Oral medicine: 13. lumps and swellings: jaws

From Volume 40, Issue 10, December 2013 | Pages 849-852

Authors

David H Felix

BDS, MB ChB, FDS RCS(Eng), FDS RCPS(Glasg), FDS RCS(Ed), FRCPE

Postgraduate Dental Dean, NHS Education for Scotland

Articles by David H Felix

Jane Luker

BDS, PhD, FDS RCS, DDR RCR

Consultant and Senior Lecturer, University Hospitals Bristol NHS Foundation Trust, Bristol

Articles by Jane Luker

Crispian Scully

CBE, DSc, DChD, DMed (HC), Dhc(multi), MD, PhD, PhD (HC), FMedSci, MDS, MRCS, BSc, FDS RCS, FDS RCPS, FFD RCSI, FDS RCSEd, FRCPath, FHEA

Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK

Articles by Crispian Scully

Article

Specialist referral may be indicated if the Practitioner feels:

Many diseases of, or in, the jaws present asymptomatically, as radiolucencies, radio-opacities or with mixed appearances on radiographs. Other presentations are as swellings, pain or sometimes fracture or disturbance of tooth eruption (displaced, missing or loose teeth). Swellings that appear to originate from the jaws may arise from subcutaneous tissues or bones. The mnemonic MINT aids diagnosis: Malformations, eg tori and fibro-osseous lesions.

Inflammatory conditions, eg odontogenic infections, osteomyelitis, actinomycosis, tuberculosis, or syphilis.

Neoplasms and cysts (see below).

Trauma causing subperiosteal haematomas.

Investigations largely involve imaging, and serum calcium, phosphate, and alkaline phosphatase levels but histopathology is almost invariably required.

Some jaw conditions are ‘pseudo-diseases’, including: unerupted teeth, tori (Figures 13), bone marrow defects, traumatic bone cyst, Stafne bone defect (static bone cyst), osteosclerosis, pseudocyst of maxillary sinus, or sub-pontic osseous hyperplasia.

A number of bone diseases may also affect the jaws.

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