|Year : 2013 | Volume
| Issue : 2 | Page : 95-100
Prevalence of odontogenic cysts and tumors among UAE population
Natheer Hashim Al-Rawi, Manal Awad, Imad Eddin Al-Zuebi, Racha A Hariri, Eman W Salah
Department of Oral and Craniofacial Health Sciences, College of Dentistry, University of Sharjah, Sharjah, United Arab Emirates
|Date of Web Publication||3-Jan-2014|
Natheer Hashim Al-Rawi
College of Dentistry, University of Sharjah, Sharjah, P. O. Box 27272
United Arab Emirates
Source of Support: The authors would like to thank the staff in
department of Oral Pathology Laboratory and Oral Surgery department
of Tawam Hospital- Al Ain for their valuable support in facilitating the
access to the data of the patients, Conflict of Interest: None
Background: Odontogenic cysts and tumors are lesions that tend to arise from the tooth apparatus or its remnants. Odontogenic cysts and tumors constitute an important aspect of oral maxillofacial pathology as they can be diagnosed in general dental practice. Aim: The purpose of this study was to evaluate the prevalence of odontogenic cysts and tumors diagnosed in the UAE and to compare the results with findings in the literature. Materials and Methods: Data of odontogenic cysts diagnosed between 1990 and 2010 were collected from the files of the Oral Pathology Laboratory and Oral Surgery Department of Tawam Hospital, UAE. Results: Most of the prevalent odontogenic cysts are radicular cysts (69.1%) - followed by dentigerous cysts (7.9%). Among the odontogenic tumors, the most prevalent is odontoma (12.2%) followed by ameloblastoma (2.9%). The middle and posterior mandible was the most common anatomic site for the formation of cysts and tumors. In fact, 93.4% of patients over 40 years presented with odontogenic cysts, whereas 6.3% presented with odontogenic tumor. Odontoma as odontogenic tumor was seen mostly in the first and second decades of life. Conclusion: The prevalence of odontogenic cysts was similar to that reported in the literature, with inflammatory cysts occurring most frequently.
Keywords: Ameloblastoma, dentigerous cysts, odontogenic cyst, odontogenic tumors, odontoma, radicular cysts
|How to cite this article:|
Al-Rawi NH, Awad M, Al-Zuebi IE, Hariri RA, Salah EW. Prevalence of odontogenic cysts and tumors among UAE population. J Orofac Sci 2013;5:95-100
|How to cite this URL:|
Al-Rawi NH, Awad M, Al-Zuebi IE, Hariri RA, Salah EW. Prevalence of odontogenic cysts and tumors among UAE population. J Orofac Sci [serial online] 2013 [cited 2020 Jan 17];5:95-100. Available from: http://www.jofs.in/text.asp?2013/5/2/95/124251
| Introduction|| |
Odontogenic cysts and tumors comprise an important aspect of oral maxillofacial pathology, as they can be diagnosed in general dental practice. Several studies have been conducted regarding the prevalence of odontogenic cysts and tumors. In one study conducted in France by Meningaud et al., the files of patients operated upon under general anesthesia for odontogenic cysts were analyzed.  It has been shown that the mean age of the patients was 41.8 ± 15.8 years. The lesions were more common in the mandible than in the maxilla (in a mandible to maxilla ratio of 3:1) with male predominance. The most frequently diagnosed odontogenic cysts found were radicular cysts (53.5%), dentigerous cysts (22.3%) and odontogenic keratocysts (19.1%). Another study has been done by De-Souza et al.,  on the demographic profile of odontogenic cysts among the Brazilian population over a 38-year period. This study showed that the prevalence of odontogenic cysts among the Brazilian population was similar to other populations around the world. The mean age for the patients affected was 31.0 years with female predominance and a male to female ratio of 0.78:1. They also found that about 68.3% of patients diagnosed were between the second and fourth decades of life. Inflammatory cysts were the most common odontogenic cysts, whereas radicular, dentigerous and odontogenic keratocysts accounted for 87.9% of all the cysts. Residual cysts accounted for 4.9% in patients with a mean age at diagnosis of 44.5 years. Another retrospective study to determine the prevalence of odontogenic cysts among the Brazilian population was conducted by Avelar et al.  This work showed that odontogenic cysts constituted 9.94% of the lesions that were biopsied in the study. Most of the earlier studies did not provide any information regarding the patients' ethnic backgrounds. However, this study showed that patients of African descent were the most affected group (41.8%) followed by the Caucasians. Forouzandeh et al.  conducted a study in (Tehran, Iran) to assess the prevalence of odontogenic cysts based on age, gender and site. Among the cysts in the oral and maxillofacial regions examined, 19.5% were cysts of the osseous structures while 81.9% of them were odontogenic in origin, 12.4% were pseudocysts and 5.7% were of non-odontogenic origin. A few studies are available on the buccomaxillary lesions and odontogenic tumors in children and adolescents. Furthermore, a comparison between the data available is difficult because of the differences in the criteria applied in each study. Gueressi et al.  conducted a study to determine the prevalence of odontogenic tumors among patients up to the age of 20 years in Argentina. Among all odontogenic tumors diagnosed, 7% of them were in children and adolescents. The mean age of the population was 12.7 years, with a male to female ratio of 2:1. The most common odontogenic tumors found were odontomas (50.9%), followed by ameloblastomas (18.3%). Fernandes et al.  conducted a study to determine the prevalence of odontogenic tumors in a Brazilian population through a 50-year period. The study showed that odontogenic tumors comprised 1.78% of all oral and maxillofacial lesions, in which 99.4% were benign lesions and only 0.6% was malignant. Benign lesions occurred in a male to female ratio of 1:1.1.2 while all the malignant lesions were found in females. Another study was conducted in Nigeria by Ladeinde et al.,  on 319 cases in a Nigerian teaching hospital. Among the oral and jaw lesions biopsied, 9.6% were odontogenic tumors. The most common odontogenic tumor was ameloblastoma (63.0%), which was more prevalent in the mandible than the maxilla (ratio of 4.1:1). Santos et al.  conducted a study to analyze odontogenic tumors determining the type, prevalence, distribution, age, gender and site. They affected individuals in the second and third decades of their life with a mean age of 26.6 years, with female predilection. The most commonly affected site was the mandible (54.3%), while the maxilla was affected in 40.15% of the cases. The most common odontogenic tumor found was odontoma (50.4%). To the best of our knowledge, no studies have been done in an Arabic population, particularly among the UAE population. Due to the discrepancies in data and lack of databases regarding these lesions among the UAE population, we attempted to conduct this study to estimate the prevalence of odontogenic cysts and tumors in the UAE population based on the data available, collected from the histopathological reports available in Tawam, Al-Ain Hospital and its outpatient clinics.
| Materials and Methods|| |
Cases diagnosed as odontogenic cysts and tumors between 1990 and 2010 were retrieved from the Oral Pathology Laboratory and Oral Surgery Department of Tawam Hospital. Data regarding age, gender, location, size, histopathological evaluation and treatment done were gathered from the clinical records, case notes and follow-up records in the files along with biopsy reports, after obtaining approval from the Ethics Committee in Tawam Hospital. Classification of the diagnosis was based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10) published by World Health Organization. Data was analyzed using the SPSS - 20 (Chicago, IL-USA)) statistical software for Windows. Descriptive statistics and test of significance were appropriately applied and used. The critical level of significance was set at P < 0.05.
| Results|| |
Among the clinical records of 500 maxillofacial cases retrieved from the archives of the Medical Records Department in Tawam Hospital and its dental center over a 20-year period, only 143 confirmed cases of odontogenic cysts and tumors were detected. In all, 66 cases (46.2%) were observed in males and 77 cases (53.8%) in females, with a male to female ratio of 1:1.17. The most common age group in this study was observed among patients ranging from 21 to 40 years of age (46.2%). In total, 128 cases (89.5%) were identified among the locals while only 15 cases (10.5%) were detected among the non-locals. Regarding the occupation of the patients affected, it was found that 39 patients (28.7%) were employed and 97 individuals (71.3%) were unemployed. Most of the cases diagnosed had odontogenic cysts, about 121 cases (84.6%), whereas 22 cases (15.4%) presented criteria of odontogenic tumors. The most common odontogenic cysts diagnosed were radicular cysts (69.1%) followed by dentigerous cysts (7.9%). On the other hand, the most prevalent odontogenic tumors diagnosed were odontoma (12.2%) followed by ameloblastoma (2.9%). The remaining 11 cases had lateral periodontal cysts as shown in [Figure 1]. The most common location of the odontogenic cysts and tumors was observed to be the middle and posterior mandibular areas with a total number of 61 cases (42.7%), followed by the anterior maxillary region (36 cases, 25.2%), then the middle and posterior maxillary regions (28 cases, 19.6%) and finally, the anterior mandibular region (14 cases, 9.8%). Four cases comprising 2.8% of the total cases presented clinically at multiple locations as shown in [Figure 2].
|Figure 1: Distribution of odontogenic cysts and tumors among a sample from the UAE population|
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|Figure 2: Distribution of the odontogenic cysts and tumors based on location|
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Patients in the second decade of their lives developed more odontogenic cysts and tumors (72.2% and 27.7%, respectively). Young adults ranging in age from 21 to 40 years revealed 56 cases of odontogenic cysts (84.8%) and 10 cases of odontogenic tumors (15.2%) and were considered the most prevalent age group having such lesions with statistical significance when compared with the other age groups (P < 0.05%). Patients over 40 years presenting with odontogenic cysts were 93.4% and those with odontogenic tumors were 6.3% [Table 1].
|Table 1: Distribution of patient age groups based on the type of lesions (P<0.05) and duration|
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When analyzing the data based on gender, males with odontogenic cysts comprised 84.8% and those with odontogenic tumors 15.2%, very similar to that found in females where the percentage of the odontogenic cysts and tumors was 84.4% and 15.6%, respectively. However, the number of cases of more than 6 months' duration was 14% in males when compared with 25% in females, whereas cases of less than 6 months' duration comprised 86% in males and 75% in females, as shown in [Table 2].
|Table 2: Distribution of patient gender groups based on the type of lesions and duration|
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As far as the location was concerned, most of the odontogenic cysts and tumors were found in the middle and posterior mandible (in 50% of the cases) in male patients, whereas, in females, both anterior maxillae (36.4%) and middle and posterior mandibles (36.4%) were equally affected (P < 0.05). The lesion size correlated with gender and was statistically significant (P < 0.05). In males, about 53% of lesions were less than 1 cm in size and 47% showed size more than 1 cm in the largest diameter. Females, on the other hand, had 76% of lesions less than 1 cm in size and 24% showed sizes more than 1 cm as listed in [Table 3].
|Table 3: Distribution of patient gender groups based on the location of the lesion|
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Analysis of the data collected based on nationality showed that 85.9% of the lesions were odontogenic cysts and 14.1% were odontogenic tumors among the local population of the UAE, compared with 73.3% of the odontogenic cysts and 26.7% odontogenic tumors among other nationalities as shown in [Table 4]. The most common site for these lesions was on the middle and posterior mandible for the UAE locals, whereas, the anterior maxilla was the most common site among others as displayed in [Table 5].
|Table 4: Distribution of patient nationality groups based on the type of lesions and duration|
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Regarding occupation, it was found that 8.8% of the employed participants had acute (<6 months) lesions compared with 25.9% in the unemployed; however, the percentage of chronic (>6 months) lesions for the employed and unemployed participants was 91.2% and 74.1%, respectively (P < 0.05).
When the duration of the different types of cysts and tumors was compared, the results revealed that 20 cases (22.5%) of the radicular cysts were less than 6 months in duration and 69 cases (77.5%) of them were more than 6 months in duration. In the case of dentigerous cysts, only one patient's cysts were less than 6 months old, whereas in the other eight cases (87.5%) they were more than 6 months in duration. On the other hand, all cases of odontoma and ameloblastoma were discovered after more than 6 months duration [Table 6]. Regarding the size of the different lesions, 75% of the radicular cysts were diagnosed before reaching 1 cm in size, whereas 24% were above 1 cm in size at the time of diagnosis. All cases of ameloblastoma observed cyst size larger than 1 cm. Dentigerous cysts and odontoma showed larger than 1 cm lesions in the percentage of (60.0%) and (63.6%) respectively, as shown in [Table 7].
|Table 6: Distribution of odontogenic cysts and tumors based on gender and duration of the lesion|
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|Table 7: Distribution of odontogenic cysts and tumors based on the size of the lesion (P<0.05)|
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Regarding location, it was found that the most common site for radicular cyst and dentigerous cysts was the middle and posterior mandibular regions at 41.7% and 63.6%, respectively. Odontomas, however, were observed mainly in the anterior maxillary region and in the mid-posterior mandibular region (29.4%). Two cases of ameloblastoma were found in middle and posterior mandibular regions and the other two cases were observed in multiple areas [Table 8].
Regarding the treatment modalities performed, enucleation was the most common procedure performed to treat radicular cysts, dentigerous cysts and odontoma with percentages of (82.3%), (54.5%) and (52.9%) respectively. However, ameloblastoma was resected in two cases (50%) and enucleated or excised in two other cases [Table 9].
|Table 9: Distribution of odontogenic cysts and tumors based on treatment provided|
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| Discussion|| |
Odontogenic cysts and tumors are lesions that tend to arise from tooth apparatus or its remnants. In the present study, odontogenic cysts and tumors were analyzed based on gender, age, occupation, nationality, type of the lesion, duration, size, location, clinical diagnosis and treatment provided.
With regards to age, the third and fourth decades of life were the most frequent age groups in this study (46.2%). These results are consistent and in agreement with the findings in prior studies. , Santos et al.,  however, showed a peak incidence in the second decade of life, this difference in age incidence probably being related to the major prevalence of odontomas in such an age range, in their study. Elderly patients (>60-year-old) represented the least age group in the present study, accounting for 6.3% of the sample. One of the major problems that the dental profession faces is the provision of care for the elderly. This age group suffers from reduced independent oral hygiene care abilities, reduced ability to communicate dental pain and problems to others and greater barriers to obtain dental treatment such as transport, financial, physical, cognitive obstacles.
The percentage of odontogenic cysts and tumors in the present investigation was equal in males and females (cysts 84% and tumors 15%), which was not consistent with the results of the study by Meningaud et al.,  who found cysts in 65% of their sample in males and 35% in females. Avelar et al.  recorded 58% in males and 42% females. Ochsenius et al.  found 53% of their sample in males and 47% in females. It is obvious that the males showed a higher prevalence for odontogenic cysts and tumors than females. However, when comparing the size of the odontogenic cysts and tumors we found that the lesions were less than 1 cm size among females, but larger than that for males; this could be attributed to the fact that females tend to be more concerned about their oral and general health than males. The same applies to the duration as females had 25% of lesions diagnosed and treated in less than a 6-month period when compared with only 14% for males. This indicates that they were diagnosed earlier, which could imply more frequent dental check-ups and examinations for females than males.
The prevalence of odontogenic cysts was more among the locals when compared with that in non-locals. This may be due to the fact that the data were retrieved from a hospital in the UAE where, more locals than non-locals seek treatment. This finding contradicts the usual norm that locals seek treatment abroad; however, they have more trust in their medical care providers nowadays. To the best of our knowledge, this is the first study done in this region on the prevalence of odontogenic cysts and tumors.
Odontogenic cysts and tumors with duration of less than 6 months for the employed participants was 8.8%, whereas for unemployed participants it was 25.9% and the lesion size of less than 1 cm for the employed patients was 59%, whereas for the unemployed patients was it 71.6%. This is probably due to the fact that the unemployed participants have more free time to seek treatment compared with the employed participants who are busy and have tight work schedules, thereby tending to put their work before their health. More studies focusing on the duration and size of the odontogenic cysts and tumors are required as there were none to compare our results with.
Radicular cysts were the most commonly observed cysts, a result most consistent with other studies. ,, The percentage of radicular cysts (69%) in this study was exactly the same as the results of Prockt et al.,  which causes great concern as most of these cysts develop due to advanced carious lesions that led to pulpal necrosis and are thus easily preventable. Meningaud et al.  found that cysts may be asymptomatic for a long period of time, which in turn, leads to severe bone destruction. The most common site for radicular cysts in their study was the mandible, which is concurrent with our findings. According to this study, dentigerous cysts were the second most common odontogenic cyst, which is the same result from most studies. More types of odontogenic cysts were detected in other studies, such as odontogenic keratocysts and eruption cysts that were absent in our sample.
Odontogenic tumors rarely present clinically in daily dental practice and therefore, it takes considerable time and effort for any center to collect cases of odontogenic tumors in adequate numbers. Odontoma was the most common odontogenic tumor occurring in our sample; this again is similar to the results of other studies conducted in the US, Canada, Mexico and Chile. ,, In contrast to the studies done in Africa, China and Turkey, however, ameloblastoma was found to be more common. 
The very low prevalence of odontogenic cysts and tumors in the UAE could not only be due to the fact that such cases are rare in this population, but also due to the lack of proper diagnostic methods and poor investigations 20 years ago that resulted in overlooking the detection of these lesions.
| Conclusion|| |
Odontogenic cysts and tumors were found mainly in the middle and posterior mandibular regions, in variable sizes, at the time of diagnosis. Radicular cysts are the most prevalent among the odontogenic cysts followed by the dentigerous cyst, whereas odontoma is the most prevalent odontogenic tumor and seen mostly in the first and second decades of life.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]