Dentigerous Cyst

Dentigerous cysts are one of the common type of odontogenic cysts. An odontogenic cyst is a fluid-filled sac that develops in the alveolar bone over a tooth that hasn't erupted yet or which is impacted. This cysts mmostly affect the molars or canines, and they are second in prevalence after the periapical cysts.

Symptoms #

Symptoms of dentigerous cysts include the following

• Tooth sensitivity is common symptom
• Swelling in jaw or the affected teeth
• Tooth displacement from its path of eruption
• A small bump is seen where a tooth is supposed to erupt
• Gaps form between the displaced teeth‌

Causes #

• Dentigerous cysts occur when fluid builds up over the tooth that has not yet completely erupted. This condition can affect anyone, but the age groups that are at higher risk are 20s or 30s.

• Generally, the odontogenic tumors and cysts originate from cells and tissues involved in normal tooth developments. Most are closely linked to genetical syndromes, for example if you are suffering from nevoid basal cell carcinoma syndrome, your body lacks a gene responsible for the suppression of tumors.

• For this reason, the genetical syndromes put you at a higher risk of developing multiple odontogenic cysts within the jaws. In worse case scenarios, you may also be at risk of developing multiple basal cell carcinomas, and related characteristics. Non-odontogenic tumors usually develop from other tissues also within the jaw, which aren’t related to the teeth.

Complications #

• The infected dentigerous cyst can lead to periodontal and periapical infections.

• An untreated dentigerous cyst causes pressure on the gum tissue leading to weakening of the gum and causing it to lose its ability to hold a tooth in place. Some cysts are associated with dead or dying teeth also called as non-vital teeth.

• When the jaw bone becomes weak due to a cystic infection, it can develop a fracture in the jaw bone. The risk is high when the cyst is in the premolar region (bicuspid region).

• Ameloblastoma or jaw tumor are rare kind of tumors that mainly affect the jaw near the molars or wisdom teeth. They originate from the cells that form the enamel. If left untreated, the swelling turns cancerous and may migrate to the lungs or lymph nodes.

Diagnosis #

The small cysts usually go unnoticed or unidentified, their diagnosis may not be possible until you have a dental x-ray. A cyst may appear on the x-ray as a small spot of infection. For further confirmation of a cyst, you may have to go for a CT scan or an MRI scan which are more advanced techniques for diagnosing cysts and tumors. These tests will also help rule out other types of cysts like aneurysmal bone cysts or periapical cysts from a dentigerous cysts.

In some special cases, particularly if a cyst is large, your dentist will quickly diagnose it as a dentigerous cyst just by looking at it.

Treatment #

After proper diagnosis, the treatment procedure mostly will depend on the size of the cysts. A small cyst is easy to remove through a simple surgical procedure, alongside the affected tooth. In some cases, the dentist will use a treatment procedure known as marsupialization to treat the cyst.‌

This technique involves surgically excision of the cyst. This process smoothens the surface from the external surface to the interior of the cyst and the cyst will remain open and can freely drain the fluid or pus that it is containing.

This method is most effective when a single draining procedure isn’t enough, and also the best method for completely removing or destroying the surrounding tissue. Marsupialization is a popular procedure that can also be applied to other conditions, like Bartholin’s cysts and pancreatic cysts. In case of the dentigerous cysts, marsupialization allows the tooth affected by the cyst to erupt without any obstruction. It also reduces the chances of a cyst recurrence.‌

Other treatment options for dentigerous cysts include the following

• Reconstruction surgery to restore or preserve the jawbone and the surrounding structures
• Medical therapy
• Supportive care to maintain a good quality of life, like assisting you with speech, nutrition, and swallowing.‌
• Subsequent follow-ups are needed to check for recurrence.