Odontoma is a benign tumor of dental tissue elements that develops in the bones of the jaws. The symptoms of odontoma depend on the location of the tumor, its size and the severity of inflammatory phenomena in the surrounding tissues. Most often, odontoma develops painlessly and is characterized by slow growth. Such a tumor is detected by a dentist accidentally during radiography or during tooth extraction. In some cases, the odontoma grows into the bone tissue, and then an ulcer forms in the oral cavity, often accompanied by the formation of purulent fistulas. Radiological and histological methods of examination allow differentiating the tumor. Odont treatment is surgical.
Odontoma is an odontogenic formation that results from an anomaly in the development of dental tissues. Odontoma is translated from Greek as “a tumor consisting of teeth”. Already from this definition it becomes clear that this tumor is organ-specific and develops only in the jaw bones. Most often, an odontoma affects the bone in the premolars and molars, both on the upper and lower jaw. The maximum growth of the tumor is observed either at the age of 6 to 11 years, which is associated with the period of eruption of permanent teeth, or later – at the stage of eruption of the third molars. The tumor is most often detected at a young age (up to 20 years) with equal probability in persons of both sexes. Its growth stops with the end of the formation of the dental rudiment, therefore, in adults, the tumor is detected accidentally during X-ray examination or during the development of the inflammatory process in the tissues of the neoplasm. Odontoma accounts for about 22% of all odontogenic tumors and is one of the most common diseases of this group. Early diagnosis and treatment of odontoma helps to prevent the development of complications.
There are two theories of the origin of odontomas. Some dentists believe that an odontoma is a malformation of one or more rudiments of teeth that consist of epithelial or mesenchymal tissues, which is a mixed odontogenic tumor. Others believe that this type of tumor is exclusively a tissue abnormality of development, because epithelial and mesenchymal cells can also occur in healthy tissues. A major role in the development of odontomas is assigned to general factors – genetic predisposition, as well as local causes – the presence of infection in the tissues of the oral cavity, injuries.
The morphological basis of the tumor, according to different authors, varies; mainly there are Malasse cells, dental plate tissue, oral mucosa and all tooth tissues (normal and supercomplete teeth). During histological examination of the tumor, it is often possible to see parts of the tooth tissues: pulp, dentin, enamel, cement, arranged in a chaotic order. Sometimes there are layers of connective tissue between the tissues of the tooth. Also, an odontoma can be represented by a homogeneous tooth tissue. Thus, an important factor in the etiology of odontomas is the high odontoblastic activity responsible for the development of the rudiments of teeth.
On the basis of the histological structure in dentistry, there are soft odontomas, hard, simple, cystic and complex. The separation of odontomas by clinical and morphological features plays an important role in the diagnosis of tumors of the maxillofacial region. A soft odontoma is the initial stage of the development of a hard one. Histologically, the soft odontoma is made by epithelial growths and soft fibrous connective tissue in the form of strands. This type of neoplasm is most often found in young children at the stage of formation of the rudiments of teeth.
Solid odontomas are also observed most often at an early age. These neoplasms are calcified and are most often localized in the area of the branch or angle of the lower jaw or in the area of the central teeth of the upper jaw. The composition of this tumor may include different parts of the tooth: enamel, dentin, cement, periodontal, pulp. These tissues may be at different stages of development and calcification. The solid odontoma is covered with a dense capsule.
A simple solid odontoma includes parts of one germ, a complex odontoma is represented by a combination of different tooth tissues, and a cystic cyst is a follicular cyst in the cavity of which parts of the dental germ are located. There is also a classification according to histopathological signs of WHO (2005), while neoplasms are divided into composite and complex. Complex odontomas may include several parts of the tooth, and composite ones are filled with tooth-like formations.
The symptoms of odontoma differ depending on the type of tumor. Thus, the course of a mild odontoma clinically resembles ameloblastoma, but odontoma is observed more often at an early age. Tumor growth is slow, but it is limited, and its termination is associated with the end of the formation of teeth. Continuous growth occurs only in solid complex odontoma. As a result of the increase in the size of the tumor, the bone swells and increases, then the cortical plate is destroyed, and the neoplasm penetrates into the periosteum, and then into the soft tissues. With severe thinning of bone tissue, such a symptom as “parchment crunch” can be determined. The bulging tissue has a dark color and a mildly elastic structure, bleeding may appear on palpation. Over time, the tumor may ulcerate.
The clinic of solid odontoma depends on the localization of the tumor. The neoplasm is characterized by expansive growth, but remains painless. The first sign is the appearance of a tumor with an uneven, bumpy surface. Gradually, the odontoma damages the bone tissue, periosteum and mucous membrane. Often there is a decubital ulcer with a bottom from the tissues of the tooth. Such tumors can often become infected, which leads to the appearance of a focus of chronic inflammation in the soft tissues that surround the neoplasm. The development of infection in soft tissues proceeds with exacerbations, so fistulas often appear with the separation of pus. Regional lymphadenitis accompanies inflammatory phenomena in the odontoma area. Solid odontomas can shift and damage formed teeth and rudiments.
Diagnosis and treatment
To diagnose odontoma, first of all, data from a clinical examination of the patient is used. To clarify the diagnosis, an X-ray examination (orthopantomogram, CT of the jaw) is necessarily carried out, which reveals a limited homogeneous shadow. Histological examination is also used to exclude malignancy of the tumor. Differential diagnosis is performed with other tumors characteristic of this area of the maxillofacial system (for example, ameloblastoma), as well as with chronic osteomyelitis.
Treatment of these neoplasms is only surgical and is carried out in a hospital by maxillofacial surgeons. The tumor with the capsule is carefully removed, the bed is scraped out. The resulting cavity is gradually filled with bone matter. Non-radical surgical treatment may be the cause of recurrent odontomas. With large-sized odontomas, jaw resection is most often performed. In the event that there is no chronic inflammation, complete calcification of the odontoma has occurred, and there are no signs of functional disorders, then such a tumor is not removed. After the removal of the tumor, further rational prosthetics and patient monitoring are very important.
Early detection of tumors is one of the main tasks of modern dentistry and medicine in general. With timely assistance, the prognosis is favorable. Odontomas are benign tumors, but in about 4% of cases, malignancy is possible, most often mild odontomas. The basis of prevention is regular visits to a dentist, rehabilitation of foci of chronic infection, medical examination.
- Wanjari S. P., Tekade S. A., Parwani R. N., Managutti S. A. Dentigerous cyst associated with multiple complex composite odontomas // Contemp Clin Dent. — 2011. — № 3. — Р. 215–217.link
- Nagaraj K., Upadhyay M., Yadav S. Impacted maxillary central incisor, canine, and second molar with 2 supernumerary teeth and an odontoma // Am J Orthod Dentofacial Orthop. — 2009. — № 3. — Р. 390–399.link
- Sales M. A., Cavalcanti M. G. Complex odontoma associated with dentigerous cyst in maxillary sinus: case report and computed tomography features // Dentomaxillofac Radiol. — 2009. — № 1. — Р. 48–52.
- Aizenbud D., Front Y. P. An impacted malformed primary maxillary central incisor diagnosed as a compound odontoma // J Clin Pediatr Dent. — 2008. — № 2. — Р. 161–165.
- Ajike S. O., Adekeye E. O. Multiple odontomas in the facial bones. A case report // Int J Oral Maxillofac Surg. — 2010. — № 6. — Р. 443–444. link
- Bordini J. Jr., Contar C. M., Sarot J. R., Fernandes A., Machado M. A. Multiple compound odontomas in the jaw: case report and analysis of the literature // J Oral Maxillofac Surg. — 2008. — № 12. — Р. 2617–2620. link
- Arunkumar K. V., Kumar V., Garg N. Surgical management of an erupted complex odontoma occupying maxillary sinus // Ann Maxillofac Surg. — 2012. — № 1. — Р. 86–89.link