In thepast, the condition was known with a variety of names causing confusion in diagnosis and treatment. The condition is usually asymptomatic and needs no treatment as such. The diagnosis of FCOD is made on the basis of typical clinico-radiological features and biopsy is usually not recommended due to the risk of postoperative infection. This paper reports a rare case of FCOD affecting mandible bilaterally in a forty-two years old woman. These lesions are clinically asymptomatic and may be found as incidental radiological finding presenting as multiple radiopaque masses within peripheral radiolucent rim located in two or more quadrants usually in tooth-bearing areas. Biopsy for histopathological examination may not be required to confirm the diagnosis due to their characteristic radiological features.
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In thepast, the condition was known with a variety of names causing confusion in diagnosis and treatment. The condition is usually asymptomatic and needs no treatment as such.
The diagnosis of FCOD is made on the basis of typical clinico-radiological features and biopsy is usually not recommended due to the risk of postoperative infection. This paper reports a rare case of FCOD affecting mandible bilaterally in a forty-two years old woman.
These lesions are clinically asymptomatic and may be found as incidental radiological finding presenting as multiple radiopaque masses within peripheral radiolucent rim located in two or more quadrants usually in tooth-bearing areas.
Biopsy for histopathological examination may not be required to confirm the diagnosis due to their characteristic radiological features. On the contrary, such attempt may increase the risk of infection or fracture of the jaw and hence will adversely affect the patient's health. A year-old female patient presented to our department with a chief complaint of pain in the left molar region of the mandible for 1 month.
The patient was otherwise healthy, and her physical examination showed no significant abnormality. Intraoral examination revealed a carious left mandibular first permanent molar and a missing second permanent molar which was extracted due to caries 2 years ago. Intraoral periapical radiograph showed well-defined irregularly shaped sclerotic masses corresponding to the roots of first and second permanent molar teeth of left mandible [ Figure 1 ]. Orthopantomogram showed multiple well-defined sclerotic masses with radiolucent border in both right and left molar region of the mandible [ Figure 2 ].
These sclerotic masses were surrounded by a thin radiolucent border and appeared to be unattached to the root apices. All teeth were vital. The results of routine hemogram and serum alkaline phosphatase were within normal limits.
Biopsy was not done as the case was diagnosed as FCOD on the basis of characteristic clinico-radiological features. Intraoral periapical radiograph showing well-defined irregularly shaped sclerotic masses corresponding to the roots of left first and second permanent molar teeth of mandible. Orthopantomogram showing multiple well-defined sclerotic masses with radiolucent border in both right and left molar region of the mandible.
FCOD is a non-neoplastic, reactive fibro-osseous lesion confined to the alveolar areas of the jaws and seen to have a typical female gender predilection affecting black women in 4 th -5 th decades with a mean age of 42 years. Similar lesions were found in oriental population and Caucasian females with identical age groups but a definite female predilection of the condition has not been explained.
The pathogenesis of the condition still remains largely obscure. Some authors accredit to the proliferation of the fibroblastic mesenchymal stem cells in the apical periodontal ligament which are cementoblastic precursor stem cells, while others hold the view that it may arise from the remnants of the cementum left after tooth extraction.
Some authors attribute to the trauma from deep bite or heavy bite causing attrition of the teeth that may activate and cause proliferation of the fibroblasts in PDL causing FCOD.
FCOD may have certain jaw bone changes that are similar to familial gigantiform cementoma FGC , another type of fibro-osseous lesion and thus creating great confusion in the differential diagnosis. However, FGC is an autosomal trait genetic disease and affects mostly children. The lesion is typical by its multi-quadrant expansile features affecting both the jaws; often crosses the midline producing asymmetry and facial disfigurement and is without any gender predilection.
The overall behavior of FGC is more akin to benign neoplasia necessitating surgical intervention, which is otherwise contraindicated for the asymptomatic FCOD. The radiological features of enostosis or exostosis may sometimes cause diagnostic confusion for FCOD.
However, their high dense radiopacities with common location of buccal surface of posterior maxillary teeth presenting as nodular growth with blanched out overlying mucosa differentiate exostosis from FCOD.
The enostosis on the other hand, is not confined to jaw bones alone and may be found in other bones as well without a radiolucent rim surrounding the radiodense area, unlike FCODs. Some other lesions with similar features of FCOD are reported in the differential diagnosis including Gardener's syndrome, Paget's disease, chronic diffuse sclerosing osteomyelitis and cemento-ossifying fibroma.
The diagnosis of FCOD is principally based on clinical findings, localization of the lesion, patient's age, gender and ethnicity as well as radiological features. In our case, we have diagnosed the condition as FCOD based on typical clinico-radiological features coupled with age and gender predilection and bilateral location in the mandible. We did not perform biopsy not only for the embodiment of the characteristic features leading to accurate diagnosis but also to avoid the risk of fractures of jaw bones and intractable infection.
The antibiotics are usually not effective due to poor tissue diffusion. FCOD is a rare condition of jaw bones and diagnosed principally by its characteristic clinico-radiological features.
As the condition remains asymptomatic, no surgical treatment is required. However, long term follow-up is carried out to assess the progress of the condition.
We, the authors would like to thank Dr. Lipsa Bhuyan and Dr. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U.
J Oral Maxillofac Pathol. Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.
This article has been cited by other articles in PMC. Keywords: Cementum, dysplasia, florid. Open in a separate window. Figure 1. Figure 2. Footnotes Source of Support: Nil. Florid cemento-osseous dysplasia: Review and report of two cases.
Indian J Dent Res. Clinical, radiographic, and histological findings of florid cemento-osseous dysplasia: A case report. Imaging Sci Dent. Clinical, radiographic, biochemical and histological findings of florid cemento-osseous dysplasia and report of a case. Braz Dent J. Florid osseous dysplasia: Report of a case presenting acute cellulitis. Mac Donald-Jankowski DS.
Florid Cementoosseous Dysplasia: A Rare Case Report
Florid cemento-osseous dysplasia: a contraindication to orthodontic treatment in compromised areas. Dario A. Florid cemento-osseous dysplasia is a sclerosing disease that affects the mandible, especially the alveolar process, and that is, in most cases, bilateral; however, in some cases it affects up to three or even four quadrants. During the disease, normal bone is replaced with a thinly formed, irregularly distributed tissue peppered with radiolucent areas of soft tissue.
Florid cemento-osseous dysplasia
Florid cementoosseous dysplasia FCOD is a rare, benign, fibroosseous, and multifocal dysplastic lesion of the jaw that consists of cellular fibrous connective tissue with bone and cementum-like tissue. FCOD is most commonly found in middle-aged black women, is generally asymptomatic, and is usually detected during radiological examination. FCOD associated with multiple impacted teeth and bone expansion is a very rare phenomenon, and there are only a few familial cases reported in the literature. In this report, a year-old male Turkish patient is presented who was diagnosed with nonfamilial FCOD from clinical, radiological, and histopathological findings.