If a capsule with liquid has formed near the root, this is a radicular dental cyst. A patient with such a pathology may not have any complaints. Unpleasant sensations occur when the contents of the cavity suppurate or grow into the maxillary sinus. Long-term existence of a radicular cyst leads to deformation of bone tissue and an increased risk of jaw fracture.
This type of cystic disease is the most common in dentistry. Moreover, neoplasms appear more often on the upper jaw than on the lower jaw. And the main reason for the development of pathology is the presence of infection. The formation of a capsule of connective tissue is a response of the body trying to isolate the source of inflammation.
In most cases, radicular dental cysts appear in patients with advanced caries, pulpitis, periodontitis, and also after illiterate dental intervention. The inflammatory process can also begin as a result of a tooth injury, with a decrease in immunity, or after an infectious disease. Cystic cavities sometimes develop due to complicated wisdom teeth eruption or malocclusion.
What is a cyst? Jaw cyst
A cyst is a cavity that is lined with epithelium and filled with fluid or soft material.
The formation of teeth (odontogenesis) is a complex process in which connective tissues and epithelium (enamel organ, dental follicle and dental papilla) participate.
The enamel organ refers to an epithelial structure derived from the oral ectoderm. The dental follicle and dental papilla are ectomesenchymal structures, because they are partly derived from neural crest cells.
For each tooth, odontogenesis begins with the apical (affecting the tip of the tooth root) proliferation of the epithelium of the oral mucosa, known as the dental lamina. The dental lamina gives rise to the enamel organ, a cap-shaped structure that subsequently takes on the shape of a bell. After the formation of the enamel organ, the dental lamina cord usually fragments and degenerates. However, small islands of dental lamina may remain after tooth formation. They are believed to be responsible for the development of some odontogenic cysts and tumors.
The enamel organ has four types of epithelium. The inner lining of the enamel organ is called the inner enamel epithelium and becomes the ameloblastic layer that forms tooth enamel. The second layer of cells adjacent to the inner enamel epithelium is the intermediate layer. Adjacent to this layer is the stellate reticulum, followed by the outer enamel epithelium. The enamel organ is surrounded by loose connective tissue known as the dental papilla. Contact with the epithelium of the enamel organ causes the dental papilla to produce odontoblasts, which form dentin. As odontoblasts lay down dentin, they induce ameloblasts to form enamel.
After initial crown formation, a thin layer of enamel organ epithelium, known as Hertwig's root sheath, grows at the apex of the tooth root. This epithelial expansion later becomes fragmented but leaves behind small nests of epithelial cells known as Malassez remnants in the space of the periodontal ligament. They are the source of epithelium for most periapical (radicular) cysts, but do not cause any odontogenic neoplasms, with the exception of squamous odontogenic tumor.
Causes
A cystic formation in the form of a capsule isolating the inflammatory focus develops against the background of the following diseases:
– pulpitis, periodontitis;
– extensive carious lesions;
– respiratory tract infections (otitis media, inflammation of the maxillary sinuses, tonsillitis);
– weakened immunity;
– difficult teething;
– bite defects;
– chronic stomatitis;
– cracks, chips of tooth enamel, mechanical injuries to teeth.
Why do jaw cysts form?
Odontogenic cysts (developing or inflammatory) get their name from the nature of their origin. Most jaw cysts are lined by epithelium, which is derived from odontogenic epithelium.
The occurrence of such cysts is usually associated with unerupted teeth (third molars of the lower or upper jaw, second premolars of the lower jaw, and canines of the upper jaw). They can also form near additional teeth and in combination with odontomas. The occurrence of odontogenic cysts is rarely associated with baby teeth.
Most often, jaw cysts are discovered between the ages of 10 and 30 years. Men, especially white-skinned men, suffer from them more often.
In most cases, dental cysts do not manifest themselves in any way and are an accidental finding obtained during an X-ray examination. But, in some cases, they can reach significant sizes, which lead to the expansion of bone tissue, but even they may not give pronounced symptoms until a secondary infection occurs.
How do jaw cysts appear?
In most cases, the cyst does not cause significant symptoms. Its development can be provoked by incorrect treatment of dental diseases or caries.
Odontogenic cysts are usually distinguished by type of origin:
· dentofacial cysts – their occurrence is associated with the crown of a tooth that could not erupt;
· keratocysts – are a consequence of Nevoid basal cell carcinoma syndrome;
radicular or radicular cysts – are of inflammatory origin and most often result from a reaction to necrosis of the dental pulp;
· bifurcation buccal cyst – typical for children 5-10 years old, it is formed in the area of buccal bifurcation of the first molars of the lower jaw;
· primary cyst – in most cases it is a keratocystic odontogenic tumor;
· orthokeratinized cyst – also refers to a subtype of keratocystic odontogenic tumor;
· eruption cyst – usually formed from a degenerating dental follicle and forms in the gum when the tooth erupts;
· newborn gum cyst – formed from the remains of the dental plate on the gum of a newborn;
· adult gingival cyst – is a variant of the lateral periodontal cyst;
· lateral periodontal – a non-inflammatory cyst on the side of the tooth, formed from the remains of the dental plate;
· calcifying cyst is a rather rare pathology, which is characterized by cystic and neoplastic signs;
· glandular cyst is a formation with a respiratory epithelial lining and potential relapse; in its manifestations it is similar to the central variant of poorly differentiated mucoepidermoid carcinoma.
Odontogenic cysts are difficult to detect at an early stage. It gives virtually no symptoms. The patient may be alarmed by tooth displacement or a change in the color of the diseased tooth. If the cyst has reached a significant size, the patient may notice protrusion of the bone structures.
A long asymptomatic course can lead to the formation of inflammatory processes, which are dangerous due to the development of suppuration and can provoke pathological fractures of the jaw bones.
If a cyst has formed in the upper jaw, it can cause nosebleeds, headaches and impaired nasal breathing.
The main symptoms associated with the presence of an odontogenic cyst (pain, fever, inflammatory changes in the oral cavity) usually appear in the later stages of the disease.
Symptoms of a dental cyst
The difficulty in diagnosing a cyst lies in the absence of symptoms. In some cases, a person may pay attention to such signs of a dental cyst as darkening of the enamel, slight displacement of the tooth and discomfort when chewing solid food, but most do not attach any importance to this. By the time pain from a dental cyst begins to appear, the granule can already grow up to 1 cm in diameter. From this moment on, the patient begins to feel other quite noticeable signs. Here are the symptoms of a dental cyst that may appear at this stage:
- aching pain in the area of inflammation;
- swelling, which can spread to the face;
- enlarged and painful lymph nodes;
- elevated temperature;
- headaches - with the development of a cyst in the maxillary sinus;
- general malaise.
Under no circumstances should these symptoms be ignored, otherwise serious consequences will arise, and removing a tooth with a cyst is not the worst of them. At the first signs of the development of the disease, you should consult a specialist.
How are odontogenic cysts diagnosed?
The leading method for identifying odontogenic cysts is radiography, which is capable of visualizing jaw cysts at an early stage of their development. On an x-ray image, the cyst is distinguished by the presence of clear boundaries, and the formation itself gives a characteristic shadow of a round or oval shape, immersed in the sinus of the tooth root.
Ultrasound examination also helps to recognize odontogenic cysts.
As already mentioned, pronounced symptoms are characteristic of the late stage of development of a pathological formation, therefore it is difficult to diagnose a cyst at the initial stage, relying only on symptoms.
The final diagnosis is made on the basis of histological examination. It is important to differentiate an odontogenic cyst from other pathologies (adenomatoid odontogenic tumor, ameloblastic fibroodontoma and calcifying epithelial odontogenic tumor).
The CT scan method is widely used in the diagnosis of jaw cysts to confirm the presence of calcifications along the wall of the cyst, as well as tiny spots that are usually not found on x-rays. In addition, computed tomography is necessary during the surgical planning stage.
Diagnostics
Often a cyst is found when neighboring teeth begin to be treated. A radicular cystic formation is clearly visible on an x-ray - it is a round-shaped shadow with a clear border, adjacent to the apex or wall of the root.
To clarify the diagnosis, electroodontometry is done. To clarify the nature of the neoplasm, a puncture with a thick needle is prescribed. To check the extent and distribution, you will additionally need radiography of the paranasal sinuses, sometimes contrast radiography and computed tomography of the upper jaw bone.
What is the prognosis for the disease?
How successfully the situation in a patient with an odontogenic cyst will be resolved depends on at what stage the cyst was discovered, how severe the symptoms were and how it was treated.
As a rule, the use of surgical treatment gives a positive prognosis. Therapeutic treatment provides a positive prognosis only if it is started at the initial stage of the disease.
A negative prognosis may be associated with detection of the disease at a late stage: odontogenic cysts can provoke the development of serious pathologies that cause deformation of the maxillofacial tissues.
What treatment methods for jaw cysts exist?
The choice of treatment method for an odontogenic cyst directly depends on the symptoms it causes, as well as the results obtained during instrumental and laboratory diagnostics.
If surgical treatment is chosen (cystotomy or cystectomy), the maxillofacial surgeon performs complete removal of the cyst. In some cases, it is necessary to remove the cyst along with the affected parts of the tooth root. Treatment is carried out in a hospital setting.
If the choice falls on therapeutic treatment, the doctor will carry out procedures aimed at reducing inflammation. This is a long process, taking at least six months.
The first step is to drain the contents of the cyst using a special drainage tube, which is inserted into a small incision in the tumor. As the contents drain out and the tumor shrinks, the size of the tube is adjusted downward.
After removing the contents of the cyst, the dentist cleans the root canals and administers medications that destroy the tumor tissue. At the end of all procedures, the doctor uses a special solution aimed at accelerating healing.
Treatment is monitored radiographically.
Both after surgical and therapeutic treatment, the patient requires preventive measures that will help avoid the re-formation of an odontogenic cyst.
Why is a dental cyst dangerous?
The irony is that, forming as a result of the body’s defensive reaction, a cyst under a tooth can ultimately lead to serious complications. The main ones:
- Periodontitis: an advanced case of dental cyst, in which inflammation from the tooth tissue spreads to the bone.
- Flux: purulent inflammation in the subgingival and subnasal jaw area. This complication of a dental cyst is accompanied by swelling of the soft tissues, including the cheeks, and severe pain.
- Tooth loss: occurs if the cyst is not treated. In this case, the lesion spreads to adjacent teeth (although the cyst itself is not an indication for removal).
In addition to the above, exacerbation of the disease can lead to even more serious consequences: purulent abscess, inflammation of the lymph nodes, osteomyelitis, sepsis and even a jaw fracture. Therefore, if you are diagnosed with a cyst, treatment should follow immediately.
Important!
The earlier a dental cyst is detected, the higher the chances of its successful treatment. So, instead of struggling with the consequences of a dental cyst, visit your dentist regularly and undergo preventive examinations to maintain oral health.
