Adenomatoid odontogenic tumor (A.O.T.) < Ameloblastoma < Dentigerous Cyst
Why are we talking about this today? Well, its important to realize that dentists aren’t just ‘tooth carpenters’ these days (well, at least the good ones aren’t…). We are doctors not only of the mouth, but of the entire head and neck. That’s right! Believe it or not we are checking every time we see a panograph (an xray that wraps around your entire jaw) for calcified arteries to hopefully prevent you or a loved one from having a stroke, heart attack or death. Dealth would suck.
Anyway, not that the following causes death, but I wanted to grab your attention so that you would read about today’s topic: the Epidemiology (cause) and Effect of some rare but interesting things I have come across in the office lately…
1. Adenomatoid Odontogenic Tumor
Q: what is it?
Ans: a growth inside the jaw usually found (by a good dentist) early enough that it amounts to no more than a slight inconvenience. A radiolucency (dark spot) in the radiograph (xray) is located around a new tooth that is unerupted, or in a spot where an extra tooth may be forming. If we find one the patient must get it checked by an oral surgeon for treatment. 66% of them are in women & usually in young females.
I think I found one of these this week, but we won’t know for sure until the tumor is removed & analyzed by the histologist (the nerd dentist superhero who sits in a lab looking through the microscope to detect oral cancer and tumors for us).
Q: what is it?
Ans: a painless lumpy swelling that can reach enormous size. In third world countries these things can go undiagnosed & untreated for decades. Pain will only occur when the growth invades into other major parts of the body. 75% of these occur in the mandible (lower jaw). This lesion will actually push apart and reform the bony structures of the body.
Key point: Ameloblastoma is often associated with impacted 3rd molars (wisdom teeth)…
Now do you still think, “My impacted molars don’t hurt- I won’t bother getting them checked” Every case is unique, so best get checked regularily, because for most of us its not an issue, but there are a few 1 in a million cases to watch for…. Men and women are equally affected on this one, but the tumors are larger in females.
3. Dentigerous Cyst
Q: What is it?
Ans: Caused by a tooth formation gone awry, this lesion develops in the jaw an is a quiet fast moving growth. Because of the speed which these can develop, the result can be a fractured jaw. Do you want to have your jaw wired shut? I didn’t think so. I happened upon on of these rare occurrences in dental school, and lucky for my patient we caught it early! An oral surgeon had to remove the cyst because they will commonly reoccur if not excavated properly. Think of this one like a huge empty space in your jaw, so when it reaches the outer edge of your bone it can crack like an potato chip. These are often linked to missing teeth (the one I found was a lower right bicuspid (right behind the canine) that “Never came in Doc.” Luckily we investigated further to check the area. So, if you have a missing tooth, this is something you need to have checked regularily by your dentist… this guy was 47 and he never had any pain or any problems… he “Just wanted a cleaning.” In the end it was a minor surgical treatment (like having a tooth pulled) and he was back to work in no time.