Diseases

Tooth cyst - causes and therapy

Tooth cyst - causes and therapy


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Cyst on the tooth

Often one Tooth cyst (medical: Odontogenic cyst) found rather accidentally in the course of a dental examination, since they have not caused any complaints to date. However, the cyst can lead to the displacement of healthy tissue and in the long term, for example, can cause significant misalignment of the teeth. In the late stages, a massive swelling often develops, which under certain circumstances also presses on the nerve pathways and thus causes pain. If bacteria colonize inside the cyst, inflammation occurs, which is also associated with massive pain. Even if the tooth cyst does not cause any symptoms, prompt therapeutic care is necessary to avoid long-term consequences.

Definition

Tooth cysts are liquid-filled, encapsulated tissue cavities (surrounded by the so-called cyst bellows) in the area of ​​the jaw, which can be traced back to the teeth or incorrect tooth formation. The medical term is "odontogenic cysts", which depending on their origin and location are in turn divided into different forms such as the radicular cysts, follicular cysts, periodontal cysts or dentition cysts. The tooth cysts are broadly classified as jaw cysts.

Symptoms

In general, most tooth cysts initially have no symptoms for a long time and only when they reach such a size that swellings or misaligned teeth become visible do those affected notice their illness. Typical symptoms at this stage include swelling of the cheek or facial asymmetry, sometimes accompanied by one-sided pain and shifting or loosening of the teeth. It is not uncommon for bacteria to enter the cyst and begin to multiply here, which can be accompanied by typical inflammation symptoms such as severe pain, redness and swelling. The development of an abscess is a further complication. With extremely large cysts, the pressure on surrounding bones can become so great that fractures (broken bones) may occur. Depending on the type of tooth cyst and where it is located, further complaints are conceivable, such as compressions of certain nerves, which can lead to numbness or even blindness (if the maxillary sinus is affected).

Different forms of tooth cysts

As already mentioned, tooth cysts can appear in different forms, the causes of which differ significantly. Also, the symptoms of the same types of tooth cyst are by no means always identical, since the cysts can manifest themselves in different places on the jaw.

Tooth root cysts

Tooth root cysts result from inflammation of the root tip on a dead tooth. If the so-called tooth pulp has died, bacteria can rise in the root canal and cause tooth root tip inflammation, as a result of which a cavity filled with fluid forms around the root tip as a tooth cyst. The medical term is "radicular cyst." These are usually painless as long as no bacterial infection develops and / or the cyst presses more strongly on the surrounding tissue.

Follicular cyst

In a follicular cyst, the epithelium that surrounds the cavity is formed from the cells of the so-called tooth sac. In the crown area of ​​a tooth that is prevented from breakthrough (retained), the tooth sac expands and a yellowish liquid collects inside. Follicular cysts are increasingly observed on the lower wisdom teeth, but also on displaced surplus teeth. In most cases, the course is symptom-free for a long time before the affected persons notice swelling and / or pain. Misaligned teeth can also occur here as a long-term consequence.

Dentition cysts / eruption cysts

The so-called dentition cysts (also called eruption cysts), which form above teeth that have not erupted, are directly related to tooth formation. A liquid-filled cavity forms between the gums and the tip of the tooth, which as a rule is broken through as the tooth grows and thus normally disappears on its own. In the meantime, the cyst can be felt as a swelling, which may also be associated with pain in the event of a bacterial infection or inflammation.

Periodontal cysts

Inflamed tooth pockets can also cause tooth cysts. These so-called periodontal cysts form on the side of the tooth neck. They also usually only cause complaints at a later stage.

Other forms of tooth cysts

So-called primordial cysts, which are caused by defective development of the tooth-forming organs, are known as further forms of tooth cysts. From the epithelium of the so-called tooth bud, a cavity is created that fills with fluid. Primordial cysts are relatively rare. The same applies to the gingival cysts, which arise from remnants of the tooth rack as cysts in the area of ​​the gingiva (gums). So-called glandular odontogenic cysts are also extremely rare and contain glandular tissue in the cavity-forming epithelium. The glandular odontogenic cyst was first described as an independent form of tooth cysts around 25 years ago. They often reach a considerable size and tend to reappear after surgical removal. So-called residual cysts usually form from radicular cysts that continue to grow independently in the jaw after the tooth to which they originally attached has been extracted.

Diagnosis

If there are no noticeable symptoms such as facial asymmetries, misaligned teeth, pain or other complaints, the diagnosis of the tooth cysts is often a coincidental finding in routine dental radiological examinations. They can be seen on the X-ray images as sharply delimited brightenings. However, this does not apply to all forms of odontogenic cysts. For example, gingival cysts are usually not recognizable on an X-ray examination. The clinical features therefore play a special role in the diagnosis. Gingival cysts, for example, are visible as small local swellings on the outside of the gums in the area of ​​the lower canines and premolars (pre-teeth). Sometimes they appear slightly bluish. Even a glandular odontogenic cyst is often not visible on the X-ray images, however possible dislocations of teeth and root resorption, which are due to the cyst, are clearly visible on the radiological examination.

Therapy

In most cases, a cyst requires surgical removal as part of a so-called cystectomy, even if the patients have so far shown no symptoms. The entire cyst, including the cyst bellows, is surgically removed. The damaged bones normally regenerate on their own after the cystectomy and after a relatively short time, no defects can be seen on the X-ray images. In the case of particularly large cysts, however, a bone replacement material may sometimes be required to compensate for the existing damage. If a cyst has formed around the root tip of a devital tooth, this is also removed as part of the cystectomy if necessary, or a root tip resection is carried out. A follicular cyst around a tooth that is prevented from eroding is usually treated with a cystectomy, in which the retained tooth is removed. However, there may also be the possibility to bring the relocated tooth into the correct position using orthodontics, so that only the cyst has to be removed and the tooth can be retained. Very large cysts can be opened and opened surgically as part of a so-called cystostomy in order to reduce the pressure and achieve a reduction in the cyst volume. Then, after some time, another operation is performed to remove the cyst bellows. A cystostomy can only be considered after a biopsy and subsequent laboratory examination of the removed tissue, as it can possibly be a malignant tumor. For the same reason, an examination of the removed cyst tissue may also be carried out after a successful cystectomy. (fp)


Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • Thomas Weber: Memorix Zahnmedizin, Thieme, 5th edition, 2017
  • Paco Weiss, Andreas Filippi, J. Thomas Lambrecht: Developmental odontogenic cysts, quintessence, 2011, ukm.de
  • German Society for Oral and Maxillofacial Surgery (DGMKG), German Society for Dental, Oral and Maxillofacial Surgery (DGZMK): S3 guideline on odontogenic infections, as of September 2016, detailed view of guidelines
  • Westcoast International Dental Clinic: Dental Cysts: What Are They and How They Can Be Prevented (accessed: August 30, 2019), westcoastinternational.com
  • Cambridge University Hospitals: Frequently asked questions about dental cysts (access: 30.08.2019), cuh.nhs.uk

ICD codes for this disease: K09ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


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