Odontogenic and Developmental Oral Lesions in Pediatric Patients

The Prevalence of Oral Anomalies Among Healthy Newborns at a Gynecological Obstetric Hospital in Quito, Ecuador: An Observational, Cross-Sectional Study

Objectives: Early observations often fail to detect anomalies that may impact the health and quality of life of newborns. This study aimed to determine the prevalence of oral anomalies in newborns and explore their possible associations with sociodemographic factors. Methods: A cross-sectional study was conducted in Quito, Ecuador, analyzing a sample of 241 newborns. The presence of oral anomalies was recorded, and their association with sex, birth weight, maternal age, and gestational factors was evaluated. Results: The prevalence of oral anomalies was 72.3%, with Epstein's pearls being the most common (50%). Other findings included Bohn's nodules and dental lamina cysts, while no cases of natal teeth or congenital epulis were observed. Ankyloglossia was identified in 1.36% of newborns. No significant correlations were found between the presence of oral anomalies and sex, birth weight, maternal age, or gestational factors. Conclusions: The high prevalence (72.3%) of oral anomalies in the studied newborns underscores the importance of early detection and management. Epstein's pearls were the most frequent anomaly, followed by Bohn's nodules, dental lamina cysts, and ankyloglossia, while no cases of natal teeth or congenital epulis were identified. No statistically significant associations were found with sex, birth weight, maternal age, or pregnancy complications. These findings emphasize the need for early pediatric dental assessment and an interdisciplinary approach to ensure proper neonatal oral health. Further research is recommended to explore potential causes and interventions to optimize oral health from birth.

Clinicopathological and molecular insights into odontogenic tumors associated with syndromes: A comprehensive review

The association between genetic syndromes and odontogenic tumors encompasses several entities, reflecting the intricate interplay between genetic factors and the development of these lesions. The present study aimed to comprehensively investigate the associations between genetic syndromes and odontogenic tumors. We delineated the diverse spectrum of syndromic connections, including key syndromes such as Gardner syndrome, Gorlin syndrome, Schimmelpenning syndrome, and others. Our findings underscore the clinical significance of recognizing odontogenic tumors associated with genetic syndromes as diagnostic indicators for early intervention. We advocate for multidisciplinary collaboration among clinicians, geneticists, and researchers to deepen our understanding of the underlying mechanisms driving these syndromic associations. In light of this, our study contributes to the growing body of knowledge in dentistry and medical genetics, offering insights that may inform clinical practice and enhance patient care for individuals affected by genetic syndromes and odontogenic tumors.

A Rare Case of Congenital Buccal Lipoblastoma in a Term Neonate

A lipoblastoma is a benign tumor of adipocytes originating from embryonic white fat and occurs in the pediatric population. Congenital lipoblastomas, however, are rare, and the incidence of these tumors in neonates is unknown. Due to their rare presentation, congenital oral lipoblastomas can, firstly, pose diagnostic challenges for the pediatrician and must be differentiated from the more commonly seen oral lesions in the newborn and other rare malignant growths. Secondly, these benign yet gradually enlarging tumors may result in obstructive and/or compressive symptoms, an important consideration for congenital tumors present in the facial, head, neck, and oral locations given impending airway compromise, dysphagia, and feeding difficulties associated with large growths. We report a rare case of congenital buccal lipoblastoma in a term female newborn presenting as a pedunculated mass arising from the left buccal mucosa. She underwent surgical excision, and histopathological analysis revealed the mass to be a lipoblastoma. Subsequently, the infant recovered well and has had no recurrence of the mass. Follow-up is recommended post-excision, given the risk of recurrence, which is higher with incomplete resection and lipoblastomatosis (a deep, infiltrative, ill-defined subtype of lipomatous tumors). The pleomorphic adenoma gene 1 (PLAG 1) gene overexpression has been implicated in a majority of lipoblastomas and may aid in the diagnosis of atypical tumors. Oral lipoblastoma should be considered in the differential diagnoses for newborns presenting with a mass or growth in the oral cavity.

Solitary ameloblastic fibroma with impacted teeth: A case report

This case report aimed to describe a rare benign mandibular tumour and assess the outcomes of the most recent reviews, between January 2017 and August 2023. Presenting a detailed clinical case, this study advances our understanding of the diagnostic and therapeutic aspects, ultimately improving the management of similar cases in clinical practice. Orthopantomogram (OPG) revealed a well-defined unilocular radiolucency extending from the midline of the ramus and teeth 47 and 48 were submerged at the base of the mandible. In the presented case, a PLANMECA ROMEXIS PROMAX® three-dimensional (3D) maximum (MAX) cone-beam computed tomography (CBCT) device was used for the 3D examination. An intraoral approach was preferred and the tumour was removed in toto by creating a bone window using a W&H® Dentalwerk Bürmoos GmbH Piezomed piezoelectric device, and the bone plates were fixed with 4 MEDARTIS® microplates, with a primary flap closure. A PANORAMIC 1000, 3DHISTECH Ltd® device was employed for the histological investigation. Odontogenic tumours are rare and typically asymptomatic, often discovered incidentally during routine radiographic examinations. Most of these benign lesions heal well after complete excision and require long-term follow-up. Once diagnosed, ameloblastic fibroma (AF) should be treated immediately to avoid malignant transformation.

Whole genome sequencing in families with oligodontia

BACKGROUND/OBJECTIVES

Tooth agenesis (TA) is among the most common malformations in humans. Although several causative mutations have been described, the genetic cause often remains elusive. Here, we test whether whole genome sequencing (WGS) could bridge this diagnostic gap.

METHODS

In four families with TA, we assessed the dental phenotype using the Tooth Agenesis Code after intraoral examination and radiographic and photographic documentation. We performed WGS of index patients and subsequent segregation analysis.

RESULTS

We identified two variants of uncertain significance (a potential splice variant in PTH1R, and a 2.1 kb deletion abrogating a non-coding element in FGF7) and three pathogenic variants: a novel frameshift in the final exon of PITX2, a novel deletion in PAX9, and a known nonsense variant in WNT10A. Notably, the FGF7 variant was found in the patient, also featuring the WNT10A variant. While mutations in PITX2 are known to cause Axenfeld-Rieger syndrome 1 (ARS1) predominantly featuring ocular findings, accompanied by dental malformations, we found the PITX2 frameshift in a family with predominantly dental and varying ocular findings.

CONCLUSION

Severe TA predicts a genetic cause identifiable by WGS. Final exon PITX2 frameshifts can cause a predominantly dental form of ARS1.

Benign Intraoral Soft Tissue Lesions in Children

Benign intraoral soft tissue pathology in pediatric patients includes developmental, traumatic, inflammatory, and infectious lesions. Common pathology includes gingival cysts, mucoceles, fibromas, and parulis. Less common lesions include peripheral ossifying fibromas, congenital epulis of the newborn, and congenital mandibular duct atresia. Most of these lesions present at painless masses but can have significant effects on children and their caregivers. Although these lesions are generally harmless, evaluation and treatment is necessary for appropriate management and health of the child.

A rare case report of ameloblastic fibrodentinoma with imaging features in a pediatric patient

Ameloblastic fibrodentinoma (AFD) is a rare benign odontogenic tumor that resembles an ameloblastic fibroma with dysplastic dentin. This report presents a rare case of mandibular AFD with imaging features in a young patient. Panoramic radiography and computed tomography revealed a well-defined lesion with internal septa and calcified foci, causing inferior displacement of the adjacent molars as well as buccolingual cortical thinning and expansion of the posterior mandible. The lesion was surgically removed via mass excision, and the involved tooth was extracted under general anesthesia. During the 5-year follow-up period, no evidence of recurrence was observed. Radiologic features of AFD typically reveal a moderately to well-defined mixed lesion with varying degrees of radiopacity, reflecting the extent of dentin formation. Radiologists should consider AFD in the differential diagnosis when encountering a multilocular lesion with little dense radiopacity, particularly if it is associated with delayed eruption, impaction, or absence of involved teeth, on radiographic images of young patients.

Developing Odontoma in the Mandible of an Eight-Year-Old Boy

Benign mixed odontogenic tumors have been repeatedly classified and reclassified over the past few decades. Odontoma is considered a hamartoma due to its slow growth and non-aggressive nature. We present an interesting case of developing odontoma in an eight-year-old boy. His complaint was a slow-growing swelling in the lower right back tooth region. Clinical examination revealed a carious deciduous second molar. The orthopantomogram revealed a well-defined radiolucency around the unerupted mandibular first premolar and impacted mandibular second premolar. Histopathology revealed an odontogenic epithelial lining overlying myxofibrous stroma with inflammatory cells and calcified structures with few odontogenic rests. Special staining methods including Van Gieson and modified Gallego stains led to the final diagnosis of a developing odontoma.

The Enigma Unveiled: Expansile Compound-complex Odontoma in the Anterior Maxilla of a Teenager

Aim and objective

The objective of this case report is to offer insight into an expansive compound-complex odontoma located in the anterior maxilla of a 15-year-old male. The focus is placed on the importance of early detection and the progressive comprehension of odontomas.

Background

Odontomas are common odontogenic lesions that are frequently discovered during examinations for delayed tooth eruption. There are two distinct classifications for odontomas-compound odontomas and complex odontomas. With its own each set of characteristics. A timely diagnosis is critical for avoiding complications.

Case description

A male individual aged 15 years exhibited an expansive compound-complex odontoma located in the anterior maxilla. The clinical examination showed delayed tooth eruption and asymptomatic swelling. The radiographic images showed a radiopaque mass with tooth-like structures and radiolucent borders affecting the surrounding dentition. A surgical excision procedure was conducted, followed by a subsequent histopathological examination confirming the diagnosis of compound-complex odontoma. The patient continued orthodontic treatment after a 1-year follow-up without recurrence.

Clinical significance

This case emphasizes the importance of regular dental exams in detecting odontomas early. This observation also highlights the growing understanding of odontomas as hamartomatous odontogenic malformations and the challenges of diagnosing them clinically. Additional molecular investigations are required to facilitate the classification and elucidation of genetic factors.

How to cite this article

Alhazmi YA. The Enigma Unveiled: Expansile Compound-complex Odontoma in the Anterior Maxilla of a Teenager. Int J Clin Pediatr Dent 2024;17(1):82-85.

Decompression of a Dentigerous Cyst Treatment in Mixed Dentition: A Case Report with 5 Years Follow-Up

Among developmental odontogenic cysts, the dentigerous type is the second most prevailing one. It is a benign intraosseous lesion commonly affecting the mandibular region. Dentigerous cysts present a high prevalence in children as they can be caused by the eruption of permanent teeth or the infection of deciduous ones. The adopted treatment modalities include enucleation (cystectomy), marsupialization, and decompression. Decompression maintains communication between the cyst and the oral medium through a sutured fixed device, namely an acrylic stent or a pretrimmed disposable suction tube. In the mixed dentition, the extraction of the affected primary teeth and the decompression approach is recommended, especially since children and parents are more tolerant of conservative treatments. We report in this study, a case of a 9-year-old boy complaining of a painful swelling in the left mandibular region. Intraoral and radiological examination revealed an expansion of the buccal and lingual cortical plates associated with teeth #73, #74, and #75 and a well-limited, unilocular radiolucent image extending from the distal aspect of tooth #31 to the mesial aspect of tooth #36 involving the crowns of the unerupted teeth #33, #34, and #35. The preliminary diagnosis was in favor of a dentigerous cyst. The treatment was to extract the deciduous teeth and to use a sterile tube for decompression. The patient was followed up for 5 years, a complete remission of the cyst was observed and the teeth #33, #34, and #35 re-erupted normally on the mandibular arch.

Benign Pediatric Jawbone Lesions: A 10-Year Clinical and Radiological Pilot Study

This study aimed at presenting a retrospective longitudinal analysis of the pediatric jaw lesions treated at the Oral and Maxillofacial Surgery Clinic in Cluj-Napoca, Romania, over a timeframe of ten years (2012 to 2022). The clinical and radiological characteristics of the jawbone lesions, the treatment outcome, and the recurrence incidence were described. All consecutive patients aged below 18 years, with histologically diagnosed odontogenic tumors (OTs), nonodontogenic tumors (non-OTs), or odontogenic cysts (OCs) were included. Age, dentition type, clinical symptoms, preoperative and postoperative radiological tests, histological diagnosis, treatment, and follow-up information one year following the diagnoses were all examined. Eighty-two cases were included. The ratio of men to women was 1.15:1, with the mandible predominating by 64.4%. Inflammatory radicular cysts predominated in 31.7% of cases. A total of 42.68% of the patients were asymptomatic. Enucleation was the most frequent surgical technique (45.1%), followed by cystectomies (28%) and marsupialization (14.6%). The overall recurrence rate was 7.3%; the most recurrent histopathological lesion was the odontogenic keratocyst. This study sheds new light on the clinical and radiological characteristics, treatment outcomes, and recurrence rate of juvenile jawbone lesions in children and adolescents. The diagnosis and treatment of jawbone lesions in children and adolescents can be enhanced with the use of epidemiological, clinical, and imagistic information.