Abstract
Purpose
There are very few published epidemiological studies that investigate oral pathology in the paediatric population in an Australian cohort.
Methods
The purpose of this study was to analyze data from histopathological specimens received over a period of 23 years at the Institute for Clinical Pathology and Medical Research ( ICPMR) , and to report on the frequency of oral pathology in the Australian pediatric population. Results obtained from ICPMR, were imported into an electronic database and data such as age, gender and histopathological diagnosis were used to determine the frequency of commonly occurring pathology in children.
Results
A total of 935 oral pathology specimens collected from paediatric patients aged 16 and under were included in the analysis. The most common pathology was salivary gland pathology (21.1%), followed by mucosal pathology (15.8%) and miscellaneous pathology (14.9%). The most frequently encountered lesion was the mucocele (19.1%), followed by periapical granuloma (5.9%), dentigerous cyst (5.1%) and the giant cell fibroma (5%).
Conclusion
In the paediatric population, oral pathology shows an increasing tendency with age, with the majority of pathology being benign in nature comprising mainly of mucoceles and dental pathology particularly, periapical granuloma’s and dentigerous cysts.
1
Introduction
The presentation of oral pathology in the paediatric patient is significantly different to that of the adult patient. It has been speculated that thinner, less keratinized attached gingiva, greater vascularity and less differentiated pattern of collagen fibers in the primary dentition render the tissues less susceptible to inflammation . In addition, increased turnover of cells due to active growth in the developing child and varying immune cell profile could be some of the other underlying factors to explain the stark contrast in the presentation of oral pathology between these groups. The occurrence of oral pathology in the paediatric population, is reported to be in the range of 5–15%, with malignant pathology in less than one percent of the paediatric population . Developmental anomalies commonly diagnosed in the mouth of newborns include Epstein pearls, Bohn’s nodules, dental lamina cysts, and natal teeth. These anomalies are usually of little concern as they are commonly regarded as normal . There is however an increase in the incidence of pathosis with increasing age, with mucous extravasation cysts and periapical pathology being the most commonly diagnosed lesions in children under 16 years of age .
To date, only a few epidemiological studies have been published worldwide, that investigate oral pathology in the pediatric population. There is however, a large variance in the reporting and classification of demographic data, making comparison between studies difficult. Majority of the scientific literature worldwide, shows approximately ten percent of specimens submitted for histopathological analysis are from children under 16 years of age, with a large proportion of lesions being benign and warranting further intervention. Though the risk of malignancy in children is low, it is important for the clinician to be able to diagnose them correctly so that appropriate timely treatment may be provided, helping reduce aesthetic and functional morbidity in the developing child. There have been only two previously published studies looking at paediatric oral pathology in the Australian cohort with the most recent one investigating 676 biopsied oral lesions over a 16-year study period.
Our study aimed to evaluate specimens from 1 to 16-year old children over a 23-year period, with the vast majority of referring clinicians being dentists or dental specialists and histopathological reporting being carried out by oral pathologists. To date there has been no published literature for the paediatric population in the state of New South Wales.
The data for our study was obtained from records of patients presenting to the Department of Paediatric Dentistry and Orthodontics at the Westmead Centre for Oral Health, a major tertiary referral center and a state-wide specialist oral health service provider for New South Wales. Westmead Hospital serves a population of over 1.85 million people and is located on the largest health and hospital campuses in Australia. The purpose of this study was to analyze data from paediatric oral biopsy reports received over a period of 23 years at the Institute for Clinical Pathology and Medical Research (ICPMR), and report on the frequency of oral pathology in the Australian pediatric population to enable comparison with worldwide data.
2
Methods
A total of 15,691 oral biopsy specimens for patients of all ages were received by the Institute for Clinical Pathology and Medical Research (ICPMR) at the Westmead Centre for Oral Health, between the years 1993–2015 (inclusive). The specimens were processed and reported by oral pathologists. The data and records were extracted and stored using a Microsoft® Excel spreadsheet (Microsoft, Inc, Redmond, Wash., USA). The data was categorized using a classification initially proposed by Jones and Franklin , which in the authors opinion remains the most exhaustive and optimally devised classification system to date.
3
Results
A total of 15,691 biopsies were received at the ICPMR during the 23-year study period, of which 935 belonged to our study population. There were 460 specimens from males and 469 from females (M: F ratio = 0.98), with six specimens of unspecified gender. There was a consistent increase in the number of biopsies received with increasing age ( Fig. 1 ).
The diagnostic category with the largest number of specimens was salivary gland pathology ( Table 1 and Fig. 2 ). Of the 196 cases in this group (21.1% of the total samples), 88.2% ( Table 2 ) were mucoceles, which also was the most likely reason why this diagnostic category was most prevalent. There were four pleomorphic adenomas and two salivary carcinomas, which although malignant were classified into the salivary gland category.
| Diagnostic Category | Male | Female | Total | % |
|---|---|---|---|---|
| Salivary gland pathology | 90 | 106 | 197 | 21.1 |
| Mucosal pathology | 63 | 83 | 148 | 15.8 |
| Miscellaneous pathology | 70 | 69 | 139 | 14.9 |
| Dental Pathology | 62 | 63 | 125 | 13.4 |
| Gingival pathology | 68 | 57 | 125 | 13.4 |
| Odontogenic cyst | 58 | 34 | 93 | 9.9 |
| Cyst – Undetermined origin | 16 | 21 | 37 | 4.0 |
| Connective tissue pathology | 6 | 17 | 23 | 2.5 |
| Odontogenic tumour | 14 | 6 | 22 | 2.3 |
| Non-odontogenic cyst | 4 | 6 | 10 | 1.1 |
| Malignant tumour | 4 | 5 | 9 | 1.0 |
| Non-odontogenic tumour | 5 | 2 | 7 | 0.7 |
| TOTAL | 460 | 469 | 935 a |
