Dentigerous cysts are a common type of odontogenic cysts. An odontogenic cyst is a fluid-filled sac that develops in the jaw bone over a tooth that hasn't erupted yet. The cysts, in most cases, affect the molars or canines, and they're second in prevalence after periapical cysts. These are cystic lesions that result from an infection in a tooth.
Although dentigerous cysts are mild, they can lead to severe complications if left untreated. They usually present in the second and fourth decades of life but are uncommon in childhood as they exclusively occur in secondary dentition. They're also known as follicular cysts and are developmental in nature.
Symptoms of dentigerous cysts include:
- Tooth sensitivity
- Tooth displacement
- A small bump where a tooth is supposed to erupt
- Gaps between displaced teeth
Smaller dentigerous cysts may not show any signs, but you’ll notice the above-mentioned symptoms when they're more than 2 centimeters in diameter.
Causes of Dentigerous Cysts
Dentigerous cysts occur when fluid builds up over the top of a tooth that has not yet erupted. The condition can affect anyone, but you’re at a higher risk if you’re in your 20s or 30s.
Generally, odontogenic tumors and cysts emanate from cells and tissues involved in normal tooth development. Most are closely linked to genetic syndromes. If you have nevoid basal cell carcinoma syndrome, your body lacks a gene responsible for the suppression of tumors.
As such, the syndrome puts you at a higher risk of developing multiple odontogenic cysts within the jaw. In worse cases, you may also be at risk of developing multiple basal cell cancers and related characteristics. Non-odontogenic tumors usually develop from other tissues within the jaw, which aren't related to the teeth.
Diagnosis and Treatment of Dentigerous Cysts
Since small cysts usually go unnoticed, 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. For further confirmation of a cyst, you may have to do a CT scan or an MRI scan. These tests will also help rule out other types of cysts like aneurysmal bone cysts or periapical cysts.
In other special cases, particularly if a cyst is are large, your dentist will quickly diagnose it as a dentigerous cyst just by looking at it.
After diagnosis, the treatment procedure will depend on the size of the cysts. A small one is easy to remove through a surgical procedure, alongside the affected tooth. In some cases, the dentist will use a treatment procedure known as marsupialization.
The technique involves surgically cutting the cyst open to form a slit and seaming the edges of the slit. This smoothens the surface from the external surface to the interior of the cyst. The cyst will remain open and can freely drain the fluid it carries.
This method is most effective when a single draining procedure isn't enough. It's also a better method than completely removing the surrounding tissue. It's a popular procedure that can also be applied to other conditions, like Bartholin’s cysts and pancreatic cysts. In the case of dentigerous cysts, marsupialization allows the tooth affected by the cyst to erupt without any obstacle. It goes a long way in reducing the chances of a cyst recurring.
Other treatment options for dentigerous cysts include:
- Reconstruction surgery to restore 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.
Lifelong follow-ups after any treatment are crucial in addressing any arising concerns. Monitoring also reduces the chances that a cyst will reappear.
Possible Complications of Dentigerous Cysts
Even with a small dentigerous cyst, having it removed can prevent future complications. Leaving it untreated can lead to:
- Infections: An infected dentigerous cyst can lead to periodontal and periapical infections.
- Tooth loss: Untreated dentigerous cyst causes distress on the gum tissue, weakening it and causing it to lose its ability to hold a tooth in place. Some cysts are associated with dead or dying teeth.
- Jaw fracture: When the jaw bone becomes weakened from a cyst infection, it can develop a fracture. The risk is high when the cyst is in the premolar region.
- Ameloblastoma or jaw tumor: These are rare tumors that mainly affect the jaw near the molars or wisdom teeth. They arise from cells that form the enamel. If left untreated, the swelling becomes cancerous and may spread to the lungs or lymph nodes.