous lesions (cyst, tumour, bone-associated lesion, and periapical disease) during the period 2006-2017, and analysed the association between some sociodemographic and clinical variables and the types of lesion. There was a total of 290 intraosseous lesions, the most common being odontogenic cysts. There was a significant association between age and odontogenic tumours (p=0.001). In relation to the histopathological diagnosis, root cysts were the most common (n=57), followed by dentigerous cysts (n=26). The lesions studied were seen most often in women between the second and fourth decades of life, odontogenic cysts being the most common type found. We know of few publications of similar epidemiological work, either in Brazil or in the rest of the world, so we suggest that more such studies are made.

Prevalence and distribution of odontogenic cysts in Sicily: 1986-2005.

The objective of this study was to assess the prevalence of odontogenic cysts (OCs) in Sicily and evaluate their distribution during a 20-year period. A cross-sectional retrospective study was carried out in 1,310 cysts of the jaw diagnosed in 12,197 individuals, who consecutively attended the Odontostomatologic Clinic of Palermo from 1986 to 2005. 1,273 cysts were classified as odontogenic, whereas only 37 were non-odontogenic. In the former group, the most frequent lesions were radicular cysts (84.5%), followed by dentigerous OCs (11.4%). Inflammatory radicular cysts were observed more in male gender, younger age at diagnosis and anterior maxilla as site of presentation. Unlike dentigerous cysts, the frequency of radicular cysts decreased from 10.4% in 1986-1995 to about 8% in 1996-2005 (P < 0.0001). Inflammatory radicular cysts are the most represented group among OCs in our area with a higher prevalence than that reported in other countries. The decreasing epidemiologic trend with time could be attributed to the possible changes in individual oral health behavior.

Clinicopathological study of dentigerous cysts in Singapore and Malaysia.

This was a retrospective study of dentigerous cysts in people from the Singapore-Malaysian region. The purpose of this study was to present the clinicopathologic features of dentigerous cysts in the Oriental population and to compare these data with those from other reported studies. Biopsy records from 1981 to 1993 of 119 cases of dentigerous cysts from patients in Malaysia and Singapore showed that 36.1% of patients were female and 63.9% patients were male. Among patients with cysts, 70.5% were Chinese, 23.2% were Malays, 2.7% were Indian and 3.6% were other ethnic groups. The mean age of these patients was 30.2 +/- 17.3 years with a peak incidence occurring in the second and third decades. The location of the lesions was almost equal to the maxilla (50.9%) and the mandible (49.1%). There was a marked predilection for the posterior mandible (42.7%) followed by the anterior maxilla (38.2%). Histologically, 90.8% of the cysts were lined by a non-keratinised stratified squamous epithelium. The cyst linings were mainly thin (90.0%) with 38.7% of cases having a mixed thick and thin lining. Mucous metaplasia was observed in 9 (7.6%) cases. Rushton bodies were seen in 3.4% of cases. Cholesterol clefts in the epithelial lining and lumen were found in 16.8% cases while 12.6% of cases exhibited cholesterol clefts in the cyst wall. Other cellular structures within the cyst wall were lymphocytes (66.4%), plasma cells (52.1%), Russell bodies (16.0%) and histiocytes (4.2%). Odontogenic keratocysts were observed in 5.0% of cases. One case of adenomatoid odontogenic tumour was also observed. Epithelial atypia was seen in 9.2% of cases, islands of stratified squamous epithelial cells in 8.4% of cases while one case showed a combination of these two features. In conclusion, some clinical features seen in this study are similar to that for the Caucasian population such as prevalence in male, peak incidence in the second and third decades and the predilection for the posterior mandible and anterior maxilla. Histopathologically, odontogenic keratocyst and adenomatoid odontogenic tumour were observed in dentigerous cysts.

Presencia de lesiones quísticas en sacos pericoronarios de terceros molares mandibulares / Presence of cystic lesions in pericoronary sacs of mandibular third molars

Introducción: a pesar de que un tercer molar no erupcionado repre- senta un riesgo de formación quística, la práctica clínica desestima el análisis histopatológico de los folículos de dichos molares. Objetivo: identificar la frecuencia de lesiones quísticas en los sacos pericoronarios de terceros molares mandibulares. Material y métodos: estudio des- criptivo, transversal, analítico y observacional, en donde se incluyeron sacos pericoronarios de terceros molares mandibulares para su análisis histopatológico, descripción de características clínico-radiográficas y su asociación con la presencia de cambios histológicos o lesiones quís- ticas. Resultados: se incluyeron 48 muestras de sacos pericoronarios, la histopatología de los sacos pericoronarios mostró que 83.3% tenían algún tipo de alteración: 13 quistes paradentales (27.1%), cuatro quistes dentígeros (8.3%), 12 folículos hiperplásicos (25.0%) y 11 folículos inflamados (22.9%). La presencia de lesiones quísticas en la población fue de 35.4%. Se detectó asociación estadísticamente significativa entre el sexo y la presencia de lesiones quísticas (p = 0.039) y entre el nivel de erupción y la presencia de cambios histológicos (p = 0.046). Con- clusiones: la frecuencia de lesiones quísticas o cambios histológicos en folículos de terceros molares mandibulares es alta, principalmente en molares parcialmente erupcionados o submucosos y sin importar la ausencia de sintomatología o alteraciones radiográficas (AU))

Introduction: although a non-erupted third molar represents a risk of cystic formation; clinical practice rejects the histopathological analysis of the follicles of said molars. Objective: identify the frequency of the histopathological changes in pericoronary sacs of mandibular third molars. Material and methods: descriptive cross- sectional, observational and analytic study, where pericoronary sacs of mandibular third molars were included for histopathological analysis, description of clinical-radiographic characteristics and their association with the presence of histological changes or cystic lesions. Results: 48 samples of pericoronary sacs were included, the histopathology of the pericoronary sacs showed 83.3% had some type of alteration: 13 paradental cysts (27.1%), four dentigerous cysts (8.3%), 12 hyperplastic follicles (25.0%) and 11 inflamed follicles (22.9%). The presence of cystic lesions in the population was 35.4%. A statistically significant association was detected between sex and the presence of cystic lesions (p = 0.039); and between the level of eruption and the presence of histological changes (p = 0.046). Conclusions: the frequency of cystic lesions or histological changes in mandibular third molar follicles is high, mainly in partially erupted or submucosal molars and regardless of the absence of symptoms or radiographic alterations (AU)

Bi-maxillary dentigerous cyst in a non-syndromic child - review of literature with a case presentation.

Dentigerous cysts are the most common developmental odontogenic cysts of the jaw, which usually occur in the second and third decade of life. It is most frequently associated with impacted mandibular third molar teeth and impacted canines. Bilateral/multiple dentigerous cysts are rare and typically associated with developmental syndromes. Non-syndromic dentigerous cyst occurring bilaterally or involving both arches at the same time is very rare. Here, we discuss the review of literature with a case of unusual occurrence of non-syndromic bi-maxillary dentigerous cysts in a child.

Dentigerous cysts presenting as head and neck infections.

OBJECTIVE: To describe dentigerous cysts presenting as head and neck infections. STUDY DESIGN AND SETTING: Retrospective analysis of 327 charts with an admitting diagnosis of head and neck infection, deep neck space infection, and dentigerous cysts treated at a tertiary care hospital between 1975 and 2004. RESULTS: Seven patients were identified who had dentigerous cysts that presented as head and neck infections. Six of these patients had recurrent infections at the same site and one was diagnosed with a submasseteric space abscess. The incidence of head and neck infections with dentigerous cysts as the underlying causative pathology was 2.1%. CONCLUSION: Head and neck infections with dentigerous cysts as underlying pathology are more common than perceived. SIGNIFICANCE: Typically not considered as sources of infection, dentigerous cysts must be considered in cases of head and neck infection. EBM RATING: C.

Age-standardized incidence rates of ameloblastoma and dentigerous cyst on the Witwatersrand, South Africa.

Although a great deal is known about the incidence of cancer, including oral cancer, no such study has been done on odontogenic tumors and jaw cysts. There are therefore no standardized data which would allow for comparative incidences in different countries and between different groups. In the present study, cases of ameloblastomas and dentigerous cysts derived from the records of all the hospital pathology departments and private pathology practices on the Witwatersrand, were recorded for the 10-year period 1965--1974. The population at risk (1970 census) was 974,390 Whites and 1,567,280 Blacks. The annual incidence rates, standardized against the standard world population, for ameloblastomas per million population are 1.96, 1.20, 0.18 and 0.44 for Black males, females and White males, females, respectively. The equivalent four figures for dentigerous cysts are 1.18, 1.22, 9.92 and 7.26. These figures show that ameloblastoma is very much more common in Blacks than Whites in the population at risk. Conversely, dentigerous cysts are much more common in Whites. This makes it unlikely that dentigerous cysts predispose to ameloblastoma formation. These epidemiologic observations give rise to speculation as to whether some component of the South African Black diet or other environmental substance might possibly be an etiologic factor in ameloblastoma.

Pathological changes related to long-term impaction of third molars. A radiographic study.

Pathological changes related to impacted 3rd molars (ITM) were studied in a radiographic investigation of 2128 randomly selected patients. In radiographs from 644 patients, 1211 ITM were noted. Pathological changes were observed in 25 of 477 (5.2%) maxillary ITM and in 59 of 734 (8%) mandibular ITM. A pathologically widened pericoronal space (indicating a dentigerous cyst) was observed in 5 of 477 maxillary and 43 of 734 mandibular ITM (p less than 0.001). Other pathologic changes observed were resorption of the 2nd molars (1% in the maxilla, 1.5% in the mandible) or loss of marginal bone on the distal aspect of the second molars (4% in the maxilla, 1% in the mandible). The risk of pathological sequelae because of ITM, apparently, is low. Prophylactic surgical removal should, therefore, be regarded with some reserve, particularly in view of the high frequency of deep impactions, with greater risk for surgical complications.