Odontoma

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Odontoma
Other namesOdontome [1] [2] [3]
Odontoma.jpg
Specialty Dentistry

An odontoma, also known as an odontome, is a benign tumour [4] linked to tooth development. [5] Specifically, it is a dental hamartoma, meaning that it is composed of normal dental tissue that has grown in an irregular way. It includes both odontogenic hard and soft tissues. [1] As with normal tooth development, odontomas stop growing once mature which makes them benign. [6]

Contents

The average age of people found with an odontoma is 14. [7] The condition is frequently associated with one or more unerupted teeth and is often detected through failure of teeth to erupt at the expected time. Though most cases are found impacted within the jaw there are instances where odontomas have erupted into the oral cavity. [8]

Types

There are two main types: compound and complex. [9]

In addition to the above forms, the dilated odontoma is an infrequent developmental alteration that appears in any area of the dental arches and can affect deciduous, permanent and supernumerary teeth. Dens invaginatus is a developmental anomaly resulting from invagination of a portion of crown forming within the enamel organ during odontogenesis. The most extreme form of dens invaginatus is known as a dilated odontoma.

There are two types of lesions which are regarded as complex odontomas with a prominent soft tissue component resembling ameloblastic fibroma. With similar presentation and treatment outcomes to complex odontomas. [6] These lesions were poorly defined previously and were removed as separate entities from the WHO Classification of Head and Neck Tumors (2017). They are now regarded as developing odontomas as histologically there are no differences. [11]

Histopathology

Odontomas are from mixed epithelial and mesenchymal components which are required for tooth development, producing enamel, dentine, cementum and pulp tissue. [6]

Presentation

Odontomas usually asymptomatic and present as chance radiographic finding, often during childhood and adolescence when teeth do not erupt within the expected timeframe. [6]

Occasionally odontomas can erupt into the mouth and this can lead to acute infections resembling a dental abscess. [10]

During the early stage of odontoma development; radiolucent flecks develop. At a later stage of development a dense radioopaque mass becomes visible as enamel and dentine forms. [6]

Aetiology

Overall aetiology is unknown. However, odontomas have been related to local trauma, inflammatory and/or infectious processes, hereditary anomalies such as Gardener's syndrome and Hermanns syndrome, odontoblastic hyperactivity, mature odontoblasts and dental lamina remnants (Cell Rests of Serres). [12]

Gardner's syndrome

Gardner's syndrome is a subtype of Familial adenomatous polyposis. The clinical presentation of this syndrome includes multiple odontomas. This condition has a high risk of malignancy through adenocarcinoma of the bowel. [10]

Treatment

Most common treatment is surgical enucleation due to well-encapsulated nature of odontomas allowing separation from surrounding bone. [10] [6]

If left untreated can result in a dentigerous cyst. [6] [12]

Epidemiology

Odontomas are thought to be the second most frequent type of odontogenic tumor worldwide (after ameloblastoma), accounting for about 20% of all cases within this relatively uncommon tumor category which shows large geographic variations in incidence. According to the same article discussion, statistics might appear misleading as most of the odontomas within high-occurrence ameloblastoma-areas, are well-likely left unreported due to hospital management problems and asymptomatic clinical picture of odontoma. [13]

In 2019, a 7-year-old boy from Tiruvallur district, [14] near Chennai, India with compound odontoma received surgery to remove 526 teeth from his lower right jaw. [15] [16]

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Tooth decay</span> Deformation of teeth due to acids produced by bacteria

Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation.

<span class="mw-page-title-main">Wisdom tooth</span> Large tooth at the back of the human mouth

A third molar, commonly called wisdom tooth, is one of the three molars per quadrant of the human dentition. It is the most posterior of the three. The age at which wisdom teeth come through (erupt) is variable, but this generally occurs between late teens and early twenties. Most adults have four wisdom teeth, one in each of the four quadrants, but it is possible to have none, fewer, or more, in which case the extras are called supernumerary teeth. Wisdom teeth may get stuck (impacted) against other teeth if there is not enough space for them to come through normally. Impacted wisdom teeth are still sometimes removed for orthodontic treatment, believing that they move the other teeth and cause crowding, though this is not held anymore as true.

<span class="mw-page-title-main">Hyperdontia</span> Condition of having extra teeth beyond the regular number of teeth

Hyperdontia is the condition of having supernumerary teeth, or teeth that appear in addition to the regular number of teeth. They can appear in any area of the dental arch and can affect any dental organ. The opposite of hyperdontia is hypodontia, where there is a congenital lack of teeth, which is a condition seen more commonly than hyperdontia. The scientific definition of hyperdontia is "any tooth or odontogenic structure that is formed from tooth germ in excess of usual number for any given region of the dental arch." The additional teeth, which may be few or many, can occur on any place in the dental arch. Their arrangement may be symmetrical or non-symmetrical.

<span class="mw-page-title-main">Enamel organ</span>

The enamel organ, also known as the dental organ, is a cellular aggregation seen in a developing tooth and it lies above the dental papilla. The enamel organ which is differentiated from the primitive oral epithelium lining the stomodeum.The enamel organ is responsible for the formation of enamel, initiation of dentine formation, establishment of the shape of a tooth's crown, and establishment of the dentoenamel junction.

<span class="mw-page-title-main">Ameloblastoma</span> Medical condition

Ameloblastoma is a rare, benign or cancerous tumor of odontogenic epithelium much more commonly appearing in the lower jaw than the upper jaw. It was recognized in 1827 by Cusack. This type of odontogenic neoplasm was designated as an adamantinoma in 1885 by the French physician Louis-Charles Malassez. It was finally renamed to the modern name ameloblastoma in 1930 by Ivey and Churchill.

<span class="mw-page-title-main">Human tooth development</span> Process by which teeth form

Tooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. For human teeth to have a healthy oral environment, all parts of the tooth must develop during appropriate stages of fetal development. Primary (baby) teeth start to form between the sixth and eighth week of prenatal development, and permanent teeth begin to form in the twentieth week. If teeth do not start to develop at or near these times, they will not develop at all, resulting in hypodontia or anodontia.

<span class="mw-page-title-main">Dental papilla</span>

In embryology and prenatal development, the dental papilla is a condensation of ectomesenchymal cells called odontoblasts, seen in histologic sections of a developing tooth. It lies below a cellular aggregation known as the enamel organ. The dental papilla appears after 8–10 weeks intra uteral life. The dental papilla gives rise to the dentin and pulp of a tooth.

<span class="mw-page-title-main">Dental follicle</span>

The dental follicle, also known as dental sac, is made up of mesenchymal cells and fibres surrounding the enamel organ and dental papilla of a developing tooth. It is a vascular fibrous sac containing the developing tooth and its odontogenic organ. The dental follicle (DF) differentiates into the periodontal ligament. In addition, it may be the precursor of other cells of the periodontium, including osteoblasts, cementoblasts and fibroblasts. They develop into the alveolar bone, the cementum with Sharpey's fibers and the periodontal ligament fibers respectively. Similar to dental papilla, the dental follicle provides nutrition to the enamel organ and dental papilla and also have an extremely rich blood supply.

<span class="mw-page-title-main">Pericoronitis</span> Inflammation of the soft tissues surrounding the crown of a partially erupted tooth

Pericoronitis is inflammation of the soft tissues surrounding the crown of a partially erupted tooth, including the gingiva (gums) and the dental follicle. The soft tissue covering a partially erupted tooth is known as an operculum, an area which can be difficult to access with normal oral hygiene methods. The hyponym operculitis technically refers to inflammation of the operculum alone.

<span class="mw-page-title-main">Dentigerous cyst</span> Medical condition

A dentigerous cyst, also known as a follicular cyst, is an epithelial-lined developmental cyst formed by accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth. It is formed when there is an alteration in the reduced enamel epithelium and encloses the crown of an unerupted tooth at the cemento-enamel junction. Fluid is accumulated between reduced enamel epithelium and the crown of an unerupted tooth.

<span class="mw-page-title-main">Central giant-cell granuloma</span> Medical condition

Central giant-cell granuloma (CGCG) is a localised benign condition of the jaws. It is twice as common in females and is more likely to occur before age 30. Central giant-cell granulomas are more common in the anterior mandible, often crossing the midline and causing painless swellings.

<span class="mw-page-title-main">Odontogenic keratocyst</span> Medical condition

An odontogenic keratocyst is a rare and benign but locally aggressive developmental cyst. It most often affects the posterior mandible and most commonly presents in the third decade of life. Odontogenic keratocysts make up around 19% of jaw cysts.

<span class="mw-page-title-main">Calcifying odontogenic cyst</span> Medical condition

Calcifying odotogenic cyst (COC) is a rare developmental lesion that comes from odontogenic epithelium. It is also known as a calcifying cystic odontogenic tumor, which is a proliferation of odontogenic epithelium and scattered nest of ghost cells and calcifications that may form the lining of a cyst, or present as a solid mass.

An ameloblastic fibroma is a fibroma of the ameloblastic tissue, that is, an odontogenic tumor arising from the enamel organ or dental lamina. It may be either truly neoplastic or merely hamartomatous. In neoplastic cases, it may be labeled an ameloblastic fibrosarcoma in accord with the terminological distinction that reserves the word fibroma for benign tumors and assigns the word fibrosarcoma to malignant ones. It is more common in the first and second decades of life, when odontogenesis is ongoing, than in later decades. In 50% of cases an unerupted tooth is involved.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

An odontogenic tumor is a neoplasm of the cells or tissues that initiate odontogenic processes.

A cyst is a pathological epithelial lined cavity that fills with fluid or soft material and usually grows from internal pressure generated by fluid being drawn into the cavity from osmosis. The bones of the jaws, the mandible and maxilla, are the bones with the highest prevalence of cysts in the human body. This is due to the abundant amount of epithelial remnants that can be left in the bones of the jaws. The enamel of teeth is formed from ectoderm, and so remnants of epithelium can be left in the bone during odontogenesis. The bones of the jaws develop from embryologic processes which fuse, and ectodermal tissue may be trapped along the lines of this fusion. This "resting" epithelium is usually dormant or undergoes atrophy, but, when stimulated, may form a cyst. The reasons why resting epithelium may proliferate and undergo cystic transformation are generally unknown, but inflammation is thought to be a major factor. The high prevalence of tooth impactions and dental infections that occur in the bones of the jaws is also significant to explain why cysts are more common at these sites.

Ameloblastic carcinoma is a rare form of malignant odontogenic tumor, that develops in the jawbones from the epithelial cells that generate the tooth enamel. It is usually treated with surgery; chemotherapy has not been proven to be effective.

The ameloblastic fibro-odontoma (AFO) is essentially a benign tumor with the features characteristic of ameloblastic fibroma along with enamel and dentin. Though it is generally regarded as benign, there have been cases of its malignant transformation into ameloblastic fibrosarcoma and odontogenic sarcoma. Cahn LR and Blum T, believed in “maturation theory”, which suggested that AFO was an intermediate stage and eventually developed during the period of tooth formation to a complex odontoma thus, being a hamartoma.

References

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  8. Bhargavan Sarojini S, Khosla E, Varghese T, Johnson Arakkal L (2014). "Eruption of odontomas into the oral cavity: a report of 2 cases". Case Reports in Dentistry. 2014: 639173. doi: 10.1155/2014/639173 . PMC   4037568 . PMID   24900927.
  9. Amado Cuesta S, Gargallo Albiol J, Berini Aytés L, Gay Escoda C (2003). "Review of 61 cases of odontoma. Presentation of an erupted complex odontoma" (PDF). Medicina Oral. 8 (5): 366–73. PMID   14595262.
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  14. Chennai dentists extract 526 teeth from mouth of seven-year-old boy , 31 July 2019, New Indian Express.
  15. Dunham J (August 1, 2019). "Boy has surgery to remove 526 teeth 'reminiscent of pearls in an oyster'". CTV News. Retrieved 3 August 2019.
  16. Saavetha's Surgical and Pathological Excellence in Unmasking 256 Teeth from a Single Site in a Child , 1 August 2019 News from Saavetha Dental College, Chennai. It features photographs and X-ray pictures.