Introduction
Children which represent the future of the world, and thus, ensuring their healthy growth and development should be a major concern of all countries worldwide. Newborns and children are vulnerable to malnutrition and infectious diseases, many of which can be effectively prevented or treated. It is estimated that in low- and middle-income countries (249 million) about 43% of the pediatric population that are younger than 5 years are at risk of not reaching their developmental potential.1
Due to the low frequency of hard tissue and soft tissue anomalies in oral region in children, the diagnosis is challenging. These lesion differs in distribution of age, sex, common location in oral cavity and origin of the lesion from the others.2
The prevalence of these diseases among different regions of the world shows considerable variation as racial and environmental specificities, and the lifestyle of each population may be the influencing fasctors. The majority of studies regarding oral conditions have been limited to investigation of caries, periodontal disease, dental trauma, clefts and malocclusion in children, despite the suggestions made by World Health Organization (WHO) regarding the epidemiologic assessment of oral lesions.3
In children there is limited data available on the lesions such as jaw cysts, odontogenic tumors, benign and malignant neoplasms, and salivary gland pathologies.4 Earlier studies conducted internationally such as one conducted by Skinner et al. over 14 year period in which they documented epidemiological information in the age group of 0–19 years old from 1525 biopsied oral lesions;5 however, Jones and Franklin reported lesions in the age group of 0–16 years with the longest follow-up data (30 years) and the number of lesions being highest (4406).6 Few studies that have been conducted in India on oral lesions in children which include one from Salem, Tamil Nadu, where Krishnan et al. analyzed 97 cases in 0–15 year age group in their 10 year period7 and other in which they analyzed 540 cases aged 0–12 years over 10 year period conducted by Heera et al. from South Kerala.8 However, upto date no such study has been reported in the Jammu & Kashmir region of India.
Aims and Objectives
To evaluate retrospectively, the pediatric oral biopsies received between 2011-2022 years in the Department Of Oral and Maxillofacial Pathology & Oral Microbiology, Indira Gandhi Government Dental College Jammu, J&K
To evaluate the total number of pediatric oral biopsies obtained below
To evaluate the incidence of pediatric oral lesions in Jammu region of J&K.
To classify the pediatric oral pathologies based on age, sex and site predilection.
To identify the histopathological correlation in oral biopsies in clinically diagnosed pediatric oral lesions.
Materials and Methods
Archives of biopsy requisition form of pediatric patients between 0 and 14 years age group were retrieved from the Department of Oral and Maxillofacial Pathology & Oral Microbiology, Indira Gandhi Government Dental College Jammu, J&K, during the time period from Januaury 2011 to December 2022. Information regarding the patients biodata including age, gender, location, provisional and histopathological diagnosis were collected and data was calculated. Biopsies were grouped under four classes, that included jaw cysts, reactive lesions, fibro-osseous lesions and odontogenic tumors. Requisition forms with incomplete clinical information or missing diagnosis were excluded. In case of different diagnoses, the first diagnosis was recorded. In patients with double biopsy, diagnosis of the second biopsy was considered. Children were sorted under three age groups, i.e. < 5 years, 5-10 years, > 10 years, respectively. Data were tabulated and analyzed by descriptive statistics using the IBM, SPSS 20.0, Chicago, USA.
Results
In this study period of 12 years, 727 biopsies were received of which 36 (4.9%) belonged to pediatric population. Prevalence was more in females (64%) compared to males (36%) [Figure 1]. The age group 10–14 years was commonly affected and below 5 years were the least affected [Figure 2]. Mandible showed greater predeliction compared to maxilla among the jaws were the most common location, which was followed by the gingiva, palate, lower lip and labial mucosa [Figure 3]. The fibromas as the provisional diagnosis were the most common pathologies which were received followed by dentigerous cysts, radicular cysts, mucoceles and pyogenic granulomas [Figure 4]. Histopathologically, dentigerous cysts (22%) were the most common followed by radicular cysts (17%), fibrous hyperplasia (14%), pyogenic granuloma (11%), central giant cell granuloma (8%), hyperplasia of minor salivary glands (5.6%) and equal percentage of aneurysmal bone cyst, peripheral giant cell granuloma, peripheral ossifying fibroma, central ossifying fibroma, juvenile ossifying fibroma, cementoblastoma, ameloblastoma, necrotic bone (2.8%) [Figure 5] [Table 1].
Figure 3
Common pediatric lesions according to location in the oral and maxillofacial region shown in bar chart
Figure 5
Prevalence of histologically diagnosed pediatric oral lesions in different categories shown in bar chart
Table 1
Percentage distribution of biopsies according to histological diagnosis
Cysts were the most common lesions that were seen, out of which dentigerous cysts formed majority, followed by radicular and aneurysmal bone cysts. Among reactive lesions most commonly diagnosed were fibrous hyperplasia, followed by pyogenic granuloma, hyperplasia of minor salivary glands, peripheral giant cell granuloma and peripheral ossifying fibroma. Among fibroosseous lesions central giant cell granulomas were diagnosed the most, followed by central ossifying fibroma, juvenile ossifying fibroma, cementoblastoma and necrotic bone. Among odontogenic tumors only ameloblastoma was diagnosed [Figure 5]. Age showed a significant association with the diagnosis where cysts, reactive and fibroossseous were seen in majority of the patients aged greater than 10 years age group. In the age group of 5-10 years again majority of the cases diagnosed were cysts, followed by reactive lesions and odontogenic tumors. In age group less than 5 years majority cases diagnosed were reactive lesions and cysts [Figure 6]. There was also significant association between gender and diagnosis with reactive lesions, fibroosseous lesions and odontogenic tumors were seen more in females and cysts were seen more in males [Figure 7].
Discussion
Many studies have been done worldwide and in India regarding the histopathological correlation of oral pediatric lesions. Pediatric biopsies account about <10% of overall cases in literature referred for histopathology services in most of the foreign and Indian studies that are available.8 However, prevalence between 11% and 27.2% was found by many authors.9 Prevalence of 4.9%, was seen in our study on comparing the total number of biopsies referred to the department. These pathologies were reported in mixed dentition in children aged above 10 years as mentioned in previous studies.7, 10, 11, 12, 13, 14 In our study, age group were further divided into three groups, namely <5 years, 5–10 years and >10 years but the age group between 10–14 years accounted for most of the pathologies. To determine the age interval for occurrence of these pathologies, difficulties among the pediatric population could be partly because there has been variations in the age range considered for pathologies in various studies. 8 The incidence of these pathologies among males and females was reported to be equal in most of the studies,6, 12 but occurrences in females is more in the studies reported in India. 7, 8 This study also reported the pediatric oral pathologies to be more prevalent in females (64%) as compared to males (36%). Also in this study most commonly affected site was mandible which is in harmony with the previous three studies reported in South India.7, 8, 15 Studies of Maia 16 et al., and Lima10 et al., reported maxilla as the most common site,but in our study mandible was found to be more affected than maxilla.
Cysts
In our study, dentigerous cysts were the most common followed by radicular/ periapical cysts. Dentigerous cysts were also the most common in the studies reported by Monique Maria Melo Mouchrek et al., 9 Kittipong Dhanuthai et al.,17 and Sumithra Das et al. 12. A single case of aneurysmal bone cyst was also seen in our study. Thus majority of diagnosis was formed by the cysts (42%), mostly seen in children that were above 10 years. Krishnan et al. and Heera et al also showed cysts forming the majority of the diagnosis in there studies. 7, 8
Reactive lesions
In our study percentage of reactive lesions was 36%, which was more in females and in children of age group above 10 years. Most commonly diagnosed was fibrous hyperplasia, followed by pyogenic granuloma, hyperplasia of minor salivary glands, peripheral giant cell granuloma and peripheral ossifying fibroma. According to Mouchrek MM et al.,9 inflammatory fibrous hyperplasia was the commonest lesion. According to Gulteklin et al.,18 peripheral giant cell granuloma was the most common lesion. Pyogenic granuloma was found to be the highest in this category by Saravani et al.4
Fibroosseous lesions
They formed 19.2% of pathologies with majority being central giant cell granulomas, followed by central ossifying fibroma, juvenile ossifying fibroma, cementoblastoma and necrotic bone. In the second and third decades of life these lesions are more common and it could be a reason that in children below 14 years of age lesser number of these lesions were being observed. Saxena et al.,19 studied pediatric jaw tumours and have reported 9 cases of fibrous dysplasia which was not seen in our study.
Odontogenic tumors
Odontogenic tumors constitute about 2.8% of pediatric pathologies with only one case each of ameloblastoma. Krishnan et al.4 and Dhanuthai et al. in their studies showed ameloblastoma to be the most common in this category.18 However reported in the odontogenic category, odontomas have been majority in the international studies [4,5,9-11,17-19] and Indian studies.8, 15
Conclusion
Our study is an attempt to study the common pediatric oral pathologies reported to Department Of Oral and Maxillofacial Pathology & Oral Microbiology, Indira Gandhi Government Dental College Jammu, J&K, from 2011 to 2022. The majority of the oral pathologies detected were benign. This study will throw some light regarding the prevalence and characteristics of the lesions prevailing in the pediatric population in Jammu region of J&K which in turn will be useful for the general dentist, researchers, surgeons, and pediatric dentists in diagnosing and managing these lesions appropriately to seek better health care and contribute to the data regarding pediatric oral biopsies.
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