A 44-year-old female visited a dentist for a routine checkup. Oral examination revealed bony masses on the buccal alveolar bone in both the maxilla and mandible.
Joen Iannucci Haring, DDS, MS
When questioned about the bony masses, the patient denied any history of symptoms associated with this region. The patient also denied any history of trauma to the involved area. The patient appeared to be in a general good state of health, with no significant past medical history. The patient`s dental history included regular dental examinations and routine dental treatment. At the time of the dental appointment, the patient was not taking medications of any kind.
The patient`s vital signs were all found to be within normal limits. Examination of the head and neck region revealed no enlarged or palpable lymph nodes. Examination of the soft tissues of the oral cavity revealed no unusual findings. Large, bilateral bony masses were noted on the buccal of both the mandible and maxilla in the premolar and molar areas (see photo).
Radiograph examination of the involved areas revealed well-defined ovoid radiopacities superimposed over the roots of the premolar and molars. The adjacent teeth were tested for vitality; all tested vital.
Based on the clinical and radiographic information available, which one of the following is the most likely diagnosis?
* buccal exostoses
* florid cemento-osseous dysplasia
* fibrous dysplasia
* ossifying fibroma
Exostoses are protuberances of bone that arise from the cortical plates in the maxilla and mandible. The cause of exostoses is unknown.
Exostoses occur most often in adults. There is no sex predilection and approximately one in 1,000 adults are affected. Buccal exostoses occur as bilateral, smooth bony masses along the buccal aspect of the maxillary and/or mandibular alveolar ridge, usually in the premolar-molar area. When palpated, the exostoses feel rock-hard.
Symptoms are not associated with buccal exostoses. The mucosa overlying the buccal exostoses typically appears intact and is normal in color. Ulcerations may occur if the mucosa is traumatized. The adjacent teeth are vital, and there is no history of pain or sensitivity.
Buccal exostoses are typically discovered during the oral examination. Radiographically, the exostosis appears as an ovoid radiopacity superimposed over the roots of the premolars and molars.
Palatal exostoses are similar to buccal exostoses except for location. As the term palatal suggests, a palatal exostosis develops from the lingual aspect of the maxillary tuberosity area. Such exostoses may occur bilaterally or unilaterally.
Buccal exostoses are benign lesions of little clinical significance. The diagnosis of a buccal exostosis is made based on the clinical and radiographic findings. If the diagnosis is in question, a biopsy should be performed to rule out other bony lesions.
Typically, no treatment for buccal exostoses is indicated. Buccal exostoses may complicate the construction of dental appliances. Therefore, surgical reduction of the lesion to the level of surrounding bone may be indicated if a partial or complete denture is needed.
Joen Iannucci Haring, DDS, MS, is an associate professor of clinical dentistry, Section of Primary Care, The Ohio State University College of Dentistry.