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Journal of International Society of Preventive and Community Dentistry

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document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = 'Topical'; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId').value = journalId; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenTopicalCollectionId').value = topicalCollectionId; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == null || document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == '') { document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value = journalId; } if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCSuccessPopup() { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } $('.js-close').on('click', function() { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.hide(); } return false; }); </script> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_dummyTargetControl"></span> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenSubscribeToEtocPopupState" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscribeToEtocPopupState" value="showemail" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenConfirmSubscriptionPageUrl" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenConfirmSubscriptionPageUrl" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenJournalId" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenSubscriptionType" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscriptionType" /> <div id="divPopupOverLay" class="Popup-Overlay" style="display: none; position: fixed; left: 0; top: 0; z-index: 3800; width: 1920px; height: 4517px;"></div> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlSubscribeToEtoc" class="etoc-popup ej-box-modal-drop-shadow" style="display: none;"> <div tabindex="-1" role="dialog" class="wk-modal horizontally-centered small wk-modal-with-overlay wk-modal-small ejp-modal"> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlMain" onkeypress="javascript:return WebForm_FireDefaultButton(event, &#39;ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_btnContinue&#39;)"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblTitle"></span> </div> <button aria-label="close dialog" class="js-close primary-button wk-button-icon wk-modal-close ejp-modal-close "> <i class="fa fa-times"></i> </button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <div class="wk-field-body"> <strong> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblThankYouMessage"></span></strong> </div> <div class="wk-field-body"> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError" style="color:Black;display:none;"> <div class="ej-error-message"> <p class="ej-error-message-icon error-red"> </p> </div> </span> <label for="Email input">Enter your Email address:</label> <div class="wk-field-body"> <input name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$txtEmailAddress" type="text" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress" class="ej-box-modal-style-1-input" /> </div> </div> <div class="wk-button-bar"> <div class="wk-button-group-left"> <input type="submit" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$btnContinue" value="Continue" onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions(&quot;ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$btnContinue&quot;, &quot;&quot;, true, &quot;&quot;, &quot;&quot;, false, false))" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_btnContinue" class="primary-button" /> <input type="button" value="Cancel" id="btnCancel" class="js-close secondary-button" /> </div> </div> </div> <div class="wk-field-item"> <div class="wk-field-body"> <a id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hypPrivacy" href="https://journals.lww.com/jpcd/_layouts/oaks.journals/privacy.aspx" target="_blank">Privacy Policy</a> </div> </div> </div> </section> </div> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlAuthenticatedUser" style="display: none;"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"></div> <button aria-label="close dialog" class="js-close primary-button wk-button-icon wk-modal-close ejp-modal-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <p> <strong> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblAuthenticatedUserTitle"></span> </strong> </p> </div> <p id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pAuthenticatedUserMessage"> </p> </div> </section> </div> </div> </div> <div id="ej-clear-float"> </div> <script type="text/javascript"> function alerts_SaveSubscriptionTypeInHiddenField(url, subscriptionType, journalId, yearId, issueId, articleId) { if (journalId && yearId && issueId && articleId) { logCounterDataAlertWhenCitedSynchronously(journalId, yearId, issueId, articleId); } $('#' + 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscriptionType').val(subscriptionType); $('#' + 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId').val(journalId); if (url) window.location = url; else __doPostBack('hypSubscribeToAlerts'); return false; } function alerts_ShowSubscribeeTOCPopup(journalTitle, journalId, subscriptionType, displaySubscriptionType) { $('#' + 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscriptionType').val(subscriptionType); var subscribeToEtocPopup = $find('subscribeToEtoc'); subscribeToEtocPopup.show(); document.getElementsByTagName( 'html' )[0].classList.add('no-scroll'); var modelPopupState = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscribeToEtocPopupState'); var emailTextBox = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress'); var thanksPanel = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlAuthenticatedUser'); var mainPanel = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlMain'); var thankYouMessageUnAuthenticated = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblThankYouMessage'); var thankYouMessageAuthenticated = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblAuthenticatedUserTitle'); if (!displaySubscriptionType) { displaySubscriptionType = subscriptionType; } if (modelPopupState.value == 'showthanksmessage') { thanksPanel.style.display = "block"; mainPanel.style.display = "none"; thankYouMessageAuthenticated.innerHTML = "Thank you for subscribing to the " + displaySubscriptionType + " for " + journalTitle + "."; } if (modelPopupState.value == 'showemail') { thanksPanel.style.display = "none"; mainPanel.style.display = "block"; thankYouMessageUnAuthenticated.innerHTML = "Thank you for choosing to subscribe to the " + displaySubscriptionType + " for " + journalTitle + "."; } if ($('.etoc-popup') != null) { document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId').value = journalId; if (modelPopupState.value == 'showemail') emailTextBox.focus(); } } $('.js-close').on('click', function () { document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress').value = ""; document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError').style.display = "none"; var pageUrl = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenConfirmSubscriptionPageUrl'); var subscribeeTocPopup = $find('subscribeToEtoc'); if (subscribeeTocPopup != null) { subscribeeTocPopup.hide(); document.getElementsByTagName( 'html' )[0].classList.remove('no-scroll'); if (pageUrl.value !== '' && pageUrl.value !== window.location.pathname) window.location = pageUrl.value; } return false; }); </script> <div id="ctl00_ctl51_Header_UserActionTools_eTocTopContainer"> <div id="eTocTop" style="display: none;"> <a rel="nofollow" title href="javascript:javascript: alerts_ShowSubscribeeTOCPopup(&#39;Journal of International Society of Preventive and Community Dentistry&#39;,&#39;jpcd&#39;,&#39;eTOC&#39;, &#39;eTOC&#39;);;" onclick="javascript: alerts_ShowSubscribeeTOCPopup(&#39;Journal of International Society of Preventive and Community Dentistry&#39;,&#39;jpcd&#39;,&#39;eTOC&#39;, &#39;eTOC&#39;);"><span id="ctl00_ctl51_Header_UserActionTools_alertLinkControlTop_defaultText" class="hideOnFixed">Subscribe to eTOC</span></a> </div> </div> <script> $(function () { //find recent searches link and move container var recentSearchesControl = $("a[id$='RecentSearches']"); if (recentSearchesControl.length) { recentSearchesControl.click(function (e) { e.stopPropagation(); if ($("#ResentSearchContainer").is(":hidden")) { $("#ResentSearchContainer").slideDown("slow"); recentSearchesControl.addClass('open'); } else { $("#ResentSearchContainer").hide(); recentSearchesControl.removeClass('open'); } }); } var eTocAccountLink = $("ul.js-user-action-toolbar__dropdown>li>a[id='SubscribeToEToc']"); if (eTocAccountLink.length) { eTocAccountLink.parent().html($("#eTocTop>a")); } }); </script> <a class="logo-secondary white" href="http://wolterskluwer.com/" target="_blank"> <h3 class="logo-secondary-text">Secondary Logo</h3> </a> <a href="#" class="sticky-search"><i class="fa fa-search"></i></a> </div> <div class="header__layout-bottom wk-grid-page-container"> <a id="hypJournals" class="logo-main" href="https://journals.lww.com/jpcd/pages/default.aspx"> <h3 class="logo-main-text">Journal Logo </h3> </a> <div class="search-v2"> <div class="search-wrapper"> <select name="ctl00$ctl51$Header$SearchTopBoxControl$ddlContentScope" id="ctl00_ctl51_Header_SearchTopBoxControl_ddlContentScope"> <option value="All">All</option> <option selected="selected" value="Articles">Articles</option> <option value="Images">Images</option> <option value="Videos">Videos</option> <option value="Podcasts">Podcasts</option> <option value="Blogs">Blogs</option> </select> <div class="input-group" id="globalSearch"> <input 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name="ctl00$ctl51$Header$SearchTopBoxControl$btnGlobalSearch" value="" id="ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearch" disabled="disabled" class="aspNetDisabled btnGlobalSearch" style="display: none;" /> <input name="ctl00$ctl51$Header$SearchTopBoxControl$hfldKeywords" type="hidden" id="ctl00_ctl51_Header_SearchTopBoxControl_hfldKeywords" class="hfldKeywords" value="disableButton" /> </div> </div> <script> $(function() { try { var objSearchBox = { btnGlobalSearchMagnifierId: 'ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearchMagnifier', searchButtonId: 'ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearch', txtKeywordsId: 'ctl00_ctl51_Header_SearchTopBoxControl_txtKeywords', hfldKeywordsHiddenId: 'ctl00_ctl51_Header_SearchTopBoxControl_hfldKeywords', defaultSearchText: 'Search' }; new Searchbox(objSearchBox).Init(); } catch (e) { console.error(e); } }); //autocomplete functionality for basic search //this functionality will call the SBA url and start suggesting after typing 3rd character var textKeywords = null; var hiddenAutocompleteApiUrl = null; var buttonGlobalSearch = null; $(function () { try { var objAutocomplete = { hiddenIsAutoCompleteEnabled: $('#ctl00_ctl51_Header_SearchTopBoxControl_IsAutoCompleteEnabled'), textKeywords: $('#ctl00_ctl51_Header_SearchTopBoxControl_txtKeywords'), hiddenAutocompleteApiUrl: $('#ctl00_ctl51_Header_SearchTopBoxControl_AutocompleteApiUrl'), buttonGlobalSearch: $('#ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearch'), enableNewAutoComplete: true, newAutoCompleteUrl: 'https://dxg-search-na-prd.wkgposvc.cloud/Query.svc/Query_Expand', newAutoCompleteMaxSuggestions: '10', newAutoCompleteDictionaryIds: 'ovid_sted28_mesh22' }; autoComplete(objAutocomplete); } catch (e) { console.error(e); } }); $(function () { let searchSelect = $('select[id$="ddlContentScope"]');; if (searchSelect.length){ searchSelect.selectize(); } }); </script> </div> <div id="main-nav-container-v2"> <nav id="main-nav" class="navbar navbar-default yamm wk-grid-page-container"> <div class="navbar-header"> <button id="fatJuicy" type="button" class="navbar-hamburger-button navbar-toggle collapsed pull-left" data-bs-toggle="collapse" data-bs-target="#zz1_TopNavigationMenu" aria-expanded="false" aria-controls="navbar"> <span class="visually-hidden">Toggle navigation</span> <span class="icon-bar"></span> <span class="icon-bar"></span> <span class="icon-bar"></span> <span class="navbar-hamburger-button__text"></span> </button> </div> <div id="navActionButtons" class="btn-group navbar-hover-color" role="group" aria-label="..."> <a id="ctl00_ctl51_lnkRegister" class="btn btn-default navbar-button" href="https://journals.lww.com/jpcd/pages/register.aspx?ContextUrl=%2fjpcd%2ffulltext%2f2015%2f05050%2fhamartomas_of_the_oral_cavity.3.aspx">Register</a> <button class="user-menu__link user-menu__link--login js-ejp-login-btn btn btn-default navbar-button" type="button" data-config="{&quot;eventName&quot;:&quot;login&quot;,&quot;eventDetail&quot;:{},&quot;isNull&quot;:false}"> <span>Login</span> </button> </div> <div id="ctl00_ctl51_TopNavigationMenuConfiguration" style="display:none" class="js-top-navigation-menu-configuration" data-config="{&quot;browsingHistory&quot;:{&quot;isEnabled&quot;:true,&quot;serviceUrl&quot;:&quot;https://apim-hlrp-ejp-prod.azure-api.net/ee&quot;,&quot;pdfDownloadUrl&quot;:&quot;/_layouts/15/oaks.journals/downloadpdf.aspx?trckng_src_pg=HistoryTab&quot;}}"></div> <div id="zz1_TopNavigationMenu" class="navbar-collapse collapse js-top-navigation-menu noindex ms-core-listMenu-horizontalBox"> <ul id="zz2_RootAspMenu" class="root ms-core-listMenu-root static"> <li class="static selected"><a class="static selected menu-item ms-core-listMenu-item ms-displayInline ms-core-listMenu-selected ms-navedit-linkNode" href="/JPCD/pages/default.aspx" accesskey="1"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Home</span><span class="ms-hidden">Currently selected</span></span></a></li><li class="static"><a class="static menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/JPCD/pages/currenttoc.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Current Issue</span></span></a></li><li class="static"><a class="static menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/JPCD/pages/issuelist.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Previous Issue</span></span></a></li><li class="static dynamic-children"><span class="static dynamic-children menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode"><span aria-haspopup="true" class="additional-background ms-navedit-flyoutArrow dynamic-children"><span class="menu-item-text">For Authors</span></span></span><ul aria-hidden="true" class="dynamic"> <li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/JPCD/Pages/informationforauthors.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Information for Authors</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="https://review.jow.medknow.com/jispcd"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Submit a Manuscript</span></span></a></li> </ul></li><li class="static"><a class="static menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/JPCD/toc/publishahead"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Published Ahead-of-Print</span></span></a></li><li class="static dynamic-children"><span class="static dynamic-children menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode"><span aria-haspopup="true" class="additional-background ms-navedit-flyoutArrow dynamic-children"><span class="menu-item-text">Journal Info</span></span></span><ul aria-hidden="true" class="dynamic"> <li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/JPCD/pages/aboutthejournal.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">About the Journal</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/JPCD/pages/editorialboard.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Editorial Board</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/JPCD/pages/affiliatedsociety.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Affiliated Society</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="https://www.medknow.com/advertise.asp"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Advertising</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="https://www.medknow.com/subscribe.asp"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Subscriptions</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="https://www.medknow.com/ReprintsAndLicensing.asp"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Reprints</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="https://www.medknow.com/rights.asp"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Rights and Permissions</span></span></a></li> </ul></li> </ul> </div> <div class="search-v2"> <div class="search-wrapper"> <select name="ctl00$ctl51$SearchBox$ddlContentScope" id="ctl00_ctl51_SearchBox_ddlContentScope"> <option value="All">All</option> <option selected="selected" value="Articles">Articles</option> <option value="Images">Images</option> <option value="Videos">Videos</option> <option value="Podcasts">Podcasts</option> <option value="Blogs">Blogs</option> </select> <div class="input-group" id="globalSearch"> <input name="ctl00$ctl51$SearchBox$txtKeywords" type="text" value="Search" id="ctl00_ctl51_SearchBox_txtKeywords" class="form-control searchText" /> <span class="input-group-btn"> <button id="ctl00_ctl51_SearchBox_btnGlobalSearchMagnifier" type="submit" class="btn btn-default"><i class="fa fa-search"></i></button> </span> <input type="hidden" name="ctl00$ctl51$SearchBox$IsAutoCompleteEnabled" id="ctl00_ctl51_SearchBox_IsAutoCompleteEnabled" value="false" /> <input type="hidden" name="ctl00$ctl51$SearchBox$AutocompleteApiUrl" id="ctl00_ctl51_SearchBox_AutocompleteApiUrl" value="https://platformservices.wolterskluwerhealth.com/autocomplete/jispc/shingle/" /> </div> </div> <div class="advance-search" style=""> <a id="ctl00_ctl51_SearchBox_lnkAdvanceSearch" href="https://journals.lww.com/jpcd/pages/advancedsearch.aspx">Advanced Search</a> <input type="submit" name="ctl00$ctl51$SearchBox$btnGlobalSearch" value="" id="ctl00_ctl51_SearchBox_btnGlobalSearch" disabled="disabled" class="aspNetDisabled btnGlobalSearch" style="display: none;" /> <input name="ctl00$ctl51$SearchBox$hfldKeywords" type="hidden" id="ctl00_ctl51_SearchBox_hfldKeywords" class="hfldKeywords" value="disableButton" /> </div> </div> <script> $(function() { try { var objSearchBox = { btnGlobalSearchMagnifierId: 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oral cavity', '09012015', 'Shankargouda Patil, Roopa Rao, and Barnali Majumdar', '5', '5', '\u00A9 2015 Journal of International Society of Preventive and Community Dentistry | Published by Wolters Kluwer – Medknow', '01732935-201505050-00003', '', true, ''); } </script> <div id="ArticleContainer"> <article id="ej-article-view" class="js-article-view ej-article-view" xmlns:ssr="http://ssr-eus-go-csi.cloudapp.net/v1/assets" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xhtml="http://www.w3.org/1999/xhtml"><section class="ejp-r-article-subsection"><div class="ejp-r-article-subsection__text">Review Article</div></section><header class="ejp-article-header"><h1 class="ejp-article-title">Hamartomas of the oral cavity</h1></header><section id="ejp-article-authors"><p id="P7">Patil, Shankargouda; Rao, Roopa S.; Majumdar, Barnali</p><section><a href="#" id="ejp-article-authors-link"> Author Information <i class="wk-icon-arrow-down-r"></i></a></section></section><section id="ejp-article-authors-info" class="ejp-article-authors-info ejp-article-authors-info--hidden"><div class="ejp-article-authors-info-holder"> <p id="AF_ID_d1276e44">Department of Oral Pathology and Microbiology, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India</p> <p id="BT_ID_d1276e50"><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">Corresponding author</strong> (email: &lt;<span><a href="/cdn-cgi/l/email-protection#d2a1b0a2b3a6bbbee3e4e3e092b5bfb3bbbefcb1bdbf" onclick="javascript:window.open('mailto:sbpatil1612@gmail.com');return false"><span class="__cf_email__" data-cfemail="0774657766736e6b3631363547606a666e6b2964686a">[email&#160;protected]</span></a></span>&gt;) Dr. Shankargouda Patil, Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, MSR Nagar, MSRIT Post, Bengaluru - 560 054, Karnataka, India. </p> <p id="BT_ID_d1276e50">This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.</p> </div></section><section id="article-journal-info"><div class="ej-journal-info"><span class="ej-journal-name">Journal of International Society of Preventive and Community Dentistry </span><span id="ej-journal-date-volume-issue-pg"><a href="/jpcd/toc/2015/05050">5(5):p 347-353, Sep–Oct 2015.</a></span><span> | </span><span class="ej-journal-doi">DOI: </span>10.4103/2231-0762.164789</div></section><section id="ejp-article-indicators" class="ejp-article-indicators"><ul class="ejp-article-indicators__list"> <li id="ej-article-indicators-open" class="ejp-article-indicators__list-item" onmouseover="javascript:Tooltip_Open()" onmouseout="javascript:Tooltip_MouseOut()"><span class="ejp-indicator">Open</span></li> </ul><button id="openArticleMetricsPopupButton" type="button" class="wk-button wk-button-ghost wk-button-icon-left ejp-article-metrics-btn" data-articleMetricsEndpoint="//services.journals.lww.com/IntegrationServices/ArticleMetricsService.svc" data-articleMetricsDetailsUrl="https://wolterskluwer.altmetric.com/details/" data-doi="10.4103/2231-0762.164789" data-suiteId="vrs_woltere_journalsglobalvrs" data-articlePublicationDate="2015-09-01" data-articlePublicationDateString="Sep-Oct 2015" data-receivedDate="" data-revisionReceivedDate="" data-acceptedDate="" data-crossrefRefLinkRoot="https://doi.org/" data-medlineRefLinkRoot="http://www.ncbi.nlm.nih.gov/pubmed/" data-pubMedId="26539384"><i class="wk-icon-filled-chart-r"></i><i class="wk-icon-filled-chart-white-r"></i> Metrics </button></section><section class="ejp-article-tabs" id="abstractWrap"><h2 class="ejp-article-tabs-heading">Abstract</h2> <div class="ejp-article-tabs__tabpanel" id="panel1" role="tabpanel" aria-labelledby="tab1"> <div id="article-abstract-content1"> <div class="ejp-article-text-abstract"> <p>The majority of oral diseases present as growths and masses of varied cellular origin. Such masses may include simple hyperplasia, hamartoma, choristoma, teratoma, benign or malignant neoplasms. The distinguishing features of hamartomatous lesions are not certain, and often these non-neoplastic masses are indiscreetly denoted as neoplasms without weighing their pathology or biological behaviour. Essentially, understanding the dynamics of each of these disease processes forms an integral part of the appropriate treatment planning.</p> </div> </div> </div></section><div class="ejp-fulltext-content js-ejp-fulltext-content"><section id="ArticleBody"><h2 class="ejp-article-outline-heading" data-level="1" id="H1-3">INTRODUCTION</h2> <p id="O4-3-2">The term hamartoma is derived from the Greek word “hamartia” referring to a defect or an error.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R1-3">1</a></sup>] It was originally coined by Albrecht in 1904 to denote developmental tumour-like malformations.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R2-3">2</a></sup>] It can be defined as a non-neoplastic, unifocal/multifocal, developmental malformation, comprising a mixture of cytologically normal mature cells and tissues which are indigenous to the anatomic location, showing disorganized architectural pattern with predominance of one of its components.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R1-3">1</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R3-3">3</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R4-3">4</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R5-3">5</a></sup>] The occurrence of multiple hamartomas in the same patient is often referred as hamartomatosis or pleiotropic hamartoma.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R3-3">3</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R6-3">6</a></sup>]</p> <p id="O4-3-3">Hamartomas are commonly observed in lung, pancreas, spleen, liver and kidney. They are rare in the head and neck region.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R3-3">3</a></sup>] Within the oral cavity, indigenous tissues that might result in hamartomatous growths include odontogenic and non-odontogenic epithelial derivatives, smooth and skeletal muscle, bone, vasculature, nerve and fat.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R5-3">5</a></sup>] Few hallmarks of a hamartoma based on literature include:[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R3-3">3</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R5-3">5</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R7-3">7</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R8-3">8</a></sup>]</p> <ul id="O3-3-2" class="wk-article__list wk-article__list--bullet"> <li class="wk-article__list-item wk-article__list-item--bullet">Developmental malformation may be present at birth, but manifests later</li> <li class="wk-article__list-item wk-article__list-item--bullet">Self-limited growth, co-ordinated with that of the surrounding tissues</li> <li class="wk-article__list-item wk-article__list-item--bullet">Can present as solitary or multiple masses</li> <li class="wk-article__list-item wk-article__list-item--bullet">May regress spontaneously</li> <li class="wk-article__list-item wk-article__list-item--bullet">Usually not encapsulated with ill-defined margins</li> <li class="wk-article__list-item wk-article__list-item--bullet">Not a true neoplasm, but a true neoplasm may develop in a hamartoma</li> <li class="wk-article__list-item wk-article__list-item--bullet">Microscopically, it consists of cytologically normal mature cells, native to the anatomic location</li> <li class="wk-article__list-item wk-article__list-item--bullet">Association with chromosomal abnormalities and syndromes.</li> </ul> <p id="O4-3-5">Nevertheless, not all the lesions stated as hamartomas in the literature justify completely the above features. According to the data tabulated in <a href="javascript:void(0)" onclick="javascript:showSlideShowByImageID('T1-3', '01732935-201505050-00003');">Table 1</a>, the most important features perceived are its limited growth potential after adolescence, microscopic appearance of unencapsulated admixture of mature cells native to the anatomic location and association with chromosomal aberrations.</p><section class="ejp-r-article-images"><figure class="ejp-r-article-images__figure"><a href="javascript:void(0)" class="ejp-r-article-images__image-link" onclick="showSlideShowByImageID('T1-3', '01732935-201505050-00003')"><img class="ejp-r-article-images__img js-lazy-load lazy-load" src="javascript:void(0);" data-src="https://images.journals.lww.com/jpcd/ArticleViewerPreview.01732935-201505050-00003.T1-3.jpeg" data-srcset="https://images.journals.lww.com/jpcd/ArticleViewerPreview@2.01732935-201505050-00003.T1-3.jpeg 2x" srcset="" alt="T1-3"></a><figcaption class="ejp-r-article-images__figcaption"><a href="javascript:void(0)" class="ejp-r-article-images__figcaption-link" onclick="showSlideShowByImageID('T1-3', '01732935-201505050-00003')">Table 1: </a><div class="ejp-r-article-images__figcaption-text">Summary of characteristic features of oral hamartomas</div></figcaption></figure></section><p id="O4-3-7">The pathogenesis of hamartomas still remains speculative.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R1-3">1</a></sup>] They are derived from any one of the embryonic lineages, most commonly the mesoderm. This is almost never in the case of neoplasm, where the neoplastic cells are clonally derived.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R9-3">9</a></sup>]</p> <p id="O4-3-8">Clinically, majority are asymptomatic and rarely pose any complications except when situated at the base of tongue. Given the non-neoplastic nature of hamartomas, conservative surgical excision is the treatment of choice. The prognosis is excellent, with nil or minute chances of recurrence.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R3-3">3</a></sup>]</p> <h2 class="ejp-article-outline-heading" data-level="1" id="H3-3">HAMARTOMATOUS GROWTH OF ODONTOGENIC APPARATUS</h2> <h3 class="ejp-article-outline-heading" data-level="2" id="H4-3">Dens invaginatus</h3> <p id="O5-3-2">Dens invaginatus is a developmental anomaly resulting in invagination of the enamel organ into the dental papilla before the mineralization of the dental tissues begin. The prevalence is 0.3–10%. Associated syndromes include William's syndrome, Nance-Huran syndrome, cranial suture syndromes and Ekman-Westborg–Julin syndrome.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R10-3">10</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R11-3">11</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H5-3">Dens evaginatus</h3> <p id="O6-3-2">Dens evaginatus (DE) represents an accessory cusp and is predominantly seen in people of Asian descent with a varying incidence of 0.5–4.3%. Clinically, DE may cause malocclusion resulting in abnormal wear or fracture and is treated accordingly.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R12-3">12</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H6-3">Enamel pearl/Enameloma</h3> <p id="O7-3-2">They represent deposits of enamel located at the cemento-enamel junction or at the furcation area. Its prevalence varies between 1.1 and 9.7%. Rarely, it may be detected within the dentin, when it is known as internal enamel pearl. Clinical significance varies depending upon its topographic relation with the furcation area.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R13-3">13</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R14-3">14</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H7-3">Odontoma</h3> <p id="O8-3-2">According to Reichart and Philipsen and the World Health Organization (WHO) 2005, compound and complex odontomas are hamartomatous lesions.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R15-3">15</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R16-3">16</a></sup>] They have a relative frequency of 4.2–73.8% and 5–30%, respectively.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R15-3">15</a></sup>] Associated syndromes include Gardner's and Hermann's syndromes.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R17-3">17</a></sup>]</p> <h2 class="ejp-article-outline-heading" data-level="1" id="H8-3">HAMARTOMATOUS GROWTH OF EPITHELIAL DERIVATIVES</h2> <h3 class="ejp-article-outline-heading" data-level="2" id="H9-3">Oral and labial melanotic macule</h3> <p id="O10-3-2">They represent a well-circumscribed flat area of brown to black mucosal pigmentation. There is an increase in melanin production by normal mature melanocytes (without increase in their number).[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R18-3">18</a></sup>] It is associated with Peutz–Jeghers syndrome and Addison's disease.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R19-3">19</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H10-3">Oral melanocytic nevi</h3> <p id="O11-3-2">Nevi or mole represents collection of nevus cells which are derivatives of melanocytes or their precursor neural crest cells. Oral nevi are usually small and show regular symmetrical outline with no change in colour, shade or texture over time. Static nevi do not require excision and may be followed up.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R19-3">19</a></sup>]</p> <h2 class="ejp-article-outline-heading" data-level="1" id="H11-3">HAMARTOMATOUS GROWTH OF MESENCHYMAL DERIVATIVES</h2> <h3 class="ejp-article-outline-heading" data-level="2" id="H12-3">Congenital and infantile haemangioma</h3> <p id="O13-3-2">Congenital haemangioma (CH) and infantile haemangioma (IH) are present at birth or develop in the infancy period.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R20-3">20</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R21-3">21</a></sup>] Majority of them involute spontaneously or gradually over the years. Microscopically, the proliferative phase of IH and CH comprises complex cellular mixtures, chiefly the endothelial cells.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R20-3">20</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R22-3">22</a></sup>] Associated syndromes include PHACES and LUMBAR syndrome.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R20-3">20</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H13-3">Vascular malformations</h3> <p id="O14-3-2">Vascular malformation (VM) refers to congenital morphogenic anomalies of the various vessels.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R20-3">20</a></sup>] Histologically, they comprise of normal vascular components.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R20-3">20</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R22-3">22</a></sup>] VM may occur as primary or in association with regional or diffuse syndromes such as Sturge–Weber, Klippel–Trénaunay, proteus syndrome, Bannayan–Riley–Ruvalcaba syndrome, and Osler–Weber–Rendu, to mention a few.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R20-3">20</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H14-3">Glomuvenous malformations</h3> <p id="O15-3-2">Glomuvenous malformation (GVM) occurs more often in children.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R23-3">23</a></sup>] Clinically, it appears as red-to-blue nodules or multifocal plaque-like lesions. Microscopically, GVM is composed of varying proportion of blood vessels and glomus cells. The familial cases have been linked to mutations in the glomulin gene located in chromosome 1p21-22.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R22-3">22</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R24-3">24</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H15-3">Exostoses</h3> <p id="O16-3-2">They are described as peripheral localized overgrowth of the bone. Based on the anatomic location in the jaws, they are termed as buccal bone exostoses, torus palatinus, and torus mandibularis.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R25-3">25</a></sup>] Surgical intervention is required only in case of tissue trauma, periodontal or prosthodontic impediment.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R26-3">26</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H16-3">Rhabdomyomatous mesenchymal hamartoma</h3> <p id="O17-3-2">It is an exceptionally rare congenital lesion of the oral cavity. It chiefly comprises of striated muscle tissue.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R27-3">27</a></sup>] It is associated with Delleman, amniotic band and Goldenhar syndromes.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R28-3">28</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H17-3">Leiomyomatous hamartoma</h3> <p id="O18-3-2">Leiomyomatous hamartoma is another rare entity which commonly involves the midline of palate and tongue. Microscopically, it consists of an unencapsulated mass of smooth muscle.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R29-3">29</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R30-3">30</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H18-3">Neurofibroma</h3> <p id="O19-3-2">As the name indicates, it is an admixture of perineural fibroblasts and Schwann cells. It is associated with von Recklinghausen's neurofibromatosis syndrome. Approximately 12% of cases are associated with the syndrome tend to develop malignancy.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R6-3">6</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H19-3">Fibrolipomatous hamartoma of nerve</h3> <p id="O20-3-2">Neural fibrolipoma or fibrolipomatous hamartoma of nerve (FLHN) is a tumour-like lipomatous process. FLHN was reported in the pharyngeal mucosa by Kumar <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">et al</em>.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R31-3">31</a></sup>] Some lesions may represent carpal tunnel syndrome as a late complication.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R23-3">23</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H20-3">Oral neurovascular hamartoma</h3> <p id="O21-3-2">The hamartomatous nature of oral neurovascular hamartoma can be supported by the characteristics such as limited growth potential, ill-defined borders and histologically consisting of closely packed groups of well-formed nerve bundles and vessels.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R5-3">5</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H21-3">Oral neuromuscular hamartoma</h3> <p id="O22-3-2">Oral neuromuscular hamartomas or triton tumours are reported to occur in the trigeminal nerve and tongue. Histologically, they show presence of mature neural and striated muscle tissue.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R32-3">32</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R33-3">33</a></sup>]</p> <h2 class="ejp-article-outline-heading" data-level="1" id="H22-3">SYNDROMIC HAMARTOMAS</h2> <h3 class="ejp-article-outline-heading" data-level="2" id="H23-3">Tuberous sclerosis</h3> <p id="O24-3-2">Tuberous sclerosis (TS) is a rare syndrome characterized by the classic triad of seizures, mental deficiency and angiofibromas, affecting about 1 in 6000 people.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R34-3">34</a></sup>] Oral hamartomas in TS were reported by Celenk <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">et al</em>. (2005) and Amin and O’Callaghan (2012).[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R34-3">34</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R35-3">35</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H24-3">Cowden syndrome/multiple hamartoma syndrome</h3> <p id="O25-3-2">Cowden syndrome represents the principal <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">PTEN</em> (phosphatase and tensin homolog) gene-related disorder which occurs in 1 in 200,000 people.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R34-3">34</a></sup>] The oral manifestations include multiple papules involving the gingivae, buccal mucosa and dorsum of tongue.</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H25-3">Proteus syndrome</h3> <p id="O26-3-2">Proteus syndrome is a rare congenital hamartomatous condition with an incidence of less than 1 in a population of 1 million.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R34-3">34</a></sup>] Reported associated oral hamartomas include exostoses of facial bones and lymphangiomas.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R36-3">36</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H26-3">Oral-facial-digital syndrome</h3> <p id="O27-3-2">Oral-facial-digital syndrome (OFDS) comprises a group of heterogeneous disorders with an incidence of 1 in 50,000–250,000 newborns.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R34-3">34</a></sup>] The oral hamartomatous findings include lingual hamartomas (in 70% cases of OFDS I). Microscopically, they are composed of muscles, adipose tissues and salivary glands.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R37-3">37</a></sup>]</p> <h2 class="ejp-article-outline-heading" data-level="1" id="H27-3">CONTROVERSIAL ORAL HAMARTOMATOUS LESIONS</h2> <h3 class="ejp-article-outline-heading" data-level="2" id="H28-3">Adenomatoid odontogenic tumour</h3> <p id="O29-3-2">The hamartomatous nature of adenomatoid odontogenic tumour is supported by its limited growth potential and lack of recurrence.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R38-3">38</a></sup>] Nevertheless, its biological behaviour has been a topic of long debate and the related research is depicted in <a href="javascript:void(0)" onclick="javascript:showSlideShowByImageID('T2-3', '01732935-201505050-00003');">Table 2</a>.</p><section class="ejp-r-article-images"><figure class="ejp-r-article-images__figure"><a href="javascript:void(0)" class="ejp-r-article-images__image-link" onclick="showSlideShowByImageID('T2-3', '01732935-201505050-00003')"><img class="ejp-r-article-images__img js-lazy-load lazy-load" src="javascript:void(0);" data-src="https://images.journals.lww.com/jpcd/ArticleViewerPreview.01732935-201505050-00003.T2-3.jpeg" data-srcset="https://images.journals.lww.com/jpcd/ArticleViewerPreview@2.01732935-201505050-00003.T2-3.jpeg 2x" srcset="" alt="T2-3"></a><figcaption class="ejp-r-article-images__figcaption"><a href="javascript:void(0)" class="ejp-r-article-images__figcaption-link" onclick="showSlideShowByImageID('T2-3', '01732935-201505050-00003')">Table 2: </a><div class="ejp-r-article-images__figcaption-text">Literature relevant to the biological behaviour of AOT</div></figcaption></figure></section><h3 class="ejp-article-outline-heading" data-level="2" id="H29-3">Ameloblastic fibroma, ameloblastic fibro-dentinoma and fibro-odontoma</h3> <p id="O30-3-2">Reichart and Philipsen proposed a neoplastic and hamartomatous line of development for the mixed odontogenic tumours. But currently, there is no substantial evidence to prove either of the above hypothesis.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R15-3">15</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H30-3">Hyperplastic dental follicle</h3> <p id="O31-3-2">It has been referred as an odontogenic hamartomatous lesion associated with single/multiple unerupted teeth. It commonly involves permanent first and second molars. Microscopically, it comprises of odontogenic epithelium and calcifications.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R53-3">53</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R54-3">54</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H31-3">Adenomatoid hyperplasia of minor salivary gland</h3> <p id="O32-3-2">It is a rare lesion of the minor salivary glands. Clinically it presents as a solitary, painless mass or nodule.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R6-3">6</a></sup>] Microscopically, it comprises of lobular aggregates of normal mucus acini.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R6-3">6</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R25-3">25</a></sup>] Recurrence and malignancy are not reported.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R6-3">6</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H32-3">Fibrous dysplasia</h3> <p id="O33-3-2">Fibrous dysplasia is a developmental tumour-like condition that becomes relatively static after skeletal maturation.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R6-3">6</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R25-3">25</a></sup>] It is associated with Jaffe–Lichtenstein syndrome, McCune Albright syndrome, and Mazabraud's syndrome.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R25-3">25</a></sup>] Malignant transformation is reported in 0.5% (1 in 200) of cases.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R6-3">6</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H33-3">Familial gigantiform cementoma</h3> <p id="O34-3-2">It is an extremely rare cemento-osseous disease restricted to the jaws.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R55-3">55</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R56-3">56</a></sup>] Its growing potential can be correlated with skeletal growth and maturation.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R55-3">55</a></sup>] If left untreated, the enlargement eventually ceases during the fifth decade.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R25-3">25</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H34-3">Mucosal neuroma</h3> <p id="O35-3-2">It is commonly associated with multiple endocrine neoplasia (MEN) IIB syndrome. Clinically, it occurs in multiple small masses. Microscopically, it is partially encapsulated and contains aggregation or proliferation of histologically normal nerves.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R6-3">6</a></sup>]</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H35-3">Congenital granular cell tumour</h3> <p id="O36-3-2">Congenital granular cell tumour is thought to be a variant of granular cell tumour, but the exact nature of the lesion is unclear. It exclusively occurs in infants or immediately after birth. Most of the lesions cease to grow or regress spontaneously without intervention.[<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R19-3">19</a></sup><sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R23-3">23</a></sup>]</p> <h2 class="ejp-article-outline-heading" data-level="1" id="H36-3">CONCLUSION</h2> <p id="O40-3-2">Oral hamartomas are unique presentations of the head and neck region. Nevertheless, the criteria to delineate hamartomas from other similar masses are ambiguous. To conclude, hamartomas should promptly be included in the differential diagnosis of the tumours of oral cavity, essentially the paediatric tumours, to avoid aggressive treatment and morbidity.</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H37-3">Financial support and sponsorship</h3> <p id="O38-3-2">Nil.</p> <h3 class="ejp-article-outline-heading" data-level="2" id="H38-3">Conflicts of interest</h3> <p id="O39-3-2">There are no conflicts of interest.</p></section><section id="article-references" class="article-references js-article-references"><h2 class="ejp-article-outline-heading" data-level="1" id="O41-3">REFERENCES</h2> <div id="R1-3" class="article-references__item js-article-reference">1. Pilch BZPilch BZ. 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