Amanda Stout

Brenda Garcia
Suki Misra
October 21, 2018
Oral Pathology Case Study #3

Our oral pathology case study dealt with a 22 year old male patient who came
into the dental office and during a routine examination. He presented with a
slight bony swelling that was located near the mandibular first molar. Radiographs
were performed and it showed a large, round radiopacity. It is well defined and
surrounded by a radiolucent rim and it is showing to obliterate the distal root of
the mandibular 1st molar. When taking vitals and performing an extra oral exam
of the head and neck, there were no palpable lymph nodes, no pain or tenderness
and the patient seemed to be in generally good health. Our patient received
routine checkups as well as some restorative treatment. We had a multitude of
choices to pick through in order to assist us in coming up with our diagnoses for
this patient. They were as follows: complex odontoma, periapical cemental
dysplasia, osteoblastoma, cementoblastoma, and focal sclerosing osteomyelitis.
Here is a summary of those particular pathologies for each one and our reasoning
behind why or why not they are suitable and match our patient’s particular
diagnoses.

Complex Odontoma consists of a mast of enamel and dentin, cementum and pulp
that does not resemble a normal tooth. Most odontomas are detected in
adolescents and young adults. (This made us believe okay, maybe because our
patient is 22 he would fall into this category.) Upon further reading we discovered
that the compound odontoma is usually located in the maxillary anterior and the
complex occurs in the posterior mandible. (which also relates to the patient) but
then the information said that the most common clinical manifestation of this is
the failure of a permanent tooth to erupt and that radiographically it appears as a
cluster of numerous miniature teeth surrounded by a radiolucent halo. This
excerpt of information was what persuaded us to pick another choice.

Periapical cemental dysplasia is asymptomatic and usually discovered during a

routine radiographic examination.(So this bit of info related to our patient so we
thought maybe it could be this one.) Further reading again indicated It occurs
commonly in the anterior mandible of patients older than 30 years old. Which
doesn’t describe the characteristics of our patient who is only 22 years old. Early
lesions are well circumscribed and radiolucent and may mimic periapical
inflammatory disease. The bone at the apical area of many teeth may be involved.
Amanda Stout
Brenda Garcia
Suki Misra
October 21, 2018
Oral Pathology Case Study #3

Well this definitely doesn’t fit the symptoms of our patient because it only deals
with his mandibular 1st molar and not numerous teeth so we decided on yet
another choice.

Osteoblastoma is an uncommon osteoid tissue forming primary neoplasm of the

bone. It has clinically and histologic manifestations similar to those of osteoid
osteoma. Osteoblastoma is categorized as a benign bone tumor, it is a bone
forming lesion that may be found within the cortex, medullary canal or periosteal
tissues. Usually occurs between ages of 10-25 so our patient could possibly still
fall into that category. Once again upon further reading it states that patients
usually will experience pain and swelling as well as tenderness, well our patient’s
symptoms stated none of those so we disregarded this one as well as a plausible
choice.

Cementoblastoma is also a rare benign periapical lesion, it represents less than

1% of all odontogenic tumors. Cementoblastomas appear as a periapical,
sclerotic, sharply marginated lesion with a low- attenuation halo and directly fuse
to the root of the tooth. This usually occurs in people under the age of 25. The
most common site of this tumor is the mandibular molar area with 50% of cases
occurring on the mandibular 1st molar. These symptoms seem to match our
patients thus far, but its rare. So the chances of cementoblastoma being the
culprit is rather rare as well. This tumor presents with no pain and is usually
asymptomatic. What made us believe that this couldn’t be our patients diagnoses
is that the radiographic appearance of this is well defined radiopaque mass with a
radiolucent peripheral line which overlies and obliterates the tooth root. It is
described as having a rounded of sunburst appearance. There is also usually
apparent external resorption of the root where the tumor and the root join. This
doesn’t match our patients symptoms, so this is not the correct choice.

Focal sclerosing osteomyelitis is also called condensing osteitis, is a change in

bone near the apices of teeth that may be a reaction to low grade infection. The
tooth most commonly associated with this is mandibular 1st molar which matches
our patient’s inflicted tooth. Radiographically this appears as a radiopaque area in
the periapical area of teeth. The borders may be diffused or well defined. (our
Amanda Stout
Brenda Garcia
Suki Misra
October 21, 2018
Oral Pathology Case Study #3

patients is well defined) in some cases a central radiolucency surrounded by the

radiopacity is seen, similar to the halo that appears around our patients
radiographic image. This is sometimes associated with a carious or restored tooth
and our patient in his medical history did state that he had numerous restorative
work done. This can be present at any age but it is usually seen first on young
adults, and our patient matches that description because he is only 22 years old.
Treatment of this disease is not necessary, the sclerotic bone remains even after
treatment of the involved teeth, on occasion such as our patient a biopsy was
taken to help eliminate certain pathology that it could be. We believe based on
the description of this condition in comparison to our patients that this would be
the most likely answer.

We attempted to pick the best possible answer, hopefully this paper allows you to
see our thought process and reason of deduction.