Sunday, August 21, 2022

Dry Socket: More Painful Than The Tooth Extraction

 

Dry Socket: More Painful Than The Tooth Extraction


Having a tooth pulled may be one of the most anxiety-inducing dental visits you will ever experience. But having the tooth pulled comes with an anesthetic of some sort, so you may feel nothing more than the prick of a needle (not pleasant, but tolerable). The true pain from having a tooth pulled comes from developing a dry socket (alveolar osteitis). The pain of alveolar osteitis can be unbearable, but it is almost always avoidable.


What Is Dry Socket?

The socket is the hole in the mouth left from the extraction of the tooth. It is typically protected by a clot that prevents the nerve from exposure to air and elements. According to the Mayo Clinic, dry socket occurs when the clot is dislodged before the extraction site has had a chance to heal. Once the clot is gone, the nerve is exposed to everything from the air you breathe to the food you eat, which can be extremely painful.


How Do I Treat It?

Over-the-counter medications like aspirin or ibuprofen can help relieve the pain, but it can become so severe that you may need a prescription pain medicine from your dentist or oral surgeon. If you believe you have lost the clot from your extraction site, contact your dentist right away. The dentist may need to clean the socket and pack it with gauze to protect it. To prevent the risk of infection, you may need to take an antibiotic. At home, you may be asked to rinse regularly with salt water to encourage the socket to heal.


How Do I Avoid It?

The American Dental Association recommends avoiding drinking from a straw or smoking after having a tooth extracted. If you take birth control pills, the estrogen in the pills can prevent effective clotting, so talk to your dentist or oral surgeon about the best time of the month to perform the surgery. Be sure to disclose all medications to your dentist, even those taken over the counter, to make sure nothing you take will add to your risk of dry socket. Follow all of your dentist's recommended follow-up care after your tooth extraction and be sure to go to your post-extraction follow-up appointment to avoid any complications.



Thursday, June 30, 2022

What is a Mouthguard?

 

What is a Mouthguard?


A mouthguard is a piece of dental equipment designed to cover your teeth and gums. There are several different types of mouthguards available. Athletes playing contact sports often wear sports mouthguards to protect their teeth, gums, and jaws during practice and games.


You can also wear a mouthguard at night to prevent sleep disturbances, such as snoring. Mouthguard designs can vary widely depending on their intended use. Anti-snoring mouthguards are designed to change the position of your jaw or tongue, keep your airway open, and prevent snoring.


Mouthguards can also be designed to be worn as you sleep to prevent teeth grinding, or bruxism. Bruxism is excessive teeth clenching and grinding that can occur as you sleep, causing jaw pain, neck pain, and noticeable damage to your teeth.


Mouthguards for teeth grinding are typically designed to cover either your top or bottom row of teeth. This added protection can help reduce the damage caused by consistent clenching and grinding throughout the night.


Some people have trouble sleeping with a mouthguard initially, and it may take a few nights to a few weeks to acclimate.


How to Pick the Best Mouthguard for You

With so many mouthguard brands and models to choose from, it can be difficult to decide which one is right for you. Proper fit is perhaps the most crucial factor when selecting a mouthguard, but there are other elements that should be considered. We’ll take a closer look at the most important factors to help you pick the best mouthguard for teeth grinding.


Materials and Durability

Custom mouthguards are often made with two layers. The interior layer is typically softer and made from acrylic or polymer, while the exterior is made from a more rigid material.


The thickness of the mouthguard is usually measured in millimeters, often ranging from 1mm to 4mm. Less expensive models may consist of a single layer and will be noticeably thinner and softer. This may cause the mouthguard to wear out faster when compared to thicker, more rigid models. The severity of your teeth grinding can also impact the overall lifespan of your mouthguard.


Mouthguard Styles

Mouthguards come in several different styles with varying price-points and degrees of customization:


Custom-Fitted: Custom mouthguards tend to be the most expensive, but they may be the most comfortable and effective for many sleepers. They are custom-fabricated to fit the exact shape of your teeth. While this style previously required a trip to the dentist, many companies now offer this service online. You’ll receive a kit to make a custom dental impression that you send back to the company. They’ll use your impression to create and deliver a custom mouthguard fitted to the exact shape of your teeth.


Boil-and-Bite: A boil-and-bite mouthguard offers a simplified version of a custom-fitted mouthguard. This style uses a special thermoplastic that’s moldable at high heat. To create a custom mold, you boil the mouthguard in water to soften the material, run it under cool water, and then bite into it to create an impression of your teeth and gums. Boil-and-bite mouthguards are generally less expensive than custom fit options, but more expensive than one-size-fits-all mouthguards.


One-Size-Fits-All: One-size-fits-all models do not provide a customized fit, but they are typically the least expensive type of mouthguard for teeth grinding. Results may vary when it comes to the comfort and fit of this style.


Fit and Comfort

A mouthguard should fit snugly and comfortably in your mouth in order to be effective. A poorly-fitted mouthguard may prevent some of the damage caused by teeth grinding, but it can also lead to jaw or mouth pain.


Custom-fitted and moldable boil-and-bite models are formed to the specific shape of your mouth and should fit comfortably. When it comes to one-size-fits-all mouthguards, you may need to try multiple models before you find one that suits the shape of your mouth and allows you to sleep comfortably.


Cleaning Requirements

Mouthguards should be cleaned and sanitized regularly.  Each manufacturer will have specific recommendations for cleaning, and instructions should be included with your night guard. If you prefer a low-maintenance option, you may want to examine the cleaning instructions prior to purchasing.


Price

Mouthguards are available in a wide range of price-points to suit almost every budget. Though mouthguards were once considered to be expensive investments, they are more accessible now with the emergence of online companies that offer direct-to-consumer shipping options. Custom-fitted mouthguards typically cost between $100 and $200, while moldable options are generally less expensive.


Mouthguard FAQsWhat is bruxism?

Bruxism is the medical term for teeth grinding and clenching. Bruxism can occur when you’re awake or as you sleep. Physicians consider awake bruxism and sleep bruxism to be two distinct conditions, though they are characterized by similar symptoms.


Overall, sleep bruxism is less common than awake bruxism. However, teeth grinding at night still affects between 15% to 40% of children and 8% to 10% of adults. Sleep bruxism can lead to a number of unwanted symptoms including:


Damage and erosion to the teethHeadachesJaw painClicking of the the joints in the jawTemporomandibular disorders (TMDs)


Sleep bruxism can have a significant impact on your quality of sleep, which may affect your physical health. Since it occurs as you sleep, you may be unaware that you suffer from it.


If you suspect you suffer from sleep bruxism, talk to your doctor or dentist. The presence of common symptoms, such as jaw pain and tooth damage, may be enough to diagnose sleep bruxism. In some instances, you may need to participate in an overnight sleep study to get a definitive diagnosis.


Can I use a regular mouthguard for teeth grinding?

You shouldn’t use a regular mouthguard for teeth grinding, as they are not designed to protect the teeth and jaw from grinding or clenching. Sports mouthguards are usually thick and protect the teeth from impact. They are meant to be used for only a few hours at a time during games or practice, rather than every night.


Mouthguards that are specifically designed for bruxism will protect your teeth and withstand light to heavy teeth grinding. Other mouthguards are more likely to crack, break, or wear down more quickly.


What’s the best way to clean a mouthguard?

The best way to clean your mouthguard is to use the instructions and tools supplied to you by the manufacturer, as this will help prevent damage to the mouthguard. Many mouthguards come with a sanitizing solution for this purpose.


Depending on the mouthguard, you may be able to use standard dental cleaning tools. A gentle but thorough scrub with a soft bristle toothbrush and nonabrasive toothpaste or mild soap can help keep your mouthguard clean between uses.


How often should I replace my mouthguard?

How often you will need to replace your mouthguard will depend on several factors including:


Mouthguard thicknessType of materialsHow severely you grind your teethHow well you take care of your mouthguard


Inspect your mouthguard regularly, looking for any cracks, tears, changes in shape, or thinning. If you experience mild teeth grinding and you take proper care of your mouthguard, it can last several months to a year or longer. Some mouthguards are made from thicker materials designed to withstand severe grinding. If you find yourself replacing your mouthguard frequently, you may want to look for a thicker, more rigid model, or a brand that allows you to buy discounted multipacks.


You may want to bring your mouthguard with you to your regular dental cleaning and checkup appointments, so that your dentist can evaluate your mouthguard for wear and tear.


Can medications cause teeth grinding?

Certain prescription medications may contribute to teeth grinding at night. Sleep experts may not have narrowed down the exact cause of sleep bruxism, but most agree that multiple factors can trigger teeth grinding and clenching as you sleep.


Amphetamines, dopamine-related medications, and selective serotonin reuptake inhibitors are thought to worsen the symptoms of bruxism. Other substances that may contribute to teeth grinding, include tobacco, caffeine, alcohol, and recreational drugs.


Monday, June 6, 2022

What You Need to Know About Bruxism and Teeth Grinding

 


Here's what you need to know about bruxism and what you can do to stop grinding your teeth.


You had a stressful day and you unleashed your tension by grinding your teeth at night, maybe grinding so forcefully that you woke up your partner. And perhaps you paid the price the next day with a headache. Head and facial pain caused by teeth grinding (also called bruxism) is serious and common. While many think of it as a problem that only affects older people, New York City-based dentist Leslie B. Goldfarb, DDS, says people of all ages can develop this habit. “Even children can grind their teeth,” she says.


When you grind, you may be putting as much as 1,200 pounds of pressure on the crowns and roots. That recurring pressure is what can break or loosen your teeth. You can get temporary relief from over-the-counter pain relievers like aspirin or acetaminophen. But that doesn’t get to the root of the problem, especially when you start to get jaw pain. For that, you’ll want to consult with your dentist and make sure you take really good care of your teeth. In the meantime, here are some ways to minimize the daily (or nightly) grind.


Steer clear of stress at the end of the day

Avoid stressful thoughts, activities, and movies in the hours before bedtime. You probably don’t realize it, but just before bed is the worst time to pay the bills, watch Netflix, or talk about your in-laws. If you are bothered by worries, jot down things that you need to address the next day. Then take a long, warm bath before you go to bed. While you’re there, cover your jaw with a washcloth that’s been soaked in hot water. The extra warmth will relax your jaw muscles.


Practice progressive muscle relaxation before you go to sleep, so tension doesn’t lead you to teeth grinding at night. Here’s how it works: When you’re lying in bed, first make a conscious decision to contract, then relax the muscles in your feet. Repeat with your calf muscles, then thigh muscles, and so on, progressively contracting and relaxing each set of muscles all the way up your body. By the time you contract and relax your neck and jaw muscles, you should feel as limp as a rag doll. Also try to avoid eating within an hour of bedtime. Digesting food while you sleep makes you more likely to grind your teeth.


Be guarded

A protective mouthguard made for boxers and defensive linebackers may work for bruxism too. These devices fall into one of three categories: stock mouth guards (which you can find at the local drugstore), the mouth-formed or “boil and bite” type (which are heated in hot water, placed in the mouth and molded to the teeth), and custom-made mouthguards (which give the most protection), according to the American Dental Association’s Council on Advocacy for Access and Prevention. If you buy your own, follow directions on how to mold it to your bite, then wear it to bed at night. The rubbery material will absorb pressure and save your teeth from damage. If you find that the mouth guard keeps falling out, or you wear it right through, talk to your dentist about a customized mouth guard. Try these other surprising DIY ways to stop teeth grinding or bruxism.


Give your jaw a break

During the day, make a conscious point of keeping your jaw relaxed and your teeth apart. As a reminder to yourself, rest your tongue between your top and lower teeth, so if you start to bite down, you’ll really know it. Experts say most people aren’t even aware that they grind their teeth, but those who can break the daytime teeth-grinding habit are less likely to do it unconsciously at night, according to the National Sleep Foundation.


Avoid excessively hard or chewy foods; not only gum and hard candy, but also steak or dried foods that require a lot of jaw action. And if you’re in the habit of chewing on the end of your pencil, try to stop. When you work your jaws during the day, the pattern is likely to continue in your sleep.


Watch what you drink

Keep alcohol consumption to a minimum, or, better yet, stop drinking altogether. This is especially important in the evening. Though sleep experts aren’t sure why, people who drink heavily at night are more likely to grind their teeth when they sleep. Also, avoid caffeinated drinks. Since caffeine is a stimulant, if you drink coffee, black tea, or caffeinated soft drinks, you’re far more likely to grind away.


Get proper nutrition

Did you know that many of the same vitamins and minerals that keep bones strong can also help your teeth? Studies on the elderly given calcium and vitamin D supplements suggest that the nutrients may have helped them to keep their teeth. Specifically, vitamin D might reduce the risk of gingivitis and periodontitis, according to a 2020 study in the International Journal of Environmental Research and Public Health.


Get jaw pain checked out

You may respond to stressful situations during the day by clenching or grinding your teeth at night, without even realizing you’re doing it. This presents a problem, since your teeth are designed to touch briefly when you’re chewing and swallowing—they aren’t built for the punishment of constant grinding. Common triggers are tension and anger. Nighttime grinding can lead to cracked teeth and headaches, as well as the neck and jaw pain called temporomandibular (TMJ) disorders. These 33 tips can make managing stress easier, and give your jaw a break too.


Get regular checkups

Experts recommend that all adults should have biannual dental cleaning by a hygienist, and a biannual oral health assessment by a dentist. “Your mouth is a mirror to your body,” notes Sree Raghavendra, DMD, assistant professor in the Department of Craniofacial Sciences at the UConn School of Dental Medicine in Farmington. Frequent touch points with a dentist will also alert you to grinding activity or bruxism you might not have been aware of, and, hopefully, prevent future damage.


When to call a healthcare professional for bruxism

If you wake up with pain in your jaw, neck, or shoulder, or have morning headaches, tell your dentist or doctor about your symptoms so you can at least try to prevent a dental emergency. This is particularly important if your bedmate reports that you grind your teeth at night. And you need to see an expert immediately if you have a broken tooth from the grinding. For severe bruxism or teeth grinding, you can be fitted with an appliance called the NTI-tss (nociceptive trigeminal inhibition-tension suppression system). It protects you from the damaging and often migraine-producing clenching on back molars. While no one loves going to the dentist, he or she has lots of ways to keep your teeth and gums healthy and your jaw and neck pain-free.



Tuesday, January 20, 2015

Adenomatoid Odontogenic Tumor (AOT): Definition, Clinical features, Diffrential diagnosis


Definition 


The adenomatoid odontogenic tumor is a relatively uncommon,well-circumscribed,odontogentc neoplasm charactezed by the formation of multiple ‘ducts-like’ structures by the neoplastic epithelial cells.


The name ‘adenomatoid’ has been given to the neoplasm because histologically numerous duct-like are often intersersed thorough out the lesion give glandular or matoid apprarance to it.


Origin

The tumor probably arises from the reduced enamel epithelium,during the presecretory phase of enamel organ development.Some investigators believe that the neoplasm develops from a pre-existing dentigerous cyst.


Clinical Features

Age-The tumor usually occurs in the younger age (e.g.second and third decade of life) Rarely it can occur in the older age.

Sex-Females are more  commonly affected in comparison to the males.

Site-The lesion most typically occurs in the maxillay amterior region (upper laterag incisor-canine area) Rarely it involves the mandeble in the angle -ramus area in about 70% cases the neoplasms occur in association with an unrupted tooth , Some lessions develop extra orally in relation to the gingiva.


Clinical Presemtation

AOT Enucleation Surgery

Image via: www.dental.washington.edu


  • The tumor usually presents a slow enlarging , small ,bony hard swelling in the maxillary anterior region.
  • Sometime it can occur in the premolar region k.
  • The lession often causes elevation of the upper lip on the involved side ,which often resuts in a change in the facial profile.
  • Dislacement of the regional teeth , mild pain and expansion of the cortical bone are usually present.
  • If the lesion is very large it may cause severe expansion of the which may sometime elicit fluctuation.
  • In many cases, the lesion is asymptomatic in nature and it is often associated with an uperupted tooth (mostly the upper canine).
  • Occasionally adenomatoid odontogenic tumor may occur extra-ossously in the anterior maxilly gingiva and it prodeces a solirary painless , asymptomatic nodular swelling. 


Radiological Features

AOT of mandibular left canine region

  • Radiographically adenomaroid odontogenic tumor presents a well-defined , unilocular,radiolucent area,which is often enclosing a tooth or tooth-like stucture.
  • Multiple small,radiopaque foci of varying radiodensity may be predent inside the lesion .
  • Expansion of the distrotion of the cortical plates and displacement of the roots of the adjoining teeth are sometime seen.
  • The border of the lesion is not well corticated and it consistently engulfs the impacted tooth including its root. This feature differentiates adenomataid adontogenic tumor from dentigerous cyts,since the later lession encloses only the crown portion of on impacted tooth.


Differential Diagnosis

  • Dentigerous cyts
  • Globulomaxillry cyts
  • Lareral periodontal cyts
  • Odontome
  • Unicystic ameloblastoma
  • Ossiffying or cementifying fibroma
  • Calcifying epithelial odontogenic tumor
  • Calcifyinh epithelial odontogenic cyts.


Histopathological Feature

  • Microscopically, adenomatoid odontogenic tumor reveals neoplastic odontogenic epithealial cells,proluferating in multiple "duck-like" patterns,within a thin but well-vascularized stroma.
  • The presence of these duck-like strucrures often give the lesion an adenomatoid or glandular apperance.
  • Each dick-like structure is bordered on the periphery by a single layer of tall columnar cell resembling ameloblasts.
  • Serial sectioning reveals that the lumens are blind ended ang they probably represent an abortive attempt at anamel oraga formation.
  • The lumen of the duck-like structures are filled with a homogenous eosinophilic coagulum.
  • Small foci of calcification are often seen , which are scattered throughout the lesion.
  • In some cases , the neoplastic cells are arranged in solid nests or rosettem and these cells simetime may fill up the entire lumen of few ducts.
  • Droplets of amorphous (PAS prositiv) eosino philic materials are frequently found in between the neoplastic calls.
  • In some adenomatoid odontogenic tumos tubular dentin or enamel matrix may also be found.
  • The neoplasm is almost always well-encap sulated and the connective tissue stroma may occasionally contain diffuse areas of hyaline materials.


Treatment 

By surgical enucleation . The associated tooth has to be removed and recurrence is rare.

Tuesday, January 13, 2015

Odontogenic Tumor : Defination & Classification

 

Definition: Odontogenic Tumors or neoplasms are a complex group of lesions derived from the dental formative tissues or their remnants ( tissues associated with the development of tooth and its supporting structures ). The constituent tissues in each of these neoplasms can resemble the various tissues found during normal odantogenesis,from inception of the tooth germ to tooth eruption.


The tooth formation or odontogenesis begins in the 6th week intra-uterin life and it originates from the oral epithelium covering the maxillary and mandibular alveolar processes .During the initial period “bud-like” swellings appear from the basal layer of the oral epithelium at specific location where individual teeth will appear from in future .


CLASSIFICATION OF ODONTOGENIC NEOPLASMS (TUMORS) 


Benign Odontogenic Neoplasms 

Ameloblastoma a kind of odontogenic tumor in left jaw:

Case courtesy of Dr Frank Gaillard, Radiopaedia.org


1.  Neoplasms of epithelial tissue origin 

a. Ameloblastoma

b. Squamous odontogenic tumor

c. Calciflying epithelial odontogenic tumor (CEOT)

d. Clear cell odontogenic tumor.


2.  Neoplasms of mixed tissue origin (Made up of both epithelium and mesenchymal tissues)

a. Adenomatoid odontogenic tumor (AOT)

b. Ameloblastic fibroma

c. Ameloblastic fibro-odontoma / fibroden-tinoma

d. Odonto-ameloblastoma

e. Complex odontoma

f. Compound odontoma

g. Calcifying epithelial odontogenic cyst.

3.  Neoplasms of the mesenchymal tissue origin 

a. Odontogenic fibroma

b. Odontogenic myxoma

c. Cementoma

d. Famillial gigantiform cementoma

e. Cementifyin fibroma

f. Bening cementolastoma


Malignant Tumors

1.  Odontogenic carcinomas :

a. Malignant ameloblastoma

b. Primary intra-alveolar carcinoma

c. Malignant variants of other epithelial tissue neoplasms

d. Malignant changes in odontogenic cysts.

2.  Odontogenic sarcomas :

a. Ameloblastic fibrosarcoma

b. Ameloblastic carcinosarcoma

c. Ameloblastic fibrodentinosarcoma


Neoplasms of Debatable Origin 

• Melanotic neuro-ectodermal tumor of infancy 

• Congenital gingival granular cell tumor (congenital epulis)

Can Xylitol Chewing Gum Protect Your Teeth?

 

You have always heard that eating sugar candy is bad for your teeth. but what if i say "chew some gum and protect your teeth"


Yes you are hearing right, i am suggesting you chewing gum ..but how does it help protect your teeth?..


I am suggesting you to have SUGAR FREE Xylitol containing chewing gums present in the market in various brands.


How does it help?

As I have discussed earlier about the process of Caries/Decay, the organism responsible for decay of the tooth is S mutans.It promotes an acidic environment in our mouths which leaves enamel susceptible to damage, erosion and eventually cavities.


Luckily, nature has provided a cheap, natural and safe remedy for this problem: xylitol. xylitol is a sweet substance commonly found in birch trees and in the fibrous portions of many fruits and vegetables.I want to discuss its application as a cavity fighting agent.


A recent study out of Korea examined the effect on cavities caused by the regular chewing of xylitol sweetened gum.


Two groups of women were assigned to chew either regular or xylitol gum for a period of one year. At ten points during that year, saliva samples were taken from these women and analyzed to determine the amounts of S. mutans.


In the xylitol gum group, the levels of S. mutans decreased consistently as the study progressed.  The researchers also found that the S. mutans produced a lower amount of sticky substances in the xylitol chewers. This is relevant because the stickiness allows for acids to cause more damage to our teeth. The combined effects of  chewing the xylitol gum led to an oral environment that was less prone to cavity formation.


The results of this first study were encouraging. But I wanted to see if this might be a fluke. It seems that it is no


Facts & Figures-

In December of 2008, a review appeared in the Journal of the American Dental Association. In it, the researchers examined the findings of 19 studies relating to the use of xylitol and sorbitol gums in the prevention of tooth decay. Their analysis found that the xylitol gum studies showed the greatest cavity prevention.


Here’s a breakdown of a few different sugar alcohols and their overall preventive effect:

Xylitol Gum – 58.66%

Xylitol & Sorbitol Combination Gum – 52.82%

Sorbitol Gum– 20.01%

Sorbitol & Mannitol Combination Gum – 10.71%


As you can see, the xylitol component appears to be the most important factor in the promotion of oral health.


So how exactly does xylitol help protect teeth? It is believed that it works to starve harmful bacteria, like S. mutans. This leads to a less acidic environment that is less prone to decay and plaque formation.


Calcium added Xylitol gums-

Preventing cavities is a very positive thing. But is there a way to strengthen enamel, if it’s weak to begin with? Maybe so.

A few years ago, scientists in Japan published a study that tested a combination gum that included calcium lactate and xylitol. Their aim was to see if such a gum could actually make tooth enamel stronger.


Volunteers were asked to either a) chew no gum, b) chew xylitol gum or c) chew gum with xylitol and calcium lactate. The voluteers chewed 4 pieces of each gum for 2 weeks. After which, their enamel was measured using an X-ray.


The results showed that the xylitol-calcium gum was about 50% more effective in promoting remineralization than the xylitol-only gum. The authors concluded that, “chewing gum containing xylitol + calcium lactate could enhance remineralization of enamel surface”.

So i suggest having these xylitol chewing gums instead of sugar candies. Care for your teeth they are precious.

Tuesday, January 6, 2015

Ameloblastoma Complete Info (with Pictures)

 

Definition

Ameloblaatoma is a benign locally aggressive neoplasm arising from the odontoenic epithelium and it is the most common odontogenic neoplasm of the oral cavity.


Etiology

Exactily not known however , the following factors may predispose the formation of ameloblastoma:

  • Trauma.
  • Infection.
  • Previous inflammation.
  • Extraction of tooth.
  • Dietary factors.
  • Viral infection.


Clinical Features

  • Incidence Approximately 1 percent among all oral tumous.
  • Age- second, third,fourth and fifth decade of life , the mean age of occurrence is about 32 years. This lesion occurs more commonly in blacks than whies.
  • Sex-  Males are affected more often females.
  • Site- Ameloblastoma in most of the cases involve the mandible (80%), especially in the molar-ramus area (70%) , although some lesions may develop in the premolar (20%) or symphysis (10%) regions.
  • Maxillary tumors also commomly involve its posterior part  and the lesions ofter have a tendency to invade into the antrum (15%) or the nasal floor.
  • Extraosseous ameloblastomas can rarely occur mostly in relation to the gingival.


Clinical Presentation


  • Clinically ameloblastoma commonly presents a slow enlarging,painless,ovoid or fusiform,bony hard swelling of the jaw.
  • The lesion causes expansion and didtortion of the cortical plates of the jawbone and displacement of the regional teeth; these are often leading to gross facial asymmetry.
  • Pain ,paresthesia and mobility of the regional teeth may be present in few cases.
  • Most of the be patients report with a typical long time history of presence of an “abscess” or a “cyst” in the jow bone that was operated on several occasions but has recurred after each attempt.
  • Lerger lesions of ameloblastoma often cause severe expansion ,destruction and thinning of the cortical plates , which often result in “fluctuation”or “egg shell cracling” of the affected bone.
  • Pathological fractures”,may occur in many such affected bones.
  • The mucosa overlying the tumor appears normal and the regional teeth are usually vital.
  • In some cases , smaller lesions may remain asymptomatic for a longer duration of time and are detected incidentally during routine radiographic examinations.
  • Many untreated lesions may reach to an enor –mous size with time.
  • Sometimes larger lesions may perforate the cortical plates and protrude outside the bone as a modular mass.
  • Maxillary tumors can invade into the maxillary air sinus and extend further up to the orbit or the nasopharynx;thereby or nasal obstruction,etc.
  • Some of the lesions may progress to ethmoidial air sinuses or even up to the cranial base.
  • Extraosseous ameloblastoma often produces a small ,nodular growth in the gingival.


Radiological Feature

  • Radiographically ameloblastoma usually pre-sent a well-defined,multilocular ,radiolucent area in the bone with a typical “honey-comb” or “soap-bubble” appearance. Few lesion can be unilocular too.
  • The lerger lesions often couse expansion,dis-tortion or even perforation of the cortical plates.
  • In radiograph the lesion typically exhibits an irregular and “scalloped”margin. 
  • Resorption of the adjoining normal teeth is often seen in rapidly growing lesions.
  • Ameloblastoma can cause expansion of the lower border of mandible. An irregular,”scallo-ped margin “ are often the typical features of ameloblastoma.
  • An the neoplasm progresses it sometimes become associated tooth (mostly the third molars) and in such cases the lesion may be resemble a dentigerous cyst.


Differential Diagnosis

  • Odontogenic keratocyst (Primordial cyst)
  • Dentigerous cyst
  • Central giant cell granuloma
  • Central hemangioma
  • Aneurysmal bone cyst
  • Fibromyxoma.


Macroscopic Features

  • On naked eye examination the tumor presents a cylindrical or fusiform swelling, which expands the bone so the severely that it can bebroken by digital pressure (egg-shell crrackling).
  • Perforation of the bone with subdequent protrusion of the tumor outside the bony wall is often noticed.
  • Cut section of ameloblastoma often appears as a “grayish-white”mass ,which contains some ‘cyst-like ‘ spaces. However no calcified is usually found within the tumor.
  • Some lesions are made up entirely of solid tissue mass although most of them have some cystic spaces of varying size within them.
  • Some intratumor cysts are large and contain either a straw colored fluid or a semi solid gelatinous material.
  • Sometimes one or two teeth may be present within thw lesion.


Histopathological Features

Histologically ameloblastoma shows neoplastic proliferation of odontogenic epithelial cells mostly in two distinct patterns ; (i) Plexiform type and (ii) Follicular type.


Plexiform Ameloblastoma

  • In this variant of ameloblastoma the neoplastic odontogenic epithelial cella proliferate in the form of “ contimuous anastomosing strands”. 
  • This patterm of neoplastic cell proliferation is also often called a “ fishnet like” pattern of arrangement.
  • The peripheral layer of cells tall columnar in nature and they often resemble the amelo-blasts.
  • Reverse polarization of the nucleu of these bordering cell is indistinct.
  • The cells situated at the center portion of the strands often resemble the stellate reticulum cells;while the cells located  berween the columnar cells and stellate reticulum cells often resemble the startum intermendium.
  • The intervening connective tissue stroma is usually thin , with minimum cellularity and often it show multiple areas of cystifications , which may be either large or small in size .


Follicular Ameloblastoma 


  • In follicular type , the neoplastic odontogenic epithelial cells proliferate in the from of multiple , discrete , follicles or islands within the fibrous connective tissue stroma.
  • Each follicle-like structure is bordered on the periphery by a single layer of tall columnar cells resembling ameloblasts. these cells have well-defined neclei situated away from the basement are called “reverse polarization” of the cell nuclei.
  • The cells located at the center of the follicles are loosely arranged and are triangular in shaps;these cells are widely seiarated from one another and they often resemble stellate reticulum cell (normally seen in the bell stage of odontogenesis)
  • While the cells located in berween the peripheral and the central group of cells appear as the stratum intermedium.
  • Occasionally a distinctive zone of hyalinization is seen surrounding the follicles.
  • Microcyst formation is often observed inside these follicles and the cysts sometimes may be large enough to occupy the entire inner part of the follicles.
  • Most of the follicular ameoloblastomas exhibit cyst formation particularty if the lesion is large.
  • The intervening connective  tissue strimas is delicate in nature and it consists chifly of collagen bundles,fibroblasts and blood vessels etc.
  • Extraosseous ameloblastoma consists of basaloid cells or they may even resemble the conventional intraosseous ameloblastomas.


Other Histological Types of Ameloblastoma

Besides the plexiform and the follicular types some other histological types of ameloblastomas can occur and they are as follows :


Acanthomatous type of ameloblastoma: It occurs in relation to follicular ameloblastoma and in this type the stellat reticulum-luke cells at the center of the follicles undergo squamous metaplasia. Sometimes the neoplastic epithelial cells can even produce “keratin pearls” whith the follicle the meoplastic cells may exhibit individual cell keratinization.


Granular cell type of ameloblastoma: In this type the cytoplasm of the stellate reticulum like cells and even the ameloblast like cells appear swollen and the cells are often densely packed with multiple, coarse,eosinophilic granules.Histologically this lesion often resembles “granular cell myoblastoma” and ultrastructural studies indicate that these geanules are either lysosomal elements or residual bodies.


Besal cell type of ameloblastoma: this lesion shows excessive proliferation of cuboidal shaped,bassaloid cells in narrow strands with the absence of stellate reticulum or other located cells The tumor often resembles basal cell carcinoma.


Cystic type of ameloblatoma: these lesions often exhibit multiple,small,microcyst formation inside the tumor.Some of the cysts are large in size


Desmoplastic type: In this type the epithelial islands or the strands are amall in size and the cells are ceboidal in shape and darkly stained.The cells of the epithelial components are widely separated by dense fibrous tissue. In this cells often penetrate into the surrounding trabacular bene.


Histogenesis of Ameloblastoma

Ameloblastoma develops from the odontogenic epithelial cells or their remnants but the exact cell of its origin is not very clearly known.According to different investigators, the possible cells or tissues from where ameloblastoma may arise are as follows.


  • Enamel organ of the developing tooth gern 
  • Cell rest of Serre (remnsnts of dental lamina)
  • Epithelial lining of the odontogenic cysts especially the dentigerous cyst.
  • The basal cell layer of the oral epithelium (rarely)
  • Cell rest of malassez.


Treatment

Surgical enucleation of the tumor and thorough curettage of the surrounding bone.Sometimes radical surgical approach may have to be adopted in case of repeared recurrences of the lesion Some tumors may cause distant matastasis.