Pattern and Characteristics of Impacted Teeth Associated With Jaw Cysts and Tumours Among Patients Attending the University of Nairobi Dental Hospital

Abstract

Background: The incidence of impacted teeth is rising globally. Besides dental hard tissue pathologies and pericoronitis, impacted teeth are also associated with destructive jaw cysts and tumours. Irrespective of these facts, non-molar tooth impactions and associated jaw pathologies are hardly published in Kenya. Objectives: To determine the pattern and characteristics of impacted teeth associated with jaw cysts and tumours among patients attending the University of Nairobi Dental Hospital Materials and method: This ten-year (January 2011 to December 2020) retrospective analytical study reviewed histopathology and dental pantomogram records of 354 patients (183 females and 171 males). Data analysis: Data was analysed using SPSS version 28 and a p value ˂ 0.05 was considered statistically significant. Frequencies, percentages and measures of central tendency were used to analyse data. The chi squared/Fisher’s exact tests and the student t-test analyses were used for categorical and continuous data respectively. Results: Of the 354 patients with jaw cysts/tumours, 358 lesions were identified of which 304 (84.9%) were developmental odontogenic lesions, 24 (6.7%) were inflammatory odontogenic and 30 (8.4%) were non-odontogenic in origin. In 52.3% of the developmental odontogenic lesions, 184 impacted teeth were observed. Of those teeth, mandibular third molars were the majority, contributing 21.2%. The next frequently impacted teeth associated with jaw cysts/tumours were the mandibular canines and maxillary canines contributing 17.4% and 16.8% of the teeth respectively. One-hundred and seventy two teeth (93.5%) had impaction depth below the cemento-enamel junction of the adjacent erupted tooth and 49.5% had mesioangular impaction. It was observed that lesion presentation was at least one decade earlier in the presence of impacted teeth. These three findings were statistically significant (p˂0.01). The most prevalent pathological entities associated with impacted teeth were dentigerous cysts (31.1%), ameloblastomas (26.8%), odontomes (15.9%) and odontogenic keratocysts (11.0%) but the overall most frequent jaw lesion irrespective of tooth eruption status was the ameloblastoma, observed in 123 (34.4%) cases. On radiographic appearance, 79.9% of all lesions and 75.6% of those with impacted teeth were radiolucent. The posterior mandible beyond the canine was the most frequently affected site being involved in 95.1% of all cases. Conclusion and recommendations: Deep dental impactions may be associated with jaw cysts and tumours therefore radiologic surveillance and clinical monitoring for all missing teeth, deep impactions and potential jaw lesions is recommended.