Odontogenic and Developmental Oral Lesions in Pediatric Patients

Abstract

This article reviews odontogenic and developmental oral lesions encountered in the gnathic region of pediatric patients. The process of odontogenesis is discussed as it is essential to understanding the pathogenesis of odontogenic tumors. The clinical presentation, microscopic features, and prognosis are addressed for odontogenic lesions in the neonate (dental lamina cysts/gingival cysts of the newborn, congenital (granular cell) epulis of the newborn, melanotic neuroectodermal tumor, choristoma/heterotopia, cysts of foregut origin), lesions associated with unerupted/erupting teeth (hyperplastic dental follicle, eruption cyst, dentigerous cyst, odontogenic keratocyst/keratocystic odonogenic tumor, buccal bifurcation cyst/inflammatory collateral cyst) and pediatric odontogenic hamartomas and tumors (odontoma, ameloblastic fibroma, ameloblastoma, adenomatoid odontogenic tumor, primordial odontogenic tumor). Pediatric odontogenic and developmental oral lesions range from common to rare, but familiarity with these entities is essential due to the varying management implications of these diagnoses.

Keywords: Ameloblastic fibroma; Gnathic; Hamartoma; Neural crest; Odontogenesis; Odontogenic cyst; Odontogenic tumor; Odontoma; Pediatric; Primordial odontogenic tumor.

Fig. 1

Histological images of the stages of tooth development, starting with the primary epithelial band (a), the early dental lamina (b), Bud stage of tooth development with associated condensation of ectomesenchyme (c) and Bell-stage of tooth development, demonstrating the inner enamel epithelium and dental papilla, prior to the commencement of hard tissue formation (d)

Fig. 2

The varied appearance of epithelial remnants of the tooth forming apparatus, which may be found throughout the soft tissues of the mandibular or maxillary alveolus as Dental Lamina Rests (DLRs) or cell rests of Mallasez in the periodontal ligament

Fig. 3

(a) Clinical appearance of dental lamina cysts in a neonate, evident on the side of the maxillary alveolus. (b) Histological features of dental lamina cysts demonstrating a thin epithelial lining, a lumen filled with keratin and a communication with the surface. (c) Gross image of a congenital (granular cell) epulis demonstrating a tan-white, fleshy homogeneous cut tissue surface. (d) Histologic appearance of sheets of a congenital (granular cell) epulis demonstrating submucosal polygonal cells with a granular, eosinophilic cytoplasm

Fig. 4

(a) Histologic appearance of a melanotic neuroectodermal tumor of infancy, tumor islands with peripheral epitheloid cells containing melanin and smaller neurogenic cells exhibit “salt and pepper” chromatin are seen. (b) Cyst of foregut origin of the tongue that demonstrated squamous, respiratory, and gastric epithelial lining (pictured)

Fig. 5

(a) A hyperplastic dental follicle demonstrating a thin epithelial lining with luminal columnar cells and low cuboidal basilar cells. (b) Eruption cyst presenting as a mucosal colored domed shaped swelling over the erupting central incisor. (c) Histologically, the eruption cyst lining is thin and bilayed resembling follicular lining

Fig. 6

(a) An inflamed dentigerous cyst exhibiting a nonkeratinized stratified squamous epithelial lining. (b) Periapical radiograph depicting a buccal bifurcation cyst as a well-defined radiolucency involving the furcation of the tooth extending beyond the apices. (c) Histologically, an inflamed buccal bifurcation cyst demonstrates non-specific features that overlap with a periapical or radicular cyst, illustrating the need for clinical correlation for an accurate diagnosis

Fig. 7

Histologic image of an odontogenic keratocyst/keratocystic odontogenic tumor demonstrating classic features of a uniform epithelial thickness, hyperchromatic basal cell layer, and wavy surface parakeratin transitioning to prominent basilar budding

Fig. 8

(a) Cropped panoramic radiograph of a compound odontoma demonstrating numerous small tooth-like structures surrounded by a thin radiolucent rim. (b) Gross examination of a compound odontoma reveals multiple small malformed tooth-like structures. (c) Compound odontoma histologically demonstrates tooth form appearance, most of the enamel has been lost during decalcification. (d) Complex odontoma demonstrates aberrant arrangement of dentin, enamel, and soft tissue

Fig. 9

(a) Clinical appearance of ameloblastic fibroma in the posterior maxilla demonstrating expansion. (b) Ameloblastic fibroma exhibiting cellular myxoid ectomesenchymal stroma containing scattered ameloblastic islands with central stellate reticulum

Fig. 10

Panoramic radiograph of an ameloblastoma (histologically conventional, solid/multicystic type) in a 7-year-old male patient. There is a well define, largely corticated unilocular radiolucency with displacement of the bicuspid crowns and resorption of the roots of the primary molar teeth

Fig. 11

Adenomatoid odontogenic tumor histology demonstrating duct-like structures, whorls, amyloid, and calcifications

Fig. 12

Primordial odontogenic tumor (a) Cropped panoramic radiograph demonstrating a well-defined expansile radiolucency in the third molar area (b) Loose, myxoid connective tissue reminiscent of dental papilla surfaced by cuboidal to columnar epithelium