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Oral Pathology - 14 - Odontogenic Tumors

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Oral Pathology

Introduction to Oral Pathology1

Oral pathology is the specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases.

Odontogenic Tumors

  • Odontogenic tumors occur in the bone and are unique to the jaws.
  • They are derived from epithelial or mesenchymal cells involved in the formation of teeth.
  • ==The term “odontogenic” comes from odonto (meaning teeth) and genic (meaning formation).==

Clinical Practice and Diagnosis

The practice of oral pathology includes the following components:

  • Research: Investigating the etiology and pathogenesis of oral diseases.
  • Diagnosis: Utilizing clinical, radiographic, microscopic, biochemical, or other examinations to identify specific conditions.
  • Management: Determining the appropriate treatment plan and monitoring patient outcomes.

Scope of Study

Key areas of focus within the field include:

  1. Developmental Defects: Abnormalities occurring during the formation of oral structures.
  2. Inflammatory Diseases: Responses of oral tissues to injury or infection.
  3. Neoplastic Conditions: The study of benign and malignant tumors of the oral cavity.
  4. Systemic Disease Manifestations: Identifying how systemic conditions (such as diabetes or hematologic disorders) present symptoms within the mouth.

Table Of Contents2

  • Developmental Conditions
  • Mucosal Lesions—Reactive
  • Mucosal Lesions—Infections
  • Mucosal Lesions—Immunologic Diseases
  • Mucosal Lesions—Premalignant
  • Mucosal Lesions—Malignant
  • CT Tumors—Benign
  • CT Tumors—Malignant
  • Salivary Gland Diseases—Reactive
  • Salivary Gland Diseases—Benign
  • Salivary Gland Diseases—Malignant
  • Lymphoid Neoplasms
  • Odontogenic Cysts
  • Odontogenic Tumors
  • Bone Lesions—Fibro-Osseous
  • Bone Lesions—Giant Cell
  • Bone Lesions—Inflammatory
  • Bone Lesions—Malignant
  • Hereditary Conditions

Odontogenic Tumors

Clinical Characteristics3

  • Benign but aggressive
  • Classic differential diagnosis for multilocular radiolucency in the posterior mandible includes:
  • Many odontogenic tumors look similar radiographically
  • Multilocular radiolucencies are often described as "bubbly" with multiple compartments
    • Ameloblastoma
    • Keratocystic Odontogenic Tumor (KCOT)
    • Central Giant Cell Granuloma (CGCG)
    • Central Odontogenic Fibroma (COF)

Ameloblastoma

  • One of the most common odontogenic tumors
  • Highly expansile behavior that can erode tooth roots and the cortical plate

Treatment

  • Wide excision or resection
  • High recurrence rate if treatment is too conservative
    • Conservative surgical excision leads to high recurrence due to its aggressive nature

Calcifying Epithelial Odontogenic Tumor

Clinical and Radiographic Features4

  • Also called Pindborg tumor
  • Presents as a radiolucency with driven snow calcifications (white flecks)

Histopathology

  • Amorphous pink amyloid with concentric calcifications termed Liesegang rings

Treatment and Prognosis

  • Treatment: Surgical excision
  • Prognosis: Good

Adenomatoid Odontogenic Tumor

Clinical and Histological Features5

  • Contains epithelial duct-like spaces (adeno = gland) and enameloid material
  • Most commonly located in the anterior maxilla and associated with an impacted canine

Treatment and Prognosis

  • Treatment: Surgical excision
  • Prognosis: Good

Odontogenic Myxoma

Clinical and Radiographic Features6

  • Also called myxofibroma
  • Characterized by myxomatous connective tissue (pulp-like material with little collagen) resulting in a slimy stroma
  • Appears as a messy radiolucency with unclear borders and a honeycomb pattern

Treatment and Prognosis

  • Treatment: Surgical excision
  • Prognosis: Moderate recurrence rate

Central Odontogenic Fibroma

Histopathology7

  • Composed of dense collagen with strands of epithelium

Clinical Presentations

  • Central: Located within bone; presents as a well-defined multilocular radiolucency
  • Peripheral: Located on the gingiva (gum - Does not present as a radiolucency because it does not erode bone)

Cementoblastoma

Clinical and Radiographic Features8

  • Well-circumscribed radiopaque mass
  • Consists of a ball of cementum and cementoblasts replacing the tooth root
    • Appears literally attached to the root of the tooth

Treatment

  • Surgical excision and extraction

Ameloblastic Fibroma

Clinical Features9

  • Occurs in children and teens
  • Most common in the posterior mandible
  • Composed of myxomatous connective tissue
  • Termed an ameloblastic fibro-odontoma if an odontoma is also present

Treatment

  • Surgical excision

Odontoma

Clinical Characteristics10

  • Opaque lesion composed of dental hard tissues
  • Can block tooth eruption
    • Can cause ectopic eruption or lead to impaction

Classifications

  • Compound: Mostly anterior; consists of a bunch of miniature teeth
  • Complex: Mostly posterior; consists of a conglomerate mass

Associated Syndromes

  • Gardner Syndrome: Characterized by multiple odontomas and intestinal polyps

Mnemonic

Multiple "teeth bits" buried in a "garden" for Gardner Syndrome

Footnotes

  1. Original PDF page 1: Oral Pathology - 14 - Odontogenic Tumors, p.1 ↩

  2. Original PDF page 2: Oral Pathology - 14 - Odontogenic Tumors, p.2 ↩

  3. Original PDF page 3: Oral Pathology - 14 - Odontogenic Tumors, p.3 ↩

  4. Original PDF page 4: Oral Pathology - 14 - Odontogenic Tumors, p.4 ↩

  5. Original PDF page 5: Oral Pathology - 14 - Odontogenic Tumors, p.5 ↩

  6. Original PDF page 6: Oral Pathology - 14 - Odontogenic Tumors, p.6 ↩

  7. Original PDF page 7: Oral Pathology - 14 - Odontogenic Tumors, p.7 ↩

  8. Original PDF page 8: Oral Pathology - 14 - Odontogenic Tumors, p.8 ↩

  9. Original PDF page 9: Oral Pathology - 14 - Odontogenic Tumors, p.9 ↩

  10. Original PDF page 10: Oral Pathology - 14 - Odontogenic Tumors, p.10 ↩

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