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Radiolucent Lesions, Burkhart, N.W., & DeLong, L. (2019). General and…
Radiolucent Lesions
Developmental Cysts
Lateral Periodontal Cyst (Botryoid Odontogenic Cyst)
- Etiology: Odontogenic, nonkeratinized developmental cysts, believed to develop from the dental lamina remnants from within bone. They are most often uniocular, radioucent, and lateral to the root of a vital mandibular cuspid or premolar tooth.
- Method of Transmission: Not applicable.
- Characteristics:
1) Extraoral: Not applicable
2) Perioral and Intraoral: Asymptomatic and not usually noticed until seen on a radiograph. Uniocular, round or oval, and is well delineated.
3) Distinguishing: Teeth is vital. Grape-like appearance.
- Dental Implications: It is necessary to rule out an inflammatory-type lesion or a more serious type of cyst.
- Treatment and Prognosis: Surgical excision and pathologic review are treatments of choice.
Pgs. 472-473
Gingival Cyst of the Adult
- Etiology: Uncommon soft tissue counterpart to the lateral periodontal cyst. Developmental cyst.
- Method of Transmission: None
- Characteristics: Firm, flesh-colored nodule that is painless, is nonmobile, and usually measures 1 to 3 mm in diameter, although some may be larger.
- Dental Implications: Definitive diagnosis is needed.
- Treatment and Prognosis: Surgical excision and histopathlogic examination.
Pgs. 473-474
Dentigerous Cyst
- Etiology: Odontogenic in development. Arise from a cystic change in the dental follicle following crown formation.
- Method of Transmission: Not applicable
- Characteristics:
1) Extraoral: Not applicable
2) Perioral and Intraoral: Usually only evident on radiographs, with no symptoms of pain or discomfort reported. Well circumscribed, uniocular, and sometimes multiocular.
3) Distinguishing: Well circumscribed, unicular.
- Dental Implications: Delayed tooth eruption is a common theme. Becomes quite large and has the potential to displace teeth and resorb roots.
- Treatment and Prognosis: Complete removal of the cyst is indicated.
Pgs. 474-475
Eruption cyst
- Etiology: Considered a variant of dentigerous cyst and is caused by the accumulation of fluid or blood between the crown and the erupting tooth due to trauma.
- Method of Transmission: Not applicable
- Characteristics:
1) Extraoral: Not applicable
2) Perioral and Intraoral: The tissue of the erupting cyst may have a darker appearance and appear elevated. Smooth bluish swelling (dome-like) on the crest of the alveolar bone.
3) Distinguishing: Bluish cast due to the inflammatory inner core and blood accumulation.
- Dental Implications: Failure of the tooth to erupt.
- Treatment and Prognosis: No treatment necessary.
Pgs. 475-476
Gingival Cyst of the Newborn (Bohn Nodules, Epstein Pearls, or Dental Lamina Cysts of the Newborn)
- Etiology: Occurs on the ridges of the oral tissues in the newborn. Palatal fusion.
- Method of Transmission: None
- Characteristics: Multiple, small cysts found in the junction of the hard and soft palate.
- Dental Implications: Differentiation is needed between this and early natal and neonatal eruption of primary teeth.
- Treatment and Prognosis: None
Pg. 476
Odontogenic Keratocyst (Also Known as Keratocystic Odontogenic Tumor [KCOT])
- Etiology: Develops from the dental lamina or its remnants.
- Method of Transmission: Not applicable
- Characteristics:
1) Extraoral: Not applicable
2) Perioral and Intraoral: Often in posterior mandibular region.Multi/uniocular and well circumscribed.
3) Distinguishing: Very aggressive features
- Dental Implications: Microscopic interpretations needed.
- Treatment and Prognosis: Careful removal of entire cyst is needed.
Pgs. 476-477
Nevoid Basal Cell Carcinoma Syndrome (Gorlin-Goltz Syndrome)
- Etiology" Prime concern for those with OKC. Inherited autosomal dominant disorder with male prevalence (3:1).
-Method of Transmission: None
- Characteristics: 5 main components - basal cell carcinoma, jae cysts, congenital skeletal anomalies, calcifications, and palmar and plantar pits. Wide nasal bridge.
- Dental Implications: None
- Treatment and Prognosis: None
Pgs. 477-478
-
Calcifying Odontogenic Cyst: COC (Gorlin Cyst)
- Etiology: Derived from reduced enamel epithelium of odontogenic epithelium.
- Method of Transmission: Not applicable.
- Characteristics:
1) Extraoral: Not applicable
2) Perioral and Intraoral: May be found as masses within the oral tissues, almost always within the gingiva. Resemble gingival cyst or a peripheral giant cell granuloma. Swelling.
3) Distinguishing: "ghost cells" when specimen is viewed microscopically.
- Dental Implications: Definitive diagnosis is important to rule out more aggressive lesions, and complete removal is necessary.
- Treatment and Prongosis: Surgical excision. Prognosis is good.
Pg. 479
Globulomaxillary Cyst
- Etiology: Fissural cyst that arose from the epithelium that was thought to be trapped when the globular portion of the median nasal process fused with the maxillary process.
- Method of Transmission: Not applicable
- Characteristics:
1) Extraoral: Do not occur unless the lesion is extremely large
2) Perioral and Intraoral: Inverted pear-shaped lesion because of the location, causing divergence of the tooth roots.
3) Distinguishing: The location and the pear-shaped configuration of the globulomaxillary cyst give it a classic type of presentation. However, a biopsy is needed to determine the cyst type.
- Dental Implications: The vitality of the teeth involved, such as the lateral and cuspid, must be evaluated.
- Treatment and Prognosis: Surgical removal. Prognosis is good.
- Pgs. 479-480
Glandular Odontogenic Cyst (Originally Called Sialoodontogenic Cyst)
- Etiology: Derived from odontogenic origins.
- Method of Transmission: Not applicable
- Characteristics:
1) Extraoral: Some clinical swelling/expansion has been noted as the common complaint.
2) Perioral and Intraoral: Both swelling and expansion may be noted. Some cases are asymptomatic.
3) Distinguishing: Those that differentiate from GOC from other cyst structures.
- Dental Implications: Follow-up is important since the recurrence rate is very high.
- Treatment and Prognosis: Most cases are treated conservatively with enucleation, curettage, cystectomy, and excision.
Pgs. 480-481
Nasopalatine Duct Cyst (Incisive Canal Cyst, Nasopalatine Duct Cyst)
- Etiology: Developmental cyst.
- Method of Transmission: Not applicable.
- Characteristics:
1) Extraoral: Size and extent of the cyst determine any characteristics such as swelling and elevation of the external surfaces around the nose and lip areas.
3) Distinguishing: When drainage occurs with the nasopalatine cyst, the patient may complain of a foul, salty taste. The patient may experience pain, discomfort, and burning.
- Dental Implications: The cyst is not radiographically diagnostic and must be removed and biopsied for definitive microscopic evaluation.
- Treatment and Prognosis: Complete surgical removal is needed. The prognosis is good.
Pg. 481
Median Palatine Cyst
- Etiology: Rare fissural cyst; entrapped epithelium along the embryonic line of fusion.
- Method of Transmission: none
- Characteristics: More apically centered toward the midline of the hard palate. Lined with stratified squamous epiuthelium and is surrounded by dense connective tissue.
- Dental Implications: Definitive diagnosis is needed.
- Treatment and Prognosis: May cause pain if nerves are involved.
Pg. 482
Static Bone Cyst (Stafne Bone Defect, Static Defect, Lingual Mandibular Bone Concavity)
- Etiology: Not a true cyst. Defect in the mandible that surrounds salivary gland tissue.
- Method of Transmission: Not applicable
- Characteristics:
1) Extraoral: Not applicable
2) Perioral and Intraoral: Asymptomatic and is usually discovered when a Panorex film is taken.
3) Distinguishing: The static bone cyst is usually found at the angle of the mandible.
- Dental Implications: Usually diagnosed clinically. When location is superior to the canal, a biopsy is needed.
- Treatment and Prognosis: Noted and followed long term.
Pg. 483
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Neoplasms
Adenomatoid Odontogenic Tumor
- Etiology: Now classified as an enapsulated benign epithelial odontogenic tumor.
- Method of Transmission: Not applicable
- Characteristics:
1) Extraoral: Swelling in the facial area is sometimes reported, causing flaring of the nasolabial fold and extending beyond the facial contour.
2) Perioral and Intraoral: Root displacement and a bony hard expansion with an eggshell cracking appearance over the protrusion.
3) Distinguishing: The glandular or duct-like structures of columnar epithelial cells and consist of polyhedral spindle cells organized in sheets and lobules.
- Dental Implications: Facial asymmetry is one of the first signs to be noticed by the patient as the tumor increases in size.
- Treatment and Prognosis: Complete removal of the tumor is necessary, and the prognosis is excellent without any recurrence.
Pgs. 483-485
Odontogenic Myxoma
- Etiology: Derived from odontogenic ectomesenchyme.
- Method of Transmission: Not applicable
- Characteristics:
1) Extraoral: Depending upon the size of the myxoma, swelling may occur in isolated areas.
2) Perioral and Intraoral: Uniocular or multiocular, and the radiolucencies are scalloped. "step ladder" or "honey-combed."
3) Distinguishing: Not applicable
- Dental Implications: Enlarged dental follicles or the dental papilla of a developing tooth may be mistaken for the myxomas upon microscopic examination.
- Treatment and Prognosis: Removed surgically, usually with a wide margin of normal bone.
Pg.485
Ameloblastic Fibroma
- Etiology: Mixed odontogenic tumor that is believed to originate from odontogenic extomesenchyme and epithelium.
- Method of Transmission: Not applicable
- Characteristics:
1) Extraoral: Depending upon the expansion, some external swelling may be present.
2) Perioral and Intraoral: Usually experiences no pain with any swelling that may occur.
3) Distinguishing: The histology of the ameloblastic fibroma is unusual and highly diagnostic.
- Dental Implications: Generally, the ameloblastic fibroma is asymptomatic.
Pgs. 485-486
Langerhans Cell Disease: Langerhans Cell Histiocytosis (Formerly Called Histiocytosis X)
- Etiology: Unknown.
- Method of Transmission: Not applicable
- Characteristics:
1) Extraoral: Poor healing is common. Resemble a "punched-out" appearance.
2) Perioral and Intraoral: One or more multiple bones in the body, including the bones around the teeth, contributing to loosening. Tenderness, pain, and swelling are common complaints.
3) Distinguishing: A key characteristic of Langerhans cell disease is premature loosening and exfoliation of teeth in children.
- Dental Implications: Lesions that occur periapically can be confused with periapical cyst or granulomas. Tooth vitality would still be present.
- Treatment and Prognosis: Depends upon the involvement of the disease and the age of the patient. Surgical treatment.
Pgs. 486-488
Infections
Osteomyelitits: Acute and Chronic Forms
- Etiology: Inflammation in bone. Male prevalence and the mandible is affected most often.
- Method of Transmission: Several infectious organisms involved in the disease process.
- Characteristics:
1) Extraoral: Lymphadenopathy, fever, and pain are often symptoms of osteomyelitis and are especially noted in the acute form.
2) Perioral and Intraoral: Bone destruction depending on being acute or chronic.
3) Distinguishing: Radiographic appearance.
- Dental Implications: Pain and lymphadenopathy. Addressing the cause is paramount. Correct antibiotic to treat the infection.
- Treatment and Prognosis: Drainage and antibiotics are needed to treat the acute form. The chronic form is more difficult to manage because of necrosis. Surgery is indicated.
Pg. 471
Burkhart, N.W., & DeLong, L. (2019). General and Oral Pathology for the Dental Hygienist (3rd). Philadelphia: Wolters Kluver. pp. 462-488