Whilst patients may recognise tooth pain, trauma and tooth loss as urgent reasons to visit their dentist, they may easily overlook odontogenic cysts. This is unsurprising: the incidence of dental cysts among the UK population is unclear, and many may be unnoticeable to both touch and sight.[i]
However, an odontogenic cyst can become an oral health risk if left undiagnosed and untreated. This poses a unique challenge for dental practitioners as the identification and management of such a cyst can be difficult, despite the jaw being the bone most frequently affected by cysts.[ii] Improving awareness for both patient and practitioner ensures early detection and, subsequently, a faster solution.
Types of cysts
A cyst is a closed-off cavity filled with semi-solid or liquid material, with odontogenic cysts found in the jawbone or the soft tissues in the mouth and face, having developed from the epithelium of the dentition.[iii] There is a higher prevalence in adult patients (13.8% of maxillofacial cases) than children (11.78% of cases).i Each cyst varies in size, severity and aetiology, yet are often benign in nature. Despite this, they can disrupt the oral cavity if they expand – this is the concern for dental practitioners.
There are two types of odontogenic cysts: inflammatory and developmental. These are broken down into further classifications, with the most common inflammatory cysts being periapical and residual, and the most common developmental form being called a dentigerous cyst.[iv]
Breaking it down
Approximately 60% of reported cysts are periapical.iv These are often unnoticed and are only visible through radiographic scans, found at the tooth root apex. If a periapical cyst becomes infected – an outcome that can occur due to the presence of dental caries and trauma – it can swell and cause pain, with the increasing size able to loosen the teeth.[v] The inflammation caused by harmful bacteria then heightens the osmotic pressure, inhibiting cellular function and making the cyst – and other problems like caries or trauma – harder to manage. Dental practitioners may discover a periapical cyst when scanning a tooth with carious lesions.iv
In the case of residual cysts, at-risk patients are those who have recently had a tooth extraction, such as orthodontic patients or those who have experienced a physical trauma.iv A residual cyst is often preceded by a different cyst which has formed apical or adjacent to an extracted tooth – its incomplete removal leads to the formation of another. Because they are located at the site of an extracted tooth, residual cysts can present a risk to the local alveolar bone if left untreated.
Dentigerous cysts account for 20.6% of odontogenic cysts and occur when fluid accumulates around the crown of an unerupted tooth.iv Younger patients (10-30) are therefore vulnerable to dentigerous cysts. Patients whose third molars are beginning to erupt should be advised on the symptoms: diastemas between the affected teeth, displacement of the teeth, swollen gingivae, and sensitivity.[vi]
Tricky treatment
Managing patients with odontogenic cysts involves rigorous checks, such as tooth vitality testing. If left untreated, an odontogenic cyst can grow, putting pressure on the alveolar bone and weakening the support for the surrounding dentition. Whereas periapical cysts can be treated with root canal therapy, residual and dentigerous cysts require enucleation, with the latter also meaning the unerupted tooth is extracted too.iv
Closed for maintenance
To help prevent an odontogenic cyst from forming, and to protect their oral health following the extraction of one, patients must maintain a consistent daily oral hygiene routine. By adhering to effective dental care, such as toothbrushing twice a day and interdental cleaning once a day, patients can reduce the risk of caries and therefore the risk of an odontogenic cyst. For those who have had a cyst enucleated, as well as the removal of a tooth, a more powerful oral hygiene solution may be needed to optimise the healing process.
The Perio Plus range of mouthwashes from Curaprox add a reliable antibacterial boost for short term daily dental care. For the swift reinforcement of gingival health, the Perio Plus Forte contains 0.2% chlorhexidine, providing intensive care before and after dental surgery by fighting plaque build-up. Xylitol gives the mouthwash a pleasant taste and further ensures strong teeth for an all-round healthier smile, supporting a smooth healing process.
Odontogenic cysts take many shapes, forms and causes. Being able to identify the most prevalent, as well as the risk factors and type of patient who may be vulnerable, is vital for dental practitioners. With the correct management strategy, including a sound awareness on the role that oral hygiene plays, patients can be guided to healthier outcomes.
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[i] Brown, S.J. and Conn, B.I. (2022). Odontogenic cysts: Classification, histological features and a practical approach to common diagnostic problems. Diagnostic Histopathology. doi:https://doi.org/10.1016/j.mpdhp.2022.02.007.
[ii] Titinchi, F. and Morkel, J. (2020). Residual cyst of the jaws: A clinico-pathologic study of this seemingly inconspicuous lesion. PLOS ONE, 15(12), p.e0244250. doi:https://doi.org/10.1371/journal.pone.0244250.
[iii] Mayo Clinic. (n.d.). Jaw tumors and cysts – Symptoms and causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/jaw-tumors-cysts/symptoms-causes/syc-20350973.
[iv] Wang, L.L. and Olmo, H. (2022). Odontogenic Cysts. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK574529/.
[v] Peri-apical cyst. (2024). Available at: https://www.royalberkshire.nhs.uk/media/ec4h1lge/peri-apical-cyst_may24.pdf.
[vi] Cleveland Clinic. (2024). Dentigerous Cyst: Symptoms, Causes & Treatment. [online] Available at: https://my.clevelandclinic.org/health/diseases/dentigerous-cyst.
