A 17-year-old boy comes to your office for his check-up, and you notice that he has heavy eyebrows and a lot of freckles. He jokes about eating sweets prior to the appointment to see if he can raise his cavity count. The boy tells you that his mother’s family has "bad teeth" and a lot of freckles. He says a freckle on her shoulder kept getting bigger until it was removed last summer. In addition to carious, misshapen teeth, X-rays reveal an odontongenic keratocyst.

Multiple basal cell nevi, appearing mainly over the nose, eyelids, and cheeks. Image courtesy of Scully C., Flint S., and Porter SR. Oral Diseases. Martin Dunitz, London. (1996).

Keratocysts develop mainly in the mandible, as shown by radiography. These usually develop within the first 30 years of life. Image courtesy of Scully C., Flint S., and Porter SR. Oral Diseases. Martin Dunitz, London. (1996).