Oral Pathology

• 1. Derived from tooth-forming tissues -enamel
• -cementum

2. Neoplasm of cells or tissues that initiate odontogenic processes (teeth formation).

3.Mostly benign (Rare to be malignant odontogenic tumor)

• 1. Ameloblastoma
• 2. Calcifying Epithelial Odontogenic Tumor
• 3. Adenomatoid Odontogenic Tumor
• 4. Calcifying Odontogenic Cyst
• 5. Odontogenic Myxoma
• 6. Benign Cementoblastoma

Maxilla or Mandible

Unencapsulated tumor --> Infiltrates the surrounding tissue

• Classic radiographic appearance:
• -multilocular
• -soap-bubble radiolucency
• *Can also appear as a unilocular radiolucency

• 80% arise in the Mandible:
• -Molar
• -Ramus

• Signs & Symptoms:
• -Slow Growing
• -Asymptomatic
• -Swelling of the affected bone

• Treatment includes:
• -Complete surgical removal
• -Recurrence is common

*Benign, Slow Growing, but locally aggressive.

Occurs less than Ameloblastoma

• Radiographic Appearance:
• -Uni or Multilocular radiolucency w/calcifications within.

Mandible to Maxilla (2:1)

• Areas most commonly affected: 
• -Premolar
• -Molar

• Tx:
• -Complete surgical Excision

Encapsulated, Benign Tumor

70% occur in females; 20 or younger

• Common Areas:
• 70% occur in the anterior, mostly maxilla

Often associated w/impacted teeth

• Signs and Symptoms:
• -Localized swelling
• -Asymptomatic

• Radiographic Appearance:
• -Well circumscribed radiolucency
• -May be associated w/ an impacted tooth

• Tx:
• -enucleation

*Recurrence is Rare

• Radiographic Appearance:
• -Well defined, Uni or Multilocular Radiolucency (may see calcification w/in)

• Seen in:
• Adults  age 40 & younger

• Tx:
• -Surgical enucleation

*Does not recur

Benign lesion occuring b/t age 10-29.

• Common Areas:
• -Posterior Mandible

• Radiographic Appearance:
• -Multilocular, honeycombed appearance w/poorly defined margins

• Surgical Excision:
• -Recurrence rate is 25%

Cementum-producing lesion that is fused to the root of a vital tooth. 

• Common Areas:
• -Continuity of the root of a mandibular premolar or molar

• Signs & Symptoms:
• -Pain
• -Obliteration of the apex of the affected tooth is common

• Radiographic Appearance:
• -Well defined, radiopaque mass w/a surrounding radiolucent halo (halo= periodontal ligament space).

• Tx: 
• -Enucleation & extraction of the affected tooth.

Most Common type of odontogenic tumors

• Composed of:
• -Enamel
• -Dentin
• -Cementum
• -Pulp

• Demographic: 
• -Adolescence⇾ failure of permanent tooth to erupt.

• Tx:
• -Surgical excision
• -Generally no recurrence occurs

*Most Odontomas are small, but larger lesions cause displacement of teeth & swelling

• 1. Compound Odontoma
• 2. Complex Odontoma

A collection of numerous small teeth

• Radiographic Appearance:
• -Cluster of numerous miniature teeth surrounded by a radiolucent halo

• Common Areas:
• Located in the Anterior Maxilla

• Consists of:
• -Enamel
• -Dentin
• -Cementum
• -Pulp
• *Does not resemble a normal tooth

• Common Areas:
• -Posterior Mandible

• Radiographic Appearance:
• -Radiopaque mass surrounded by a thin radiolucent halo

• aka SCHWANNOMA
• Benign tumors derived from nerve tissue
• Can occur at any age

• Common Areas:
• -IO:  Tongue

• Tx:
• -Surgical Excision:
• -Generally do not recur

• von Recklinghaus Disease:
• -Inherited Disorder
• -Multiple neurofibromas of the skin and other sites

• 1. Hemangioma
• 2. Kaposi Sarcoma

Benign proliferation of capillaries (common vascular lesion)

• Most present @ birth
• Common Areas:
• -Head & Neck (50% or more)
• -IO:  Tongue
• *Involvement of tongue may lead to macroglossia

• Tx:
• Variable
• *Some undergo spontaneous remission

Malignant vascular tumor

• Clinical Appearance:
• -Purlple Macules
• -Plaques
• -Exophytic Lesions
• Common Areas:
• -Skin & Oral tissues
• -Gingiva & Hard Palate 

Tx:

• -Surgical excision
• -Radiation Therapy
• -Chemotherapy

*Recurrence is common in HIV+ Pts & disease may progress rapidly

• 1. Torus
• 2. Exocytosis
• 3. Osteoma and Osteosarcoma

• Benign lesion of normal compact bone; bony hard lobulated mass
• -Asymptomatic

• Common Areas:
• -Midline of palate
• -Lingual aspect of mandible

• Demographic:
• -More prevelant in women than men
• -Hereditary basis

-Surface ulceration may occur if traumatized

• Tx: 
• None usually necessary

Small Nodular growth of normal compact bone

-Asymptomatic, bony hard nodules on the buccal aspect of the alveolar ridges

May see an increase in persons who grind or have bruxism.

• Tx: 
• None usually indicated

• Osteoma:
• -Asymptomatic benign tumor
• -Composed of normal compact bone
• -Slow growing
• Common Areas:
• -posterior mandible

*Large osteomas may cause expansion of the involved bone.

• Gardner's Syndrome:
• -Multiple supernumerary teeth
• -Multiple osteomas
• -Intestinal Polyposis

• 1. Leukemia
• 2. Lymphoma
• 3. Multiple Myeloma

Broad group of disorders characterized by an overproduction of atypical WBCs

WBCs multiply & spill over into the circulating blood & tissues.

• Acute leukemia:  common in children
• Chronic leukemia:  seen in adults

*More common in men than women

• Tx: 
• -chemotherapy
• -radiation therapy
• -corticosteroids

• Prognosis:
• -Depends on the extent of disease & type of leukemia

-Malignant tumor of lymphoid tissue.

• Clinical Appearance:
• -Gradual enlargement of involved lymph nodes
• Common Areas:
• -IO location is Tonsilar area

• Demographic:
• -More common in Men than Women

• Tx:
• -Radiation
• -Chemotherapy
• -Surgery or a Combinaiton of Tx options.

Malignant proliferation of plasma cells that causes destructive lesions in bone.

• Demographic:
• -Patients age 70
• -More common in Men than Women

• Signs & Symptoms:
• -Bone pain
• -Swelling
• -Pathologic fractures of bone is common (shows as multiple radiolucent lesions)

• Common Areas:
• -Mandible (More common)
• -Maxilla
• Also seen in :
• -skull
• -spine
• -ribs
• -pelvis
• -long bones

• Tx:
• -Chemotherapy
• -Radiation

• Prognosis:
• -Poor; Less than 20% of Pts survive 5 years
• -Most common cause of death is renal failure