An incidental finding of a Complex Odontoma – A reminder regarding the importance of routine investigations

Maria-Alexandra Barbu1, Cristina Frezzini1, Iain Varley1
1-Department of Oral and Maxillofacial Surgery Department
Sheffield Teaching Hospitals NHS Foundation Trust


Abstract

Introduction:
Complex odontomas are rare odontogenic tumors composed of a disorganized mass of dental tissues, typically detected during routine radiographic examinations. They represent a developmental anomaly rather than a true neoplasm and are most often diagnosed in the first two decades of life. Although usually asymptomatic, complex odontomas may impede eruption of permanent teeth or alter the normal development of adjacent anatomical structures, warranting early recognition and appropriate management.

Case report:
We report the case of an 11-year-old fit and well female who presented with a complex odontoma of the LR7 region. This was an incidental finding following imaging taken for orthodontic treatment purposes.
We describe the investigation, diagnosis and management of this child’s condition.

Discussion:
This case highlights the incidental detection of a complex odontoma during orthodontic evaluation and underlines the potential implications for tooth eruption and mandibular growth. Multidisciplinary input involving orthodontics and oral and maxillofacial surgery is crucial for establishing an appropriate management plan, balancing surgical intervention with preservation of developing teeth and the inferior alveolar nerve. Early diagnosis allows timely intervention, preventing complications such as impaction, malocclusion, or pathological fracture. Recognition of odontomas as incidental findings on panoramic radiographs emphasizes their significance in orthodontic and pediatric dental practice.

Introduction: Efficient referral pathways are crucial for prompt and exceptional paediatric surgical care. This audit evaluates the trend, demography and outcomes of paediatric referrals to Royal Hallamshire Hospital’s Oral and Maxillofacial Surgery department (OMFS). The understanding of referral patterns allows for strategic resource allocation, enforces evidence-based planning and streamlines patient centred care by developing data-driven referral pathways.

Methods: A retrospective audit was conducted involving 649 paediatric patients referred to our institution over a 12-month period (August 2024 to July 2025). The data was categorised according to referral source, date, clinical indication and subsequent management. The data was analysed using descriptive statistic and graphical representation for ease of interpretation.

Results: Preliminary analysis revealed a sizeable variation in referral sources and clinical indications. A notable portion of referrals originate from Sheffield Children’s Hospital (65%) with laceration (49%) being the major indication of referral. Majority of paediatric patients underwent admission and surgery at 39% followed by treatment under local anaesthesia (LA) at 19%. This audit also indicates the highest frequency of referrals are in the month of May at 86, inversely February reported the lowest frequency at 29.

Conclusion: The trend demonstrates significant seasonal variation and potential over-referral in certain categories. This audit emphasizes the need for closer cooperation and clear communication channels between primary care providers, district hospitals and other tertiary centres. The findings provide actionable insights to guide resource allocation, informed decision making and infrastructure development. Enhanced triage protocols, appropriate staff education, and adequate manpower could mitigate unnecessary hospital referrals and encourages timely interventions of high priority cases.