the term florid osseous dysplasia was coined in 1976 by melrose et al . 1 . till today , nearly 2% cases have been reported in the indians according to current literature 2 . focal cementoosseous dysplasia was coined by summerlin and tomich in 1994 based on site of occurrence of the cementoosseous dysplasia in the oral cavity 3 . bhaskar and cutright ( 1968 ) summarized the characteristics of this disorder as follows : ( 1 ) the lesions are restricted to the jaw bones , ( 2 ) the vast majority of the individuals are above 30 years of age , ( 3 ) predominantly seen in black women , ( 4 ) mandibular involvement is much more common than maxillary involvement 4 . this article enlightens a family in which mother and daughter showed clinical characteristics , imaging findings , and histopathological sections of florid cementoosseous dysplasia . a female patient aged 24 years reported to our department with a complaint of pain and swelling in the right maxillary posterior region of the jaw , since a year . one year back , she noticed a swelling associated with pain , which was intermittent , throbbing in character , and with no aggravating factors . on clinical examination , bilateral submandibular lymphnodes were palpable and nontender . diffused extraoral swelling was present on the right middlethird of the face extending superiorly from the infraorbital region to inferiorly up to the line joining the angle of the mouth to the tragus of the ear , and anteriorly from the ala of the nose to posteriorly till 3 cm in front of the right tragus of the earhas been edited for sense . please check and approve .. intraorally , bilateral maxillary arch expansion along with pus discharge in relation to 15 , 16 regions was found and noticeable expansion of mandibular arch was seen ( fig . . 15 , 16 region . ( b ) cropped maxillary occlusal radiograph of the patient showing the large , numerous , irregularly shaped , sclerotic radiopacities admixed with diffuse illdefined , radiolucent  radiopaque areas along with multiple impacted teeth . a woman aged 45 years reported to our department with a complaint of decayed teeth in the left mandibular posterior region of the jaw . on inspection , intraorally , adequate mouth opening was seen , bilateral expansion of the maxillary arch and noticeable expansion of mandibular arch was present . orthopantomograph revealed multiple radiopaque masses with radiolucent borders found in both quadrants of the lower jaw . thin radiolucent lesions were seen with most of the sclerotic areas confined within the alveolus and epicenter of the lesions are above the inferior alveolar nerve canal ( fig . panoramic radiographs showing multiple radio opaque lesions seen in the periapical regions of the mandible . in both the cases , epicenter of the lesion is above the inferior alveolar canal [ case 1(above ) and 2 ( below ) ] . histopathological sections revealed large mass of sclerotic bone , which was hypocellular with resting and reversal lines were evident . sections from soft tissue showed fibrous to fibrocellular stroma with dilated blood vessel and chronic inflammatory cell infiltration . photomicrograph showing large sclerotic mass of bone and cementumlike material in the fibrous connective tissue . blood chemistry of calcium , phosphorus , and alkaline phosphatase was carried out for both the individuals , and was within normal limits . in our case , broad spectrum antibiotics along with periodic recall was advised . only periodic followup and good oral care a female patient aged 24 years reported to our department with a complaint of pain and swelling in the right maxillary posterior region of the jaw , since a year . one year back , she noticed a swelling associated with pain , which was intermittent , throbbing in character , and with no aggravating factors . on clinical examination , bilateral submandibular lymphnodes were palpable and nontender . diffused extraoral swelling was present on the right middlethird of the face extending superiorly from the infraorbital region to inferiorly up to the line joining the angle of the mouth to the tragus of the ear , and anteriorly from the ala of the nose to posteriorly till 3 cm in front of the right tragus of the earhas been edited for sense . please check and approve .. intraorally , bilateral maxillary arch expansion along with pus discharge in relation to 15 , 16 regions was found and noticeable expansion of mandibular arch was seen ( fig . . 15 , 16 region . ( b ) cropped maxillary occlusal radiograph of the patient showing the large , numerous , irregularly shaped , sclerotic radiopacities admixed with diffuse illdefined , radiolucent  radiopaque areas along with multiple impacted teeth . a woman aged 45 years reported to our department with a complaint of decayed teeth in the left mandibular posterior region of the jaw . on inspection , intraorally , adequate mouth opening was seen , bilateral expansion of the maxillary arch and noticeable expansion of mandibular arch was present . orthopantomograph revealed multiple radiopaque masses with radiolucent borders found in both quadrants of the lower jaw . thin radiolucent lesions were seen with most of the sclerotic areas confined within the alveolus and epicenter of the lesions are above the inferior alveolar nerve canal ( fig . panoramic radiographs showing multiple radio opaque lesions seen in the periapical regions of the mandible . in both the cases , epicenter of the lesion is above the inferior alveolar canal [ case 1(above ) and 2 ( below ) ] . histopathological sections revealed large mass of sclerotic bone , which was hypocellular with resting and reversal lines were evident . sections from soft tissue showed fibrous to fibrocellular stroma with dilated blood vessel and chronic inflammatory cell infiltration . photomicrograph showing large sclerotic mass of bone and cementumlike material in the fibrous connective tissue . blood chemistry of calcium , phosphorus , and alkaline phosphatase was carried out for both the individuals , and was within normal limits . in our case , broad spectrum antibiotics along with periodic recall was advised . only periodic followup and good oral care even though the familial form of florid osseous dysplasia is rare , it was reported in several literatures . in 1982 , sedano et al . described cemental dysplasia occurring in 10 members of the same family under the term of  autosomal dominant cemental dysplasia .  among caribbean individuals , in 1989 , thakkar et al . described a case of familial periapical cemental dysplasia . in 1991 , among a white family , oikarinen et al . diagnosed as gigantiform cementoma in three members ( father , son , and daughter ) 1 . in 2008 , moshref and his coauthors specified florid cementoosseous dysplasia as the dysplastic lesion associated with osteogenesis imperfecta in one family pedigree literature 2 . other members of the same family were normal . in a systematic review of the literature , it was found that 59% of cementoosseous dysplasia cases arise in african patients , 37% in asians , and 3% in caucasians 5 . most common in the fourth decade of life , but the age range is broad 6 . loh and yeo in oriental individuals , diagnosed nine cases over a 34year period . among them , eight were middleaged chinesebased women and the other was an indian woman 7 . in our case , we diagnosed based on the patient 's age , gender , clinical findings , localization of lesions , and radiological features as well as ethnicity . clinically , in most cases , affected patients are asymptomatic , and the disease is detected only on routine dental radiographs . however , occasional patients may have dull , intermittent , poorly localized pain , especially in lesions that are infected secondarily 1 , 8 . this condition is not affected with abnormalities elsewhere in the skeleton and there are no disturbances in the blood chemistry . radiologic findings of florid cementoosseous dysplasia ( fcod ) depends on the degree of maturation of the lesion . radiographs often demonstrate numerous , irregularly shaped , sclerotic radiopacities admixed with diffuse illdefined , radiolucent  radiopaque areas . in mature cases , lesions appear as completely radiopaque with radiolucent periphery and surrounded by sclerotic borders same as pcd ( periapical cemental dysplasia ) . fcod affects both jaws bilaterally , mainly mandibular posterior region and occurs above the inferior alveolar nerve canal 2 , 9 , 10 . yonestu and nakamura reported mild bony expansion based on occlusal radiographs or axial computed tomography images 11 . osseous dysplasia ( od ) considered to be originated from the periodontal ligament space and plays an important role in the formation of cementum by regulating the differentiation of pdl stem cells 12 , 13 . all types of od consist of fibrous cellular tissue , both woven as well as lamellar bone and masses of cementumlike material and no capsule . hard tissue component in most cases does not fuse with the root surface of the involved teeth , but may merge with the surrounding bone 14 . the histopathologic features that help to distinguish fcod and cementoossifying fibroma are that fcod demonstrates multiple fragments without a fibrous capsule , thick curvilinear bony trabeculae , irregular cementoid masses , loose collagen fibers , and free hemorrhage throughout the lesion . in contrast , cementoossifying fibroma showed a single large , intact specimen with a fibrous capsule , ovoid cementoid deposits , dense collagen fibers , and free hemorrhage at its border 15 . paget 's disease affects the whole mandibular region and shows loss of lamina dura , whereas epicenter of florid cementoosseous dysplasia is above mandibular canal . paget 's disease involves multiple bones such as spine , femur , skull , pelvis , and sternum with abnormal biochemical serum changes , such as increased alkaline phosphatase levels , but fcod shows no other bony changes , or dermatological neoplasms or tooth malformations 16 . therapeutic interventions are not entitled for cementoosseous dysplasias unless complications such as bone infections or deformity of face are seen 14 . in case of secondary infection , antibiotics are ineffective in dysplastic bone . sequestrectomy of the infected cemental / osseous structures combined with antibiotics are given in complicated cases 7 , 17 . in our case , broadspectrum antibiotics along with periodic recall was advised . only periodic followup and good oral care conservative approaches such as broadspectrum antibiotics in case of infections along with periodic followup are required . in asymptomatic individuals , only periodic followup and good oral care
key clinical messagefamilial florid cementoosseous dysplasia is a very uncommon condition . 
 cementoosseous dysplasia is totally asymptomatic in many cases , in those conditions , lesions are detected in a radiograph taken for other purposes . in this report , we describe a family in which mother and daughter exhibited clinical , radiographic , and histologic features of florid cementoosseous dysplasia .