Odontogenic tumors - Classified and Treatment

Creator: Dr. Gayathri P
Published: 2022-04-29T17:52:14

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Abnormal growth on the jaw bone always provides a serious concern. Read below to know more about odontogenic tumors.

Written by

Dr. Gayathri P

Medically reviewed by

Dr. Sneha Kannan

April 29, 2022

May 2, 2023

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Contents

What Are Odontogenic Tumors?
How Is It Classified?
What Are the Clinical Features?
What Are the Radiological Findings?
What Are Malignant Odontogenic Tumors?
How Are Odontogenic Tumors Treated?

Introduction:

Have you ever wondered where our teeth come from? The answer is, the tooth structure and its apparatus usually arise through the interaction between ectoderm (give rise to tooth enamel) and ectomesenchyme (produces structures other than enamel) tissues. This article reviews the various tumors arising from the tissues that form teeth and their structures.

What Are Odontogenic Tumors?

The odontogenic tumor is an abnormal mass developed from the ectoderm or ectomesenchyme that gives rise to the teeth and surrounding structures. However, the exact cause of the odontogenic tumors is still a mystery. They are mostly benign (non-cancerous) and rarely spread to surrounding tissues (malignant).

How Is It Classified?

The recent classification of the benign odontogenic tumors by the World Health Organization (WHO) is listed below:

What Are the Clinical Features?

What Are the Radiological Findings?

It is essential to understand specific terms before getting into their radiographic features.

Unilocular: Single cavity or compartment.
Multilocular: It consists of many cavities.
Radiolucent: Areas that appear dark in the X-rays.
Radiopaque: Refers to areas that appear dense (resist the passage of light) in X-rays.

Ameloblastoma - The tumor presents as multilocular, and one of its types known as unicystic ameloblastoma shows a radiolucent margin covering the crown portion of an unerupted tooth.

Squamous Odontogenic Tumor - A triangular-shaped radiolucency is visualized between the teeth and is unilocular.

Adenomatoid Odontogenic Tumor - It presents as small radiopaque areas within the single radiolucent mass.

Calcifying Epithelial Odontogenic Tumor - Calcified areas are observed within the radiolucent mass. It varies from radiolucent to radiopaque areas around the unerupted tooth.

Ameloblastic Fibroma - The radiolucent areas are visualized around the misplaced teeth.

Odontomas - It is often diagnosed incidentally and shows calcified tooth-like structures surrounded by a radiolucent margin.

Cementoblastoma - The margins of the tumor appear as a radiolucent rim covering a mass around the tooth root.

What Are Malignant Odontogenic Tumors?

The benign odontogenic tumor rarely spreads to surrounding tissues. The characteristic features include pain, rapid growth, and loss of sensation.

Few of the malignant odontogenic tumors are listed down:

Ameloblastic Carcinoma - Individuals over 45 years of age are usually affected, and on examination, abnormal voice, pain, swelling, and difficulty in jaw motions are observed.

Sclerosing Odontogenic Carcinoma - It rarely occurs and is usually present in the molar region of the lower jaw and destroys the surrounding bone.

Odontogenic Sarcoma - The incidence is high in adults over 30 years of age. An expanding growth that causes pain and altered sensation in the lower jaw is usually reported.

How Are Odontogenic Tumors Treated?

The odontogenic tumors are diagnosed with various imaging techniques like X-rays, computed tomography (CT), or magnetic resonance imaging (MRI) and through biopsy (a sample of tissue is surgically removed for examination). Then, the treatments are planned accordingly depending on the clinical and radiographic features.

Enucleation: The whole tumor is surgically removed, leaving behind the surrounding tissues intact. It is done for benign tumors, and the recurrence is relatively high.
Wide Excision: The tumor is surgically removed and the surrounding tissues to reduce its recurrence rate.
Radiotherapy: High-frequency radiation is targeted on the tumor site to reduce its size and control its progression.
Chemotherapy: Certain drugs are used to destroy the tumor cells. It is usually followed after surgical excision.

Conclusion:

The occurrence of odontogenic tumors are few and far between. The prognosis depends on the type of tumor and the treatment provided. Generally, the recurrence is low in benign tumors after complete excision. It is advisable to consult a dental surgeon for any abnormal swelling and pain in your jaw to diagnose the condition and differentiate it from tumors.

Frequently Asked Questions

1. What Is the Treatment for Odontogenic Tumors?

Odontogenic tumors are usually treated with surgery. The benign (non-cancerous) tumors are entirely removed with the help of surgery. Other than that, some other methods may also be used to treat the tumors, which include radiation therapy and chemotherapy.

2. Which Is the Most Common Odontogenic Tumor?

Odontoma is considered one of the most common odontogenic tumors. These tumors usually do not have any symptoms and may interfere with the development of the tooth or the eruption. Odontomas usually looks like oddly shaped tooth that can be small or large and is made of dental tissues.

3. What Is the Origin of Odontogenic Tumors?

The odontogenic tumors can originate from any of the following tissues, which include
- Remnants of the dental lamina.
- Enamel organ.
- Odontogenic cyst lining.
- Oral mucosa basal cells.
They can present as abnormal growth in and around the jaw or teeth and can either be multicystic or unicystic.

4. What Are the Different Odontogenic Tumors?

There are various odontogenic tumors of the jaw which include -
- Ameloblastoma.
- Calcifying epithelial odontogenic tumor.
- Squamous odontogenic tumor.
- Adenomatoid odontogenic tumor.

5. Can Oral Tumors Be Removed?

Oral tumors can be removed easily through surgery if the tumor has not spread beyond the mouth or other parts of the throat or mouth (oropharynx). In case the tumor is large or spread to other parts of the neck, a combination of surgery, radiotherapy, and chemotherapy may be done to remove the tumor.

6. Who Removes Tumors From the Mouth?

An oral surgeon can remove the tumors from the mouth. The surgeons will perform a wide resection to treat oral cancer by surgically removing the tumor along the margin of healthy tissue. In the case of large tumors, a plastic surgeon may also be needed to repair the affected area by using reconstructing techniques.

7. What Is the Most Common Odontogenic Cyst?

Periapical cysts are considered the most common type of odontogenic cysts. These are inflammatory cysts and comprise about 60 % of odontogenic cyst cases. They usually develop at the root apex of a non-vital tooth due to inflammation caused by dental caries or trauma.

8. Is Oral Tumor Removal Surgery Dangerous?

There are always some risk factors linked with all surgical procedures, which can be minor to major complications. However, it is rare to have such complications, but there is always some chance. But with the advancement in equipment and diagnostic methods, the risk of complications is very low.

9. Are Oral Tumors Cancerous or Non-cancerous?

Oral tumors are composed of cancerous (malignant) and non-cancerous (benign) tumors. These non-cancerous tumors, without any treatment, with time, may start spreading to other areas of the neck and head or other parts of the body. Where they can accumulate and starts growing and become cancerous. These most commonly start as thin or flat cells that line the lips and inside of the mouth.

10. What Type of Tumors Cannot Be Surgically Removed?

The tumors that are large are difficult to remove surgically. Therefore, surgery can remove some but not all cancer tumors. A method called debulking is done in case removing an entire tumor at once can damage the body or organ. Surgery is mostly done in cases where tumors cause pain or pressure on other body parts, and in severe cases, combination therapy with chemotherapy and radiotherapy, along with surgery is used to treat cancerous tumors.

11. How Are Odontogenic Tumors Diagnosed?

Odontogenic tumors or cysts can be diagnosed on a routine examination during a dental visit. These can be easily identified in a radiograph or other imaging tests such as MRI (magnetic resonance imaging) or CT (computed tomography). In the radiographs, the tumors are present as unilocular or multilocular radiolucent lesions with distinct borders. But in the radiographs, it is not possible to differentiate the type of tumor for that biopsy or other imaging tests may be prescribed.

12. Are Odontogenic Tumors Malignant or Benign?

Odontogenic tumors may be benign (non-cancerous) or malignant (cancerous). The tumors that are derived from epithelial and mesenchymal remnants of the tooth germ are classified into malignant and benign tumors. Malignant odontogenic tumors are challenging to study due to their complexity and rarity, such as metastasizing (malignant) ameloblastoma, clear cell odontogenic carcinoma, ghost cell odontogenic carcinoma, odontogenic sarcomas, and ameloblastic fibrosarcoma.

13. How to Differentiate Between Tumor and Cyst?

Tumors and cysts are different types of growths. They do look similar but have very distinctive characteristics such as treatment, causes, and risk factors. The tumor is composed of abnormal cells, while the cyst is a cavity filled with fluid, air, or other substance. The best way to tell apart both these growths is through biopsy, which involves removing a sample of affected tissue and studying it under a microscope.

Sources

Dr. Gayathri P

Dentistry

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