While the exact mechanism of action of how fluoride causes enamel mottling remains unknown, it is well-recognized that with increased amounts of fluoride concentrations in the drinking water, the resultant enamel hypoplasia becomes progressively evident, as increased fluoride levels interfere with ameloblastic
function, which adversely affects both enamel matrix formation and enamel matrix calcification.
Lesions included adnexal neoplasm, ameloblastic
fibro-odontoma, basal cell carcinoma, benign fibrous histiocytoma, blue nevus, chondrosarcoma, compound nevus, epithelioma adenoides cysticum, esthesioneuroblastoma, Ewing sarcoma, fibrosarcoma, giant cell granuloma, granulocytic sarcoma, hemangioma, hemangiopericytoma, Langerhans cell histiocytosis, lymphangioma, lymphoma, melanoma, neuroblastoma, neurofibroma, ossifying osteofibroma, osteochondroma, osteosarcoma, port wine stain, rhabdomyosarcoma, Spitz nevus, and xanthogranuloma.
Therefore, PIOSCC must be considered in the differential diagnosis of malignant tumors of odontogenic epithelium, including ameloblastic
carcinoma, clear cell odontogenic carcinoma, central mucoepidermoid carcinoma, odontogenic ghost cell carcinoma, and a malignant variant of calcifying epithelial odontogenic tumor.