Tooth cyst: what is it, symptoms, treatment, photo
What it is? A cyst is a complex cavity pathological formation, consisting of a membrane and liquid or soft contents.
Among the many varieties, a separate group is distinguished - odontogenic cysts formed with the participation of teeth: radicular and follicular.
How does a tooth root cyst develop, and what is it? In the absence of treatment for periodontitis or root filling failure, the root canal lumen becomes a breeding ground for infection for a long time.
In the case of good resistance of the body, a connective tissue is formed around the apical opening of the tooth. a capsule designed to reduce the release of microbes and toxic products of their vital activity, their isolation from others fabrics. Over time, a cavity is formed around the apex of the root, consisting of two layers. The membrane is represented by connective tissue lined with epithelial cells from the inside. instagram profile viewer
The latter constantly produce fluid that maintains a slight excess pressure inside the cyst, which leads to a slow resorption of the surrounding bone tissue.
Radicular cyst of the tooth develops without any external symptoms, without causing discomfort to the patient. Gradually increasing in size, it can exist for years and be detected on an X-ray during an accidental examination or during suppuration during an exacerbation of chronic periodontitis.
Outside the stage of exacerbation, a tooth cyst can manifest itself after reaching a size of a centimeter or more by protrusion of the outer bone plate of the jaw, which can be determined by palpation (feeling). At the same time, under the fingers, there is a slight bending of the thinned bone layer with a characteristic sound similar to the crunch of a celluloid toy.
In the case of complete destruction of bone tissue by the cyst wall, a defect covered by a thin and soft mucous membrane is palpated. When the cyst covers the roots of adjacent teeth, the latter can be displaced, which is clinically manifested in the form of a change in the position of the teeth in the oral cavity.
With an exacerbation of chronic periodontitis, the cyst suppurates, its contents become thick, with an unpleasant odor and turns white. The characteristic symptoms will not be long in coming. Severe pain appears, radiating to the adjacent teeth or the opposite jaw. The pain increases significantly when tapping on a sore tooth, which is an important diagnostic sign for detecting the cause of inflammation. A fistula with purulent discharge may form on the gum in the area of cyst projection.
The diagnosis of a radicular cyst is usually straightforward. The main research method - X-ray, allows you to identify a rounded area with less pronounced bone pattern and clear contours. The cyst can be located tangentially in relation to the apex of the tooth root, but it can also surround it from all sides.
If the image of the roots of adjacent teeth is superimposed on the cyst contour in the image, the integrity of their periodontal gap should be monitored. If the latter is broken, this is a sign of involvement of other teeth in the cyst structure. Otherwise, the teeth are not involved, and their image against the background of the cyst is a consequence of the projection of the volumetric structure of the jaw on the plane of the X-ray film.
Differential diagnosis of a tooth root cyst is carried out with non-odontogenic cysts of the jaws and some types of oncological diseases. Neodontogenic cysts affect the body of the jaw, not the alveolar ridge and are not associated with the roots of the teeth. To distinguish it from oncology, in doubtful cases, a morphological examination of the contents of the cyst and capsule fragments is carried out.
There are two main methods of treatment of radicular cyst of the tooth - therapeutic and surgical.
If it is impossible to use one of these methods, the tooth must be removed with curettage of the cyst walls through the bone hole.
It is indicated for small cysts and well-passable root canals in young people. The average treatment regimen consists of the following stages:
This type of cyst is much less common than radicular cysts. Most often, they arise in the area of the lower third molars (wisdom teeth) from the remnants of tissues that took part in the laying of tooth germs. Clinically do not appear until suppuration or accidental detection.
Diagnostics is straightforward. On the roentgenogram, it is visible as a cavity formation with clear contours outlining the tooth, usually in contact with the coronal part of the cyst wall.
Tooth cyst is a disease that is dangerous for its secretive and steady growth. Therefore, if it is found, it is necessary to follow the treatment recommended by the doctor. This will prevent a number of complications, including purulent inflammation or significant surgery.
Among the many varieties, a separate group is distinguished - odontogenic cysts formed with the participation of teeth: radicular and follicular.
Causes and structure
How does a tooth root cyst develop, and what is it? In the absence of treatment for periodontitis or root filling failure, the root canal lumen becomes a breeding ground for infection for a long time.
In the case of good resistance of the body, a connective tissue is formed around the apical opening of the tooth. a capsule designed to reduce the release of microbes and toxic products of their vital activity, their isolation from others fabrics. Over time, a cavity is formed around the apex of the root, consisting of two layers. The membrane is represented by connective tissue lined with epithelial cells from the inside. instagram profile viewer
The latter constantly produce fluid that maintains a slight excess pressure inside the cyst, which leads to a slow resorption of the surrounding bone tissue.
Tooth cyst symptoms
Radicular cyst of the tooth develops without any external symptoms, without causing discomfort to the patient. Gradually increasing in size, it can exist for years and be detected on an X-ray during an accidental examination or during suppuration during an exacerbation of chronic periodontitis.
Outside the stage of exacerbation, a tooth cyst can manifest itself after reaching a size of a centimeter or more by protrusion of the outer bone plate of the jaw, which can be determined by palpation (feeling). At the same time, under the fingers, there is a slight bending of the thinned bone layer with a characteristic sound similar to the crunch of a celluloid toy.
In the case of complete destruction of bone tissue by the cyst wall, a defect covered by a thin and soft mucous membrane is palpated. When the cyst covers the roots of adjacent teeth, the latter can be displaced, which is clinically manifested in the form of a change in the position of the teeth in the oral cavity.
With an exacerbation of chronic periodontitis, the cyst suppurates, its contents become thick, with an unpleasant odor and turns white. The characteristic symptoms will not be long in coming. Severe pain appears, radiating to the adjacent teeth or the opposite jaw. The pain increases significantly when tapping on a sore tooth, which is an important diagnostic sign for detecting the cause of inflammation. A fistula with purulent discharge may form on the gum in the area of cyst projection.
Diagnostics of the tooth root cyst
The diagnosis of a radicular cyst is usually straightforward. The main research method - X-ray, allows you to identify a rounded area with less pronounced bone pattern and clear contours. The cyst can be located tangentially in relation to the apex of the tooth root, but it can also surround it from all sides.
If the image of the roots of adjacent teeth is superimposed on the cyst contour in the image, the integrity of their periodontal gap should be monitored. If the latter is broken, this is a sign of involvement of other teeth in the cyst structure. Otherwise, the teeth are not involved, and their image against the background of the cyst is a consequence of the projection of the volumetric structure of the jaw on the plane of the X-ray film.
Differential diagnosis of a tooth root cyst is carried out with non-odontogenic cysts of the jaws and some types of oncological diseases. Neodontogenic cysts affect the body of the jaw, not the alveolar ridge and are not associated with the roots of the teeth. To distinguish it from oncology, in doubtful cases, a morphological examination of the contents of the cyst and capsule fragments is carried out.
Tooth root cyst treatment
There are two main methods of treatment of radicular cyst of the tooth - therapeutic and surgical.
If it is impossible to use one of these methods, the tooth must be removed with curettage of the cyst walls through the bone hole.
Therapeutic method for the treatment of tooth cysts
It is indicated for small cysts and well-passable root canals in young people. The average treatment regimen consists of the following stages:
- 1) Organization of access to the mouths of the crustal canals. For this, all destroyed tissues are excised and / or previously imposed seals are removed.
- 2) A special tool is used to detect the entrances to the root canals, determine their patency, direction and length. A control X-ray is taken with metal instruments inserted into the canals.
- 3) Expansion of root canals and excision of the infected walls, and in the presence of an old root filling, its complete removal.
- 4) At all stages of work in the root canals, constant and abundant treatment with antiseptic solutions, for example, chlorhexidine or sodium hypochlorite, is necessary.
- 5) After mechanical and antiseptic treatment of the root canals, the apical opening is opened and the drug is removed from the apex, most often on the basis of calcium hydroxide. This group of agents has a high alkalinity (12) and neutralizes the acidic environment inside the cyst, and also has a high antimicrobial activity. Hydroxide causes destruction of the membranes of the cyst and promotes the restoration of bone tissue, including being a source of calcium necessary for this.
- 6) Temporary filling of root canals is carried out several times with an interval of 1-3 weeks until the appearance of X-ray signs of destruction of the cyst. After each intermediate stage of treatment, the tooth cavity is sealed with a temporary filling material.
- 7) Upon completion of the treatment, filling of the root canals and the outer part of the tooth is performed using any standard technology. The subsequent final restoration of the jaw bone tissue may take from one month to 1-2 years.
Surgical method for the treatment of tooth root cysts
- 1) A thorough endodontic treatment of the tooth is carried out with antiseptic treatment of the root canal and subsequent filling with glass ionomer cement.
- 2) After high-quality anesthesia, the gum is incised over the cyst for a length exceeding the length of the bone defect. The edges of the wound are parted and held.
- 3) The outer bone plate is cut out in the cyst projection area.
- 4) The walls of the cyst are scraped out with cutting off the accessible part of the root. If a root filling defect is found, the cut line is sealed with additional filling material.
- 5) A preparation is placed into the cavity that accelerates the regeneration of bone tissue (bone sawdust or flour), the wound is sutured. A pressure bandage of the "mouse" type is applied to the skin.
Follicular (tooth-containing) cyst
This type of cyst is much less common than radicular cysts. Most often, they arise in the area of the lower third molars (wisdom teeth) from the remnants of tissues that took part in the laying of tooth germs. Clinically do not appear until suppuration or accidental detection.
Diagnostics is straightforward. On the roentgenogram, it is visible as a cavity formation with clear contours outlining the tooth, usually in contact with the coronal part of the cyst wall.
Treatment is only surgical. After anesthesia, the gum flap is discarded and the bone fragment is cut out, opening access to the cyst. The shell is husked, the tooth is removed. The gums are sutured, sometimes leaving elastic drainage.
Tooth cyst is a disease that is dangerous for its secretive and steady growth. Therefore, if it is found, it is necessary to follow the treatment recommended by the doctor. This will prevent a number of complications, including purulent inflammation or significant surgery.