What is an Oral Cyst?
A cyst on a tooth is often the result of a problematic tooth or damaged gum tissue. These small pockets of fluid can sometimes be sterile or may contain infectious material. Dental cysts can be found around the roots of dead/inflamed teeth, inside the gums, around impacted wisdom teeth, in your maxillary sinuses, or within the jawbone.
If you notice strange growths in your mouth or other problems with your teeth, don’t hesitate to discuss these changes with your dentist. Early treatment could mean identifying a serious health problem at an early stage or preventing further dental issues. The cause and severity of a dental cyst will determine the course of treatment.
An oral cyst is a type of small growth that can appear in the mouth. It is a small, fluid-filled sac that feels like a small bump to the touch. This cyst in the mouth is sometimes referred to as a mucocele or mucous cyst. In most cases, cysts in the mouth may seem uncomfortable, but they are harmless.
They most commonly appear on the inside of the lips, but they can also form on the inside of the cheeks, tongue, palate, the floor of the mouth, and around any piercings located in the mouth.
A cyst in the mouth is not the same as a cyst on a tooth.
What does a cyst on a tooth look like and what causes it?
Cysts usually begin forming at the tip of the root of a dead or inflamed tooth for the following reasons:
• Some form due to the improper way teeth have grown and positioned themselves in the mouth, while others result from an abnormal way a tooth developed.
• Root canal treatments that failed due to natural reasons or as a result of an unsuccessful/poor procedure.
• Due to a genetic syndrome (Gorlin syndrome) – if this is the cause, other symptoms will also be involved.
• Cysts can form around the crowns (and roots) of impacted teeth. Impacted wisdom teeth are common causes of cyst formation.
• If the root of a dead or inflamed tooth is untreated or treated improperly.
Dental cysts can form on any of your teeth and usually appear one at a time. However, some people are more prone to them than others. This is due to the condition of their teeth or because they have an existing health problem that includes cysts on the teeth as one of the symptoms. Your dentist should be able to explain the cause of your specific cyst in detail.
What problems can a tooth cyst cause?
A tooth cyst can cause the following problems:
• Pain and/or swelling due to infection
• Weakening of the jawbone as the cyst spreads
• Migration of teeth as the growing cyst pushes them aside
• Breathing and sleeping problems related to sinus issues.
Asymptomatic tooth cysts can go unnoticed for months or even years.
What types of tooth cysts do we distinguish?
1. Periapical cyst (odontogenic cyst or radicular cyst)
The most common odontogenic cyst, with different names, including radicular cyst, apical periodontal cyst, and cyst at the root end. Death or necrosis of the pulp tissue within the tooth, caused by decay or trauma, will trigger this type of cyst. The necrosis process of the pulp causes inflammation and the release of toxins at the tip or end of the root.
It is usually treated with endodontic therapy. If endodontic treatment is not effective, tooth extraction is performed, and the cyst area is cleaned and filled with artificial bone material.
Traditional methods have not been sufficiently effective because cysts often recurred. To avoid this, retrograde root canal filling is required according to the most modern treatment methods.
2. Follicular tooth cyst or dentigerous cyst
Most commonly found around the lower wisdom teeth or permanent upper canines, they develop around the crown of an unerupted tooth. Pressure from the erupting tooth on the follicle can cause a dentigerous cyst. This pressure can disrupt blood flow and create a buildup of fluid between the enamel membrane tissue and the crown of the tooth. Dentigerous cysts usually grow quickly and spread.
Treatment involves extracting the affected tooth and surgically removing the cyst, a procedure called cystectomy. Treatment is often successful, and the patient is advised to monitor for the return of symptoms.
3. Keratocystic odontogenic tumors (KCOTs)
Found mainly in the posterior part of the lower jaw or mandible, their characteristics are similar to other types of tooth cysts. A precise diagnosis can only be made through biopsy and microscopic analysis, or panoramic x-ray.
Swelling is often the only symptom the patient will feel. Several theories exist regarding the origin of keratocysts. Some experts believe the cyst develops where a tooth was supposed to be, while others argue that tumors arise from the lamina of impacted teeth.
Treatment involves cystectomy with additional treatments. The patient is monitored for life to check for signs of recurrence.
How will I know if I have a dental cyst?
A small tooth cyst developing inside the jawbone can be visible on an x-ray. Larger cysts can cause noticeable hard swelling on the face. Your teeth may also begin to shift rapidly around the area affected by the cyst.
Confirmation of a cyst diagnosis is made from a tissue sample (biopsy) taken during the surgical removal of the lesion. There are other tumors that may resemble cysts but are treated very differently. Periodic dental x-rays are essential for identifying dental cysts and other bone abnormalities.
How are tooth cysts treated?
There are two ways to treat a tooth cyst:
• Surgical procedure (cystectomy) – for the removal of all types of cysts or tumors.
• Endodontic therapy – performed in combination with surgical removal if the cyst is associated with an infected root canal.
Oral cyst surgery (tooth cystectomy)
1. Step: Diagnosis
Tooth cysts are usually detected during a routine examination, which includes dental x-rays. Your dentist may order a 3D CBCT scan, which will provide more information about the cyst and its relationship to surrounding teeth and other structures (nerves, sinuses) within the bone.
2. Step: Preoperative preparation
A few days before the procedure, a thorough cleaning of dental plaque and polishing of the teeth is performed. An oral probiotic is also given to increase the number of beneficial bacteria in the saliva to make healing more effective. If root canal treatment is needed, it will be done before the surgery.
3. Step: Cyst removal
The cyst is removed by an oral surgeon through an opening in the bone under local anesthesia. You may also choose to be under conscious sedation throughout the procedure to ensure that everything goes without anxiety.
If the tooth is embedded in the cyst, it can also be removed. Bone graft material can also be placed to fill the void left after the cyst is removed. Sutures will be placed in the gums, which will be removed after a few days or will dissolve on their own.
The excised tissue may be sent to a pathology lab for identification under a microscope. This is important for recognizing other types of tumors that may resemble cysts.
Treatment of a cyst in the mouth
The best way to treat an oral cyst is to simply leave it alone and maintain proper oral hygiene, brushing after every meal and flossing at least once in the evening. These cysts will burst on their own, without causing serious side effects or complications.
Do not try to puncture or burst the oral cyst yourself. This can lead to unintended injury or even serious infection.
How to prevent dental cysts?
Teeth that remain alive rarely develop cysts. If the nerves in a tooth die (as a result of infection or trauma), it needs to be treated professionally so that it does not become a source of infection. If this is successful, the tissues near the root should not be stimulated to form a cyst (or abscess). These are the reasons why regular visits to the dentist are very important.
Sometimes your dentist may be concerned that you may have an impacted tooth. In such cases, a 3D i-CAT CT scan is recommended to check the position and condition of the tooth. This can help detect cysts while they are still small and/or prevent the formation of cysts by removing the potential starting point.