Dental cyst - causes and therapy

Often, a dental cyst is more likely to be detected by chance during a dental examination because it has not caused any discomfort. However, the cyst can lead to the displacement of healthy tissue and in the long term, for example, bring about significant dental malocclusion. In the late stage often develops a massive swelling, which may also presses on the nerve pathways and thus causes pain. If bacteria settle within the cyst, it causes inflammation, which is also associated with massive pain. Even though the dental cyst causes no discomfort, timely therapeutic care is needed to avoid long-term consequences.

contents

definition
symptoms
Different forms of dental cysts
diagnosis
therapy

definition

Dental cysts are liquid-filled, encapsulated tissue cavities (surrounded by the so-called cystic bladder) in the area of ​​the jaw, which originate in the teeth or a faulty tooth formation. The medical term is "odontogenic cysts", which, in turn, depending on their formation and location in various forms such as the radicular cysts, follicular cysts, periodontal cysts or dentition cysts are divided. The dental cysts are in the broader sense of the jaw cysts assigned.

The tooth root cyst sometimes causes considerable pain, but can also come along without noticeable symptoms. Image: www.fotolia.com © Henrie

symptoms

In general, most of the dental cysts initially run for a long time without symptoms and only when they reach such a size that swelling or malocclusions become visible, the sufferers notice their disease. Typical symptoms at this stage include swelling of the cheek or facial asymmetry, sometimes accompanied by unilateral pain and shifts or loosening of the teeth. Not infrequently, bacteria invade the cyst and begin to multiply, which can be accompanied by typical inflammatory symptoms such as severe pain, redness and swelling. The development of an abscess threatens as a further complication. With extremely large cysts, the pressure on surrounding bones can become so great that fractures (broken bones) may occur. Depending on which form of the tooth cyst is located 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 dental cysts

As already mentioned, dental cysts can occur in different forms, which differ significantly in their causes. Also, the discomfort of the same types of dental cyst are by no means always identical, as the cysts may manifest in different parts of the jaw.

Root cysts
Tooth cysts develop as a result of inflammation of the root apex on a dead tooth. If the so-called tooth pulp is dead, bacteria can rise in the root canal and cause a tooth root inflammation, as a result, forms around the root tip around a fluid-filled cavity as a dental cyst. The medical term is "radicular cyst." These usually run painlessly, as long as no bacterial infection develops and / or the cyst increasingly presses on the surrounding tissue.

Follicular cyst
In a follicular cyst, the epithelium surrounding the cavity forms from the cells of the so-called tooth sac. In the crown area of ​​a breakthrough-herniated (retained) tooth, the dental cervix widens and a yellowish fluid accumulates inside. Follicular cysts are increasingly observed on the lower wisdom teeth, but also on displaced supernumerary teeth. The course of the disease is usually free of symptoms for a long time before the affected person notices a swelling and / or pain. Malocclusions can also occur here as a long-term consequence.

Dentition cysts / eruption cyst
Immediately associated with tooth formation are the so-called dental cysts (also called eruption cysts), which form above unbroken teeth. Between the gum and the tooth tip, a fluid-filled cavity forms, which is usually broken in the further growth of the tooth and thus usually disappears by itself. Until then, the cyst can be felt as a swelling, which in the case of a bacterial infection or inflammation may also be accompanied by pain.

Periodontal cysts
Inflamed tooth pockets can also cause dental cysts. These so-called periodontal cysts form on the side of the cervix. They also usually cause discomfort at a later stage.

Other forms of dental cysts
As other forms of dental cysts so-called primordial cysts, which are caused by a faulty development of the tooth-forming organs known. From the epithelium of the so-called tooth bud creates a cavity which fills with liquid. Primordial cysts are relatively rare. The same applies to the gingival cysts, which arise from remnants of the dental arch 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. For the first time, the glandular odontogenic cyst was described 25 years ago as an independent form of dental cyst. They often reach a considerable size and tend to reoccur after successful surgical removal. So-called residual cysts usually develop from radicular cysts, which continue to grow independently in the jaw, after the tooth to which they originally attached was pulled.

diagnosis

If there are no obvious symptoms such as facial asymmetry, malocclusions, pain or other ailments, the diagnosis of dental cysts is often incidental to routine dental radiological examinations. They are recognizable on the X-ray images as sharply defined lightening. However, this does not apply to all forms of odontogenic cysts. For example, gingival cysts usually can not be detected in an X-ray. Therefore, the clinical features in the diagnosis play a special role. For example, gingival cysts become visible as small local swellings on the outside of the gums in the lower canines and premolars (premolars). 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 Wurzelresorptionsen, which go back to the cyst, clearly visible in the radiological examination.

therapy

In most cases, a cyst needs surgical removal as part of a so-called cystectomy, even if the patients show no symptoms so far. The entire cyst including the cystic bladder is surgically removed. The damaged bones usually regenerate on their own after cystectomy and after a relatively short time, no defects can be detected on the X-ray images. Occasionally, however, extra-large cysts may require a bone substitute material to compensate for the existing damage. If a cyst has formed around the root tip of a devital tooth, it will also be removed as needed during cystectomy or a root tip resection will be performed. Also, a follicular cyst around a breakthrough tooth is usually treated with a cystectomy that removes the retained tooth. However, under certain circumstances, it is also possible to place the displaced tooth orthodontically back in the correct position, so that only the cyst has to be removed and the tooth can be preserved. Very large cysts may be surgically opened and held open as part of a so-called cystostomy to reduce pressure and reduce cyst volume. Subsequently, after some time, another procedure to remove the cystic bladder. Cystostomy is only considered after a biopsy followed by a laboratory examination of the extracted tissue, as it may be a malignant tumor. For the same reason, after successful cystectomy, an examination of the removed cyst tissue may be necessary. (Fp)

Picture 1: Dieter Schütz