What Is Dentigerous Cyst?

Overview

A dentigerous cyst, also known as a follicular cyst, is a non-cancerous growth that looks like a small balloon filled with fluid. It occurs around the crown of an unerupted or partially erupted tooth. It is the second most common form of cyst that originates from the process of tooth formation.

This lesion is often found around the very last molars in the lower jaw or surrounding the canines in the upper jaw.¹ Dentigerous cysts form when fluid builds up in the sac surrounding a developing tooth. These cysts are generally painless and patients are unaware of their presence.

They are often discovered by chance during routine dental checkups when X-rays are taken. Dentigerous cysts are normally harmless, they can become quite large and cause pressure on surrounding teeth, erosion of the roots of surrounding teeth, bone loss and expansion of the jaw bone. In rare situations, they can become infected and lead to more serious complications. 

The cyst and the affected tooth are removed surgically, a procedure called cyst enucleation. In some circumstances, a less invasive procedure marsupialisation cyst marsupialization is performed. Regular follow-up sessions are essential for detecting any symptoms of recurrence or problems. Early identification and care are critical in preventing potential dental and bone complications linked with dentigerous cysts.

Causes of dentigerous cyst

The specific aetiology (cause) of a dentigerous cyst is not always obvious, however, it is thought to be mostly connected to tooth formation. Here are some possible reasons and related factors:

Dentigerous cysts can occur due to interruptions in the developmental stages of teeth. This might result in displacement of the developing tooth, which creates conditions favourable to cyst development.

A cyst arises when fluid builds up between the sac surrounding the developing tooth and the crown of an unerupted or partially erupted tooth. Various reasons might cause this fluid buildup. Some people may be predisposed to having dentigerous cysts due to a hereditary component.

In other circumstances, studies have revealed a possible familial relationship. Trauma to a tooth or surrounding region might cause the eruption process to be disrupted. This trauma may lead to the creation of a dentigerous cyst if it happens during the key stage of tooth development.

Inflammation in the tissues around an impacted tooth, potentially caused by infection or other inflammatory diseases, might provide an environment which can lead to cyst development. Teeth that are slow to erupt or stay impacted (unable to fully emerge from the gum) for a lengthy period are more likely to develop a dentigerous cyst.

Hormonal imbalances or changes throughout developmental stages (e.g. puberty), can impact tooth growth and eruption patterns, increasing the probability of cyst formation. Environmental conditions or exposures during tooth development may lead to the creation of dentigerous cysts. Precise triggers in this group are not usually well-defined.

It is important to note that these conditions may contribute to the formation of dentigerous cysts, but they do not ensure their occurrence. Many occurrences of dentigerous cysts develop without a known cause.

Signs and symptoms of dentigerous cyst

Dentigerous cysts can present with a variety of signs and symptoms, but they can also be completely asymptomatic(showing no evident signs). Symptoms can include:

• Swelling or enlargement: There may be visible swelling or enlargement in the affected area. This swelling may not be painful
• Discomfort or pain: Patients can experience mild to severe pain or discomfort if the cyst becomes infected or exerts pressure on nearby tissues²
• Sensitivity or tenderness: The area surrounding the affected tooth can be sensitive or tender if pressure is applied. Loosening of adjacent teeth: As the cyst grows, surrounding bone is resorbed. When teeth don't have any bony support they may shift or become mobile
• Discolouration of the gingiva: The surrounding gum tissue may appear bluish or purple.
• Delayed Tooth Eruption: If the cyst is preventing the tooth from erupting normally, it may cause the tooth to emerge later in the oral cavity
• Difficulties in chewing or speaking: Normal activities including eating and speaking may be hampered if the cyst grows bigger or causes displacement of surrounding teeth
• Unpleasant taste or odour: Infection of the cyst may cause foul breath or an unpleasant taste in the mouth
• Sinus or nasal problems: If the cyst is located in the upper jaw, it may lead to sinus-related symptoms such as congestion or sinus pressure
• Radiographic findings: Dentigerous cysts are often identified during normal dental X-rays or radiography. They are seen as well-defined, radiolucent (black) regions surrounding the impacted tooth³

Diagnosis of a dentigerous cyst

A dentigerous cyst is diagnosed using a combination of clinical examination, x-rays and laboratory testing of the specimen.

The following is a step-by-step procedure for identifying a dentigerous cyst:

1. A thorough patient history is essential. This includes any symptoms (pain, swelling, oedema), any history of trauma to the region, and any other pertinent medical or dental issues
2. A comprehensive clinical examination by a trained dentist or oral and maxillofacial surgeon is the first step in diagnosis. The affected area will be examined by the dentist, who will search for evidence of swelling, discomfort and discolourations of the surrounding tissue
3. Radiography: To view an impacted tooth or any related cystic lesion X-rays like peri-apical views or panoramic radiographs can be taken. Dentigerous cysts are characterized by well-defined radiolucent (dark) patches surrounding the crown of an impacted tooth. The cyst is often linked to the tooth's neck and will be circular or oval³
4. CT (Computed Tomography) or CBCT (Cone Beam Computed Tomography): A CT scan or CBCT may be advised in some circumstances, particularly when three-dimensional imaging is necessary for a more complete examination and treatment planning. This might offer a clearer picture of the cyst's size and location³
5. Histopathological analysis: If investigations imply the presence of a dentigerous cyst, laboratory testing will be able to confirm the diagnosis by microscopic inspection of a small piece of the cyst lining
6. Differential diagnosis (alternative diagnosis): Lesions that occur in the jaws can often have a similar clinical or radiographic presentation. It is very important to distinguish a dentigerous cyst from other oral and maxillofacial disorders that may have similar characteristics

It is important to remember that identifying a dentigerous cyst requires the knowledge of a competent dental or maxillofacial healthcare practitioner. Correct diagnosis and a treatment plan can only take place by analyzing all the relevant clinical information and imaging studies.

Management and treatment for Dentigerous Cyst

A dentigerous cyst is normally managed and treated using a combination of conservative and surgical techniques. The particular treatment approach will be determined by the size of the cyst, its location, the patient's age, overall health, and the presence of any other related problems.

Treatment options include:

• Monitoring and observation: Regular dental check-ups and x-ray follow-ups can be used to monitor small, symptomless lesions that show no signs of change^4,5
• Aspiration: Aspiration is the process of removing fluid from a cyst with a needle and syringe. This procedure relieves some pressure and discomfort caused by larger cysts. Aspiration is a temporary treatment measure and not a permanent solution. Further management will be needed 
• Enucleation: This is the most commonly used surgical procedure for dentigerous cysts. A surgical opening is made in the wall of the cyst. At this point, the fluid contents usually leak out and are suctioned from the procedure site. The cyst lining is then peeled from the surrounding bone, resulting in the complete removal of a small balloon-like sac. The soft tissue sac is then sent away to a laboratory for testing to confirm a dentigerous cyst diagnosis. The size of the cyst will determine whether it is done under general or local anaesthesia⁶
• Marsupialisation: Marsupialisation involves creating a small surgical opening in the cyst wall. Once again the fluid contents are drained from the area leaving behind a cavity. The cyst cavity is then packed with a ribbon-like material which is covered with a special medicament called BIPP. Every week a small piece of ribbon is removed, encouraging the large cyst to shrink, making it easier to remove when it is smaller⁶ 
• Removal of the involved teeth may be suggested if the impacted tooth is badly damaged, deformed, unsalvageable or severely displaced
• Orthodontic care (braces) may be needed to correct any displaced teeth or correct spacing concerns produced by the presence of the cyst 
• Histopathological examination (laboratory diagnosis): Regardless of the treatment method chosen, the tissue sac that has been removed from the bone should be sent to a laboratory for testing to confirm the diagnosis and exclude any potential cancers
• Post-operative care: After surgery, patients will be informed about proper post-operative care, this may include pain medication, antibiotics to prevent infection, antiseptic mouth rinse and advice for maintaining good oral hygiene
• Follow-up and monitoring: Regular follow-up sessions are required to check recovery, verify there is no recurrence, and manage any post-operative problems

It is vital to highlight that each patient requires a unique treatment plan, and decisions should be made in cooperation with a trained oral and maxillofacial surgeon or dentist. Early detection and management together with consistent follow-up treatment is critical to achieve the best results for patients presenting with dentigerous cysts.

FAQs

What is a dentigerous cyst?

A dentigerous cyst, also known as a follicular cyst, is a harmless fluid-filled sac that occurs around the crown of a partly or fully erupted tooth. It is one of the most common cysts related to tooth development.

What causes the formation of a dentigerous cyst?

It is not always apparent what causes it, although it is thought to be connected to developmental defects, genetic susceptibility, trauma and hormonal impacts.It is thought to be caused mostly by interruptions in the normal tooth formation process.

Do dentigerous cysts hurt?

 No, not always. Dentigerous cysts are frequently asymptomatic, meaning they produce no pain or discomfort. However, if the cyst becomes infected or becomes very large it can exert pressure on surrounding structures like teeth, soft tissue and bone. Leading to pain and discomfort.

How do you detect a dentigerous cyst?

Clinical examination, radiographic imaging (X-rays) and histological investigation (laboratory testing) are used to make a diagnosis. A well-defined radiolucent region around the crown of an impacted tooth on X-ray is an important sign.

Will a dentigerous cyst disappear on its own?

Dentigerous cysts do not usually heal on their own. Without treatment, they can enlarge and potentially create issues like pressure on neighbouring teeth, root resorption, tooth decay, and jaw bone expansion.

What treatment options are available for a dentigerous cyst?

Treatment options include observation and monitoring, aspiration to drain fluid, enucleation (surgical removal of the cyst together with the impacted tooth), marsupialization (shrinking of the cyst and, in certain circumstances, tooth extraction.

Will a dentigerous cyst recur after treatment?

Recurrence is possible, especially if the cyst lining is not entirely removed during surgery. Regular follow-up sessions are essential for detecting any symptoms of recurrence or complications.

Can a dentigerous cyst become cancerous?

Dentigerous cysts are not malignant. However, it is critical to distinguish them from other lesions that may be malignant, which is why a histological investigation is undertaken following excision.

Are dentigerous cysts preventable?

Dentigerous cysts cannot be completely avoided since they are largely caused by developmental and hereditary causes. Early identification and intervention can help prevent and treat them.

Summary

A dentigerous cyst is a benign cystic lesion that arises around the crown of a tooth that has not yet fully erupted. It is caused by developmental flaws in tooth formation. Clinical examination, radiographic imaging, and histological investigation are all used to make a diagnosis.

For tiny, asymptomatic cysts, treatment options vary from surveillance to surgical treatments such as enucleation or marsupialization. Early identification and action are critical for avoiding problems. Dentigerous cysts are not malignant, however, histopathology is used to confirm the diagnosis.