A.O. Lawal1, A.O. Adisa1, and T.J. Lasisi2
- Department of Oral Pathology,College of Medicine, University of Ibadan, Nigeria.
- Department of Oral Pathology, University College Hospital, Ibadan Nigeria. Attribute to Department of Oral Pathology,College of Medicine, University of Ibadan, Nigeria.
Florid cemento-osseous dysplasia (FCOD) is commonly seen in black women, but few cases have been reported in sub-Saharan Africa. This article presents two cases of FCOD seen at the University College Hospital Ibadan. Two women aged 70 and 60 years were initially diagnosed as chronic osteomyelitis but both were eventually diagnosed as florid cementoosseous dysplasia after radiological examination by orthopanthomogram. Diagnosis of florid cemento-osseous dysplasia is possible by clinical examination and the distinct radiological presentation, especially on orthopanthomogram and a biopsy may not be required.
Keywords: Florid cemento-osseous dyplasia, women, Ibadan.
Dr. A.O. Lawal
Department of Oral Pathology,
College of Medicine,
University of Ibadan.
Cemento–osseous dysplasias are a group of disorders known to originate from periodontal ligament tissues and involve essentially the same pathological process.1 They are usually classified depending on their topography and radiographic appearances, into three main groups: periapical, focal and florid cemental dysplasias.1
Florid cemento-osseous dysplasia was first described by Melrose et al2 in 1976. This condition has been interpreted as a dysplastic lesion or developmental anomaly arising in tooth-bearing areas.2 Florid cemento-osseous dysplasia is more commonly seen in middle-aged black women although it may also occur in Caucasians and Asians.3,4 The processes may be totally asymptomatic and may be detected incidentally when radiographs are taken for some other purposes. Symptoms such as dull pain or drainage are almost always associated with exposure of sclerotic calcified masses in the oral cavity.5 This may occur as the result of progressive alveolar atrophy under a denture or after extraction of teeth in the affected area.5
The lesions show a marked tendency for bilateral symmetric involvement, and it is not unusual to encounter extensive involvement of all four posterior quadrants.2
Although FCOD is said to be commonly seen in middle aged black women, report of cases from sub- Saharan Africa, especially Nigeria the most populous black nation, is rare. We present a report of two cases seen at the University College Hospital Ibadan.
A 70 year old woman presented at the dental outpatient clinic of the University College Hospital Ibadan, with a 16 year history of pain and discharge from a sinus located on the left jaw. She had presented 10 years earlier at the same clinic but absconded due to financial constraints. On examination, there was a tender swelling on the left body of the mandible with a discharging sinus in relation to teeth 34, 35 and 36. Oral hygiene was poor and there were no carious teeth but there was an area of necrotic bone exposure in the region of 32, 33, 34, 35 and 36. An initial diagnosis of chronic suppurative osteomyelitis was made. An orthopanthomogram however showed diffuse mottled radio-opaque masses within the body of the mandible extending from tooth 38 to tooth 48 (Fig 1). A diagnosis of florid cement-osseous dysplasia complicated by chronic suppurative osteomyelitis was thus made. The patient was placed on oral clindamycin tablets 300mg bid but was subsequently lost to follow up.
A case of a 60 year old woman who presented at the dental clinic of the University College Hospital Ibadan, with a 3 months history of tooth ache and jaw swelling which had been progressively increasing in size. She had applied traditional medicine without any appreciable relief. There was no relevant medical history. Examination revealed a healthy looking woman, not pale or jaundiced. There was a warm, tender, diffuse swelling on the left body of the mandible. Intra-oral examination showed poor oral hygiene with swelling and pus discharge in the left buccal sulcus in relation to tooth 37. No carious teeth were observed, tooth 36 was however, tender to percussion. On radiological examination, Orthopanthomogram showed widespread radio-opaque masses affecting all four quadrants of the jaws with a sequestrum forming on the left mandibular quadrant and tooth 36 floating in its socket (Fig 2).