Odontomas are hamartomas that most frequently occur in children and young people, with a higher incidence in the second decade of life. They are not, however, limited to this age group. Odontomas in themselves are rare tumors, with cases comprising only 0.1% of the general population, but make up a large proportion of odontogenic tumors [1]. In fact, they are the most common masses of odontogenic origin to occur in the oral cavity.

They consist of dental tissue that is both mesenchymal and epithelial in origin and may contain any of components of teeth, that is, pulp, dentin, enamel or cementum. It is unclear in the literature whether the tumors have a male or female predilection, however, some authors claim that odontomas have a marginal female preponderance [2].

Odontomas are usually small and asymptomatic, although generally, they can disrupt the eruption of neighboring teeth. Symptomatic odontomas typically present with displaced teeth, pain, swelling and a disruption of the bony architecture of the jaw [3]. The latter is especially common with odontomas that present as a large mass, prone to complications such as bone expansion and impaction [4] [5]. Patients may have other dental problems simultaneously.

Odontomas are often classified into two types: compound and complex. They can occur both in the maxilla or mandible, although the former is the more common location [2] [6]. Compound odontomas are small, organized structures that resemble a cluster of teeth [7]. They tend to occur in the anterior part of the maxilla. In contrast, complex odontomas are poorly differentiated structures that contain cementum, dentin, and enamel. These tend to develop in the posterior maxilla. Odontomas can occasionally occur in soft tissue (gums) [8].

There are a number of risk factors for the development of odontomas, and these include trauma, infections, inherited conditions like Gardner and Hermann's syndromes, genetic mutations, and the abnormal proliferation of a type of neural crest cells (odontoblasts) that are found in the pulp [6].

• Pain

  We report a case of a large erupting complex odontoma that caused pain, infection and facial asymmetry. This case is significant as there are few reports of complex odontoma erupting in the oral cavity. [cda-adc.ca]

  Neither the patient nor her parents could recall any history of pain or swelling in the area. She did not have a positive medical history of any hereditary disease. [ncbi.nlm.nih.gov]

  Sometimes clinical indicators of their presence may include bone expansion, pain and tooth displacement or unerupted normal teeth. Enucleation is curative and recurrence is not a problem. [srmjrds.in]

• Severe Pain

  His father, Suresh Gavai, told the Mumbai Mirror that his son began complaining of severe pain a month ago. [foxnews.com]

  The teeth were deep inside and an attempt to retrieve them caused severe pain and discomfort to the patient under local anesthesia. Therefore, the wound was closed with the help of collagen sheet supported with an acrylic palatal plate. [journals.lww.com]

• Diarrhea

  Dental injuries due to African traditional therapies for diarrhea. West J Med 2000; 173 : 135–137. 20. Baba S, Kay E J. The mythology of the killer decidous canine tooth in Southern Sudan. J Pedod 1989; 14 : 48–49. 21. [nature.com]

• Malocclusion

  Odontomas are familiar entities but their eruption into the oral cavity is an extraordinary occurrence, which may be associated with pain, infection, malocclusion, etc. Not many cases of erupted odontomas have been reported in the literature. [ncbi.nlm.nih.gov]

  Orthodontic treatment may be indicated to correct malocclusion [ 2 ]. [rroij.com]

  Routine post-operative clinical and radiographic analysis is essential to monitor the eruption of the teeth thereby aiding in the prevention of malocclusion. [omicsonline.org]

  The tumor commonly associated with malocclusion, eruption disturbances and pathological anomalies, but they seldom cause bony expansion. [scielo.sa.cr]

• Small Teeth

  Well-defined small teeth like structure were noticed distal to maxillary second molars bilaterally. [jdrr.org]

  The mandibles are long and straight, inserted in the middle of the front margin of the head, and generally have only 2 or 3 large teeth near the tips (Figs 1a, 3) (although they sometimes have small teeth along the inner margins which are much smaller [web.archive.org]

  Compound odontomas are regularly calcified tissue that bear similarity to teeth or appear as a collection of small teeth. [ncbi.nlm.nih.gov]

• Fracture

  A two-stage surgical treatment was chosen; first, removing most part of the lesion and preserving the second molar, decreasing the risk of a pathological mandibular fracture. A maxillo-mandibular fixation for a period of 4 weeks was used. [ncbi.nlm.nih.gov]

  Postoperative instructions were given to the patient and her parents and a soft diet was recommended in order to avoid complications, such as mandibular fracture. A control visit was performed one week after surgery. [sciencerepository.org]

  Contents Management of Salivary Gland Disorders 396 ranaffement of Temooromandibular loint Disorders 427 Orthognathic Surgery 464 Orofacial Clefts 493 Orofacial Neuropathy 515 Basic Principles in Management of Patients With Maxillofacial Injuries 545 Fractures [books.google.com]

• Decrease in Height

  Odontoma eruption in the oral cavity might also be explained by bone remodeling in an edentulous area: the bone decreases in height until the odontoma is exposed (13). [scielo.edu.uy]

• Agitation

  The patient had reported no anxiety or agitation, and the use of benzodiazepines produced slight amnesia. The surgical procedure, like almost all dental procedures, implies various risks and benefits. [sciencerepository.org]

There are two standard methods of diagnosis of odontomas, and these include radiographic imaging, as well as histological analysis of the sample tissue. Often, odontomas are discovered incidentally, during routine radiographs [2] [6].

Typical radiographic features are dependent on the type and stage of a particular tumor. Initially, tumors may be radiolucent, with the inclusion of small calcifications. They progress to being entirely radiodense, with a persisting radiolucent rim. Compound odontomas may show denticles, which appear in different shapes and sizes and resemble teeth, within a well-demarcated, septate, radiolucent mass [9].

Complex odontomas have no recognizable structures and are a mixture of dense material within a lucent margin [3] [10]. Dentigerous cysts may also be visualized, although their occurrence is rare.

Treatment of Odontoma: Surgical Removal of the Odontoma is the only treatment advised. No Recurrence is seen after surgical removal. [juniordentist.com]

The treatment of choice for odontoma could be surgical removal of the lesion with preservation of the underlying succedaneous tooth bud. [omicsonline.org]

Early treatment allows the impacted tooth to re-start the physiological eruption. A conservative surgical approach is advisable in order to minimise damage to the impacted teeth and preserve their normal timing and path of eruption. [ncbi.nlm.nih.gov]

Although similar in age range and clinical location to the odontoma, the neoplastic tumor has a clinically aggressive growth.3-4 Treatment: Except for rare, large, complex lesions like this case, odontomas do not require treatment unless they block tooth [dentalcare.com]

The analysis of the described cases showed that early diagnosis and early removal of the odontoma are essential in improving the prognosis of the involved teeth. Early treatment allows the impacted tooth to re-start the physiological eruption. [ncbi.nlm.nih.gov]

Treatment for Odontoma Odontomas are treated by simple local excision and their prognosis is excellent. They don’t recur and are not invasive. [annaiarulhospital.com]

Etiology of Odontoma: The basic Etiology of Odontoma is Unknown. Although not confirmed local trauma or infection during the developmental stages has been associated with Odontomas. [juniordentist.com]

The etiology of odontoma is unknown, although several theories have been proposed. This article describes a case of a large infected complex odontoma in the residual mandibular ridge, resulting in considerable mandibular expansion. [ncbi.nlm.nih.gov]

The etiology of odontoma is unknown and almost asymptomatic. So, it usually is found in routine radiographic examination, and most common presenting symptom is impacted or unerupted permanent teeth and retained primary teeth. [journal.kapd.org]

[…] of ameloblastic fibro-odontomas as developing odontomas rather than a distinct tumor (IARC: WHO Classification of Head and Neck Tumours, 4th Edition, 2017) Terminology Compound odontoma Complex odontoma Ameloblastic fibro-odontoma Peripheral odontoma Epidemiology [pathologyoutlines.com]

Meta-analysis of the epidemiology and clinical manifestations of odontomas. Med Oral Patol Oral Cir Bucal 2008;13(11):E730–E734. 6. Perumal CJ, Mohamed A, Singh A, et al. [ijcpd.com]

Metaanalysis of the epidemiology and clinical manifestations of odontomas. Med Oral Patol Oral Cir Bucal. 2008; 13 (11): 730-734. [ Links ] 9. Iatrou I, Vardas E, Theologie-Lygidakis N, Leventis M. [scielo.org.mx]

A clinical–histological and retrospective epidemiological study of 46 cases. Med Oral, 5 (2000), pp. 367-372 [15] M. Hisatomi, J. Asaumi, H. Konouchi, Y. Honda, T. Wakasa, K. Kishi. [elsevier.pt]

Metaanalysis of the epidemiology and clinical manifestations of odontomas. Med Oral Patol Oral Cir Bucal., 13 (2008), pp. 730-734 [9] I. Iatrou, E. Vardas, N. Theologie-Lygidakis, M. Leventis. [elsevier.es]

[…] common odontogenic tumor Usually diagnosed during the first two decades of life No sex predilection Sites Can occur in any tooth bearing area Compound odontoma usually occurs in anterior maxilla Complex odontoma usually occurs in posterior mandible Pathophysiology [pathologyoutlines.com]

Madhuri Vegesna *, Chandrasekhar R and Vinay C Department of Pedodontics and Preventive dentistry, Vishnu Dental College, Bhimavaram, AP, India *Corresponding Author: Madhuri V Department of Pedodontics and Preventive Dentistry Vishnu Dental College, [omicsonline.org]

Odontoma has a limited growth potential; it should be removed completely to prevent relapse. [12] Sreedharan et al. suggested that to prevent impaction of permanent adjacent to the odontomas, it should be removed when the permanent teeth exhibit one half [srmjrds.in]

1–3Department of Pedodontics and Preventive Dentistry, HP Government Dental College and Hospital, Shimla, Himachal Pradesh, India Corresponding Author: Thakur Seema, Department of Pedodontics and Preventive Dentistry, HP Government Dental College and [ijcpd.com]

Early diagnosis plays an important role in preventing craniofacial and tooth developmental problems. [ijds.in]

The purpose of this study is to report the case of a complex odontoma in a child impacting a permanent molar and preventing its eruption. [ncbi.nlm.nih.gov]

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