Dental cysts or oral cysts are often the result of a problematic/decayed tooth or distressed gum tissues. These small pockets of fluid can sometimes be sterile or might contain infectious material like pus. Dental cysts can be found around the roots of non-vital/infected teeth, within the gums, around impacted wisdom teeth, in maxillary sinuses or within the jawbone.
What is a cyst?
An oral cyst is a type of small fluid filled growth that can occur in the mouth. It’s a small fluid-filled sac that feels like a little bump in the oral cavity. These oral cysts are sometimes referred to as mucoceles or mucous cysts and in most cases, oral cysts may cause discomfort, but they are harmless.
Most common sites of oral cysts include lingual sides of the lips, but it’s also possible for oral cysts to form on the linngual sides of cheeks, tongue, palate, the floor of your mouth, and around any oral piercings if present.
Causes of dental cyst
Usually cysts begin to form at the tip of the roots of a non-vital, discolored or dead tooth.
Some cysts form because of the improper growth of tooth and others form because of the abnormal way a tooth has developed
A root canal which has failed naturally or as a result of an improper procedure
Because of a genetic syndrome like Gorlin’s syndrome, if this is the case it may include other symptoms also
Cysts can form around the crowns and roots of impacted teeth. Wisdom teeth that are impacted are common causes for cyst formation
Types of cysts
Periapical Cyst (Odontogenic Cyst Or Radicular Cyst)
Periapical cysts is the most common odontogenic cyst and has various names, including radicular cyst, apical periodontal cyst, root end cyst, dental cyst, etc.
The death or necrosis of the pulp tissue inside the tooth, which is caused due to tooth decay or any trauma will cause this type of cyst. The process of pulpal necrosis causes inflammation and the release of toxins at the apex or end of the root tip developing a cyst.
These type of cysts are commonly treated by endodontic therapy. In case the endodontic treatment is not effective, the extraction of the tooth is used, the place of cyst is cleaned and filled with the artificial bone material.
Traditional methods were not effective enough as cysts used to reoccur. To avoid this the retrograde root canal filling should be used according to the most modern treatment methods to prevent reoccurance.
Follicular Cyst Or Dentigerous Cyst
Follicular cysts are most commonly found in the area of the lower third molar teeth or the permanent upper canines, develop around the crown of an unerupted tooth.
The pressure exerted by an erupting tooth on the follicle may form the dentigerous cyst. This pressure can obstruct the blood flow to the site and create an accumulation of fluid between the enamel membrane tissue and the coronal portion of the tooth. Dentigerous cysts usually grow and expand very rapidly.
The extraction of the associated tooth and the surgical excision of the cyst is the treatment option for the follicular cyst. Treatment is often successful, the patient is recalled to watch for recurrance in subsequent check-ups.
Keratocystic Odontogenic Tumors (KCOTs)
Keratocystic Odontogenic Tumors are found mostly in the posterior area of the lower mandible and their characteristics are similar as other types of cysts mentioned above. A precise diagnosis can be achieved just with biopsy and microscopic analysis, panoramic x-ray to confirm the cyst as keratocyst.
Swelling is often the only symptom a patient will experience, pain may or may not be present. There are several theories surrounding the origin of the keratocyst, some experts believe the cyst develops in the place the tooth should have while others argue that the tumors arise from the lamina of impacted teeth.
Treatment for KCOTs include surgical excision with additional treatments. The patient is monitored throughout his lifetime to check for evidence of recurrance as the reoccurance rate is high in keratocyst.
There are mostly two ways to treat a dental cyst, they are as follows
Surgery – mostly used for the removal of all types of cysts or tumors.
Endodontic Therapy – This is done in conjunction with surgical removal if the cyst is associated with an infected root canal or failed root canal treatment.
Surgical Removal Of Dental Cyst
Step 1 : Detection
Dental cysts are normally diagnosed during a routine examination, which includes dental x-rays. Your dentist may order a 3D CBCT scan that will provide more information about the cyst and its relationship with surrounding teeth and other structures like nerves, sinuses etc, within the bone to properly analyze the type of cyst.
Step 2 : Pre-surgical Preparation
A few days before, a thorough scaling and polishing is done to maintain proper oral hygiene. An oral probiotic is also given to boost the numbers of beneficial bacteria in the saliva so that healing is smooth and faster. If you require root canal treatment, this will be completed prior to the surgery only.
Step 3 : Removing The Cyst
The cyst is removed by oral surgeon through a window in the bone under a local anaesthesia. You may also choose to be sedated for the entire procedure to ensure an anxiety free experience or if you have any other concerns related to anesthesia.
If there is a tooth embedded within the cyst, it might also be extracted or removed along with the cyst. Bone grafting material may also be placed to fill the empty space left behind after the cyst is removed. Stitches will be placed in the gums afterward and these will be removed after a few days or a week.