ACTINOMYCES-ASSOCIATED CALCIFICATIONS IN A MANDIBULAR DENTIGEROUS CYST THAT PRESENTED WITH INFERIOR ALVEOLAR NERVE PARESTHESIA

Abstract

<h3>Introduction</h3> Dentigerous cysts account for approximately 20% of all odontogenic cysts. The classical presentation is as a unilocular radiolucent lesion associated with an unerupted tooth. Typically asymptomatic, they are often an incidental finding of radiographic investigations. The objective of this case report is to highlight that infected dentigerous cysts may have an atypical presentation that may raise the clinical suspicion of a neoplastic process. <h3>Case Description</h3> This case report describes a rare and atypical presentation of a dentigerous cyst in the mandible that presented with pain and paresthesia of the lower lip. The radiological presentation of the lesion was also unusual, with the lesion manifesting as a well-defined radiolucency containing multiple radiopacities. Histology revealed an infected dentigerous cyst with <i>Actinomyces</i> colonies and dystrophic calcification. <h3>Discussion</h3> There are very few described cases of dentigerous cysts presenting with paresthesia and/or <i>Actinomyces</i>-associated calcification. Our literature review, however, suggests that <i>Actinomyces</i>-associated pathology is more common than one would expect. Although actinomycosis is typically described as an infection of soft tissues, <i>Actinomyces</i>-associated lesions can have a highly variable clinical presentation. This includes the ability to produce <i>Actinomyces</i>-associated calcifications, although this is rarely observed. <h3>Conclusions</h3> Infected dentigerous cysts containing <i>Actinomyces-</i>associated calcifications may need to be considered in the differential diagnosis of lesions presenting as a mixed radiopacity in the jaws. This case also draws attention to the fact that neurosensory disturbance, which is typically associated with malignant disease and injury to the neurovascular bundle, can be a presenting feature of benign entities such as dentigerous cysts.