Pediatric Patients Odontogenic and Developmental Oral Lesions

Pathology and Dentistry

Introduction

The article titled, Odontogenic and Developmental Oral lesions in Pediatric Patients, by Bilodeau and Hunter (2021) is essentially a review of ondogenesis and how oral lesions develop in the jaw region among pediatric patients. The article further provides information on pathogenesis of odontogenic tumors, their prognosis, microscopic features and how they present clinically. While this article explains how oral lesions are developed in children, it fails to exhaust on all odontogenic and developmental oral lesions.

This article highlights the various odontogenic lesions in pediatrics by indicating that most of them are benign. According to Freilich (2020), the said lesions consist of malignant odontogenic tumors, benign odontogenic tumors, and cysts. It is from the tissues that give rise to teeth that lesions are formed. Most lesions are common while others are rare - which makes diagnostic process uncertain (Hunter and Niklander, 2020). The authors further highlight the different oral lesions in pediatrics, their clinical presentation, and histological features. The odontogenic lesions in young children and infants are inclusive of, but they are not limited to, cysts of the foregut region, choristoma/heterotopia, Melanotic Neuroectodermal Tumor, Congenital (Granular) Epulis of the Newborn, and Dental Lamina Cysts/Gingival Cysts of the Newborn. Lesions associated with eruptive teeth are inclusive of; Buccal Bifurcation Cyst/Inflammatory Collateral Cyst, Odontogenic Keratocyst Cyst/Keratocystic Odontogenic Tumor, Dentigerous Cyst, Eruption Cyst, and Hyperplastic Dental Follicle. Odontogenic Hamartomas and tumors are inclusive of; Primordial Odontogenic Tumor, Adenomatoid Odontogenic Tumor, Ameloblastoma, Ameloblastic Fibroma, and Odontoma (Bilodeau and Hunters, 2021).

Analysis

Focusing on the strengths, the authors of the article were objective given that they based their arguments on facts that are from reports of diagnosis which uses biopsy as a tool for diagnosis of oral lesions. The authors indicate that, “in general, 8.2% of oral biopsies are received from patients less than 16 years of age” (71). The title of the article is unambiguous and clear given that it describes what will be explained in the review. Further, the article is well laid out and organized in that the authors have used subheadings in the different odontogenic lesions and tumors thus making it easy to identify each lesion with its specific features and presentations. The authors have also used microscopic images to illustrate the different lesions - which makes it easy to understand how the various lesions presents in pediatrics. The clinical presentation, pathology, and histological features of each has been explained. In addition, the authors of the article have made suggestions for future study which could be of great relevance to pediatric dentistry. Moreover, the authors of the article have cited materials from peer-reviewed journals which is important in as far as the further enhancement of reliability is concerned. On the other hand, the article has some limitations. First, the authors of the article have focused on odontogenic tumors in pediatric patients only, implying that discussing the said tumors in both children and adults would make the article voluminous yet the tumors are more common in adults. The authors further suggests that gnathic boney tumors are also common but fail to explain them by indicating that they can be covered in other sections, for example “head and neck pediatric pathology special edition” (82). Third, the authors of the article only highlight the important and common entities of odontogenic and developmental oral lesions, thus failing to exhaust all the oral lesions. Moreover, the article over-generalized the oral pathology of the findings from biopsy in pediatric patients. Oral pathology of each lesion would have given a different outcome. The authors further indicate that the results of biopsy vary among different diagnostic service providers - indicating that the sample size is not big enough to support the claim that oral biopsies are mainly received from the age group indicated (Bilodeau and Hunter, 2021). In addition, the authors of the article appear to contradict themselves by indicating that “some lesions can be particularly challenging due to their relative rarity, combined with the complexity of normal developmental processes”(82). In addition, the authors fail to offer treatment suggestions for the said lesions like is the case in other similar articles I came across. For instance, Freilich (2020) has suggested that the treatment for odontogenetis keratocyst is curettage and enucleation. Further the article is limited given that the authors indicate that some information will be discussed in other articles. For example the authors point out that more information on choristomas will be discussed in head and neck pediatric pathology. Also, the authors fail to give meaning to some abbreviations used in the article. This is especially crucial owing to the fact that some readers may not be familiar with some of the terms used in this realm. For example, the authors do not give the full meaning of abbreviations such as FGF, MNETI, GFAP, and NRAS.