Removal of maxillary cyst. Jaw cyst description of causes

Follicular cyst

Follicular cyst is a rare odontogenic neoplasm of the jaws. At the Leningrad Dental Institute for 1934-1938. observed 411 patients with jaw cysts, of which 14 were follicular. In the clinic of maxillofacial surgery of the Perm Medical Institute over 25 years, out of 990 patients with jaw cysts, 41 patients had follicular cysts.

Follicular cysts in the jaws occur more often at the age of 12-15 years and in the third decade of life.

In our biopsy material, 26 patients had follicular cysts: 14 in males and 12 in females. The patients were distributed by age as follows: 7-10 years - 8 patients, 11-20 years - 8, 21-30 years - 3, 31-40 years - 3, over 40 years - 4 patients.

The follicular cyst is most often localized in the upper jaw, respectively, in the molars and canines, less often in the premolars, and very rarely in the incisors. Sometimes a follicular cyst is located in the lower edge of the orbit, in the nose or in the maxillary sinus, filling it entirely.

Radiologically, a follicular cyst is defined as a round or oval defect in the bone tissue of the jaw with a sharply defined edge and the presence of a tooth (teeth) in the wall or cavity of the cyst.

Currently, the size of the cyst at most reaches the size of a chicken egg.

A follicular cyst is, as a rule, a single-chamber cavity located in the jaw, delimited from the bone tissue by a capsule. According to the localization of the cyst, thickening occurs in the jaw area, often with facial deformation. In other cases, the bone tissue of the jaw can be sharply thinned - until it is completely resorbed.

A very characteristic feature of a follicular cyst is the presence of one or several rudimentary or formed teeth, most often located in the wall of the cyst; the crowns of the teeth usually protrude into the lumen of the cyst. Sometimes there are only tooth crowns, without the formation of roots. In some cases, the tooth lies freely in the cyst cavity; Often it contains an impacted tooth that is missing from the dentition. The cavity of the cyst is filled with a light, yellowish liquid, in which cholesterol crystals, desquamated epithelial cells, and sometimes an admixture of blood are found.

A microscopic examination of the walls of a follicular cyst reveals the following picture: stratified squamous epithelium lines the inner surface of the cyst and is located on a connective tissue capsule, which is easily separated from the bone tissue of the jaws when the cyst is removed. Sometimes stratified squamous epithelium forms separate outgrowths inside the cystic cavity.

In infected follicular cysts, the epithelium is often desquamated; the inner surface of the cyst is fresh granulation tissue, only in places with an epithelial lining (Fig. 46).

Along the periphery there is a connective tissue capsule, also with perivascular inflammatory cellular infiltrates of round and plasma cells with an admixture of leukocytes. In these cases, the lumen of the cyst contains a turbid or purulent fluid containing a large number of leukocytes.

A follicular cyst develops from a normally embedded or supernumerary dental germ of a permanent, less commonly, milk tooth.

A follicular cyst occurs from the outer epithelial layer of the dental sac (follicle) in the period before the formation of enamel and occurs as a result of degeneration and proliferation of cells of the enamel organ and the subsequent appearance of a cyst. The latter can form both around permanent and baby teeth.

As for the causes of a follicular cyst, there are different opinions, which mainly come down to trauma to the developing tooth, such as pressure on the tooth germ of a baby tooth, or to a lack of space for a growing wisdom tooth, or infection of the tooth germ.

Due to the period in which the normal development of the dental follicle is disrupted, the following may occur: 1) a cyst without teeth, 2) a cyst containing parts of them, 3) a cyst containing formed teeth. Thus, a follicular cyst is essentially a dental malformation.

A follicular cyst develops slowly over a long period of time. Sometimes, in case of incomplete removal of the epithelial lining, relapses occur after surgery.

Morphologically, a follicular cyst should be differentiated from a radicular cyst and a cystic form of adamantinoma.

Macroscopically, a follicular cyst is characterized by the presence of rudimentary and formed teeth, which does not happen in a radicular cyst.

Microscopically, based on a piece of the cyst wall sent for examination, it is not possible to differentiate it from a radicular cyst without additional clinical and radiological (presence of teeth) data.

A cyst is a tissue formation covered with epithelium, the cavity of which contains fluid. It can appear in various internal organs.

The cyst also forms in the bone of the upper and/or lower jaw, and it quite often affects this area and has characteristic symptoms and signs.

Characteristics of the pathology

A jaw cyst is a cavity, the inner surface of which is lined with epithelium, and the outer wall is formed by fibrous tissue. Liquid contents—exudate—accumulate inside the cyst. Its dimensions can range from 5 mm to several cm.

Cystic formations are classified as benign tumors - they do not spread to surrounding tissues and internal organs. But this does not mean that this tumor is not dangerous: if treatment is not started in a timely manner, the cyst accumulates pus in the jaw and grows in size. Its development is dangerous due to intoxication of the body and such a serious complication as sepsis.

Cystic formations may not manifest specific symptoms for a long time. In such cases, they are identified during testing.

Experts believe that cysts in the jaw are a congenital pathology. However, it has been proven that neoplasms can form as a result of tissue inflammation, with advanced pathological processes in the oral cavity, as a reaction of the body to infection.

The cavity can become inflamed and thereby provoke the development of a purulent process, which is accompanied by severe pain and swelling of the gums.

The only way to treat jaw cysts is surgical enucleation ().

Lower jaw cyst on x-ray

Provoking reasons

Cysts in both the upper and lower jaw teeth are formed due to several factors. These include:

Such cavities can form in a patient of any age.

Modern classification - it is important to distinguish

Depending on the cause of appearance, as well as the predominant symptoms, the following types of jaw cysts are distinguished:

Primordial, also known as primary, or keratocyst. It is formed in the so-called “” zone or in the corner areas of the lower jaw. The tumor can be single- or multi-chamber. The cavity contains dense contents. The surgical method of eliminating keratocysts does not guarantee the absence of relapse: very often after surgery, repeated suppuration is observed, and the risk of tumor growth cannot be excluded.
, or basal The cyst usually forms in the upper jaw. A tumor develops when tissues that are close to the root of the tooth become inflamed. The formation of the capsule is a response to the inflammatory process. A characteristic feature of this type of formation is the ability to grow into the jaw bone. Hilar cysts often suppurate. They can penetrate the maxillary sinus, which creates a risk of developing sinusitis.
Follicular. This type of cyst is formed from the enamel tissue of unerupted teeth. In its cavity, in addition to the liquid contents, there are rudimentary teeth, and sometimes already fully formed ones.
Traumatic. Most often localized in the lower jaw area, it occurs after a strong blow.
Aneurysmal. Such a cyst forms in the lower jaw, next to completely healthy teeth. It contains blood or a liquid that resembles it in color. The main reason for this phenomenon is considered to be puberty.

Different types of formations cause different symptoms, which become noticeable only when the cyst reaches a certain size.

Keratocyst to the wisdom tooth area

Characteristic symptoms

When a jaw cyst with a large diameter forms, a round protrusion forms on the patient’s face. During the inflammatory process, which almost always accompanies the development of formation, the following symptoms are observed:

Methods for detecting formation and features of its treatment

The main way to detect a cyst in the jaw area is. The greatest amount of necessary information provides .

With its help, the specialist determines the location of the tumor, the degree of its growth, and the level of influence on the teeth located next to it. Magnetic resonance imaging is also performed for diagnostic purposes.

Cysts are treated surgically. The main task of the specialist is to preserve the integrity of the teeth located next to the formation, as well as restore their functioning. For these purposes, perform the following manipulations:

if the patient is diagnosed with a radicular cyst with a diameter of no more than 8 mm, the root canal is washed, a medicine is injected into it that neutralizes inflammation and infection, and then cemented;
an incision is made in the gum area, removing a small tumor along with the tips of the roots of the teeth, the canals are subsequently treated and the removed tissue is replaced with artificial materials;
remove the tumor along with the tooth if the tumor has formed near the ““;
if the tumor has grown and provoked purulent inflammation of the jaw bone, a large-scale surgical intervention is performed; after eliminating the tumor, the affected tissue is scraped out.

After surgery, the patient is prescribed long-term treatment based on antibiotics.

Hidden and obvious dangers

Even with treatment, there is no guarantee that the cyst will not reappear. But this does not mean that there is no point in dealing with this problem: if the necessary therapeutic measures are not carried out in a timely manner, there is a significant risk of suppuration and subsequent penetration of purulent masses into the blood, which is fraught with the development of sepsis.

In addition, a benign neoplasm can transform into malignant and provoke the development of cancer.

Another consequence of untreated cysts is loosening of teeth and their loss. This can only be corrected in the future using .

Preventive measures

Given the long asymptomatic period of cyst development, experts recommend regular X-ray examinations to monitor this process.

If a jaw injury occurs (, bruise), then an x-ray must be taken immediately, and a repeat one a month after the start of treatment.

After surgery to remove a cyst, you should avoid eating too hot or cold food and regularly rinse your mouth with antiseptic solutions. You should include as many cereals as possible in your diet. You should take vitamin complexes to strengthen local and general immunity.

After completing each meal, you need to thoroughly rinse your mouth with water, and in general it is advisable to thoroughly rinse your mouth after each meal.

What is a jaw cyst? This is a hollow capsule with liquid located in the jaw bone. Cyst formation does not depend on age; both adults and children are susceptible to pathology. The formation is benign in nature and may not appear for a long time. When inflamed, suppurating, jaw cysts are accompanied by severe pain (pressing, aching, pulsating), hyperemia and swelling of the gums. They can provoke the loss of not only diseased, but also healthy (adjacent to the formation) teeth. A festering neoplasm can be accompanied by various diseases: osteomyelitis, sinusitis, periostitis, fistulous tract formation.

Types of cysts in the jaw

Clinical manifestations of cystic systems are classified depending on the location and shape, size, causes of occurrence:

Retromolar formation

It occurs as a result of complex eruption, which results in long-term chronic inflammation. In most cases, the formation is formed in the area of wisdom teeth, which are often characterized by severe and prolonged eruption;

Radicular cyst of the jaw

This form is the most common type of formation. The radicular cyst of the lower jaw, like the upper one, is a cavity with liquid contents, which is localized in the area of the apex of the tooth root. Occurs as a result of prolonged inflammation of the periapical tissues. The development of formation leads to deformation processes in bone tissue, an increased risk of fracture of the jaw bone, and can provoke the development of malignant tumors. Radicular cyst of the maxilla is more common.

Aneurysmal

It is not common, it is a cavity filled with blood. Formed on the lower jaw. It occurs due to hormonal imbalances (in most cases during puberty). The growth and development of an aneurysmal cyst of the mandible leads to its deformation.

Follicular cyst of the jaw

A follicular (near-coronal) formation is formed around the crown of an unerupted tooth, which differs from a reticular (root) dental cyst. The reason for the formation is a congenital anomaly, as a result of which the tissues of the rudiment degenerate into a cystic formation. A follicular cyst of the lower jaw, like the upper one, can occur at different stages of dental formation. In some cases, formations appear before the development of a full-fledged tooth (only its rudiment is present), and can form before the final development of the root (the crown part is formed, there is no root). In most cases, a neoplasm develops after the dental unit has completely formed.

Nasoalveolar (nasolabial formation in the vestibule of the nose)

Located above the front upper incisors, under the upper lip. Formed from the remains of epithelial tissue. In most cases it occurs in women. It is a round formation, not associated with the roots of the teeth, and is formed in the soft tissues. A nasoalveolar cyst of the maxilla can cause deformities in the form of narrowing of the nasal entrance, depression of the bone at the site of the cyst.

Residual (residual)

The cause of this type of formation is an incorrectly performed surgical operation to remove the root formation. When extracting a tooth with a basal cyst, parts of it remain unremoved, and a residual cyst is formed from them. The combination of residual formation and reticular formation occurs in most cases.

Traumatic

It occurs as a result of a traumatic external influence (bruise, blow, damage). In some cases it is asymptomatic.

Reticular cyst of the jaw

A hilar cyst occurs as a result of the development of periodontitis - inflammation of the soft tissues surrounding the root. The body's defenses form a membrane around the source of inflammation, preventing the spread of the inflammatory process to neighboring areas. The membrane with liquid contents is a cyst.

Reasons for formation

The main factors provoking the formation of jaw tumors are:

Dental diseases of hard tissues: advanced caries, enamel hypoplasia, fluorosis. As a result of the destruction of hard tooth tissues, the infection penetrates into the soft tissues through the root canals, causing the formation of cystic structures;
Infection of soft tissues as a result of improper filling;
Pulp diseases;
Traumatization as a result of mechanical impact: blows, bruises, damage from incorrectly selected crowns, orthodontic systems;
Infectious and inflammatory processes in the nasopharynx (sinusitis, acute rhinitis). Pathological microorganisms affect the bone and soft tissues of the tooth, penetrating from the sinuses (nasal, maxillary);
Congenital pathologies.

Symptoms of a jaw cyst

Why is a cyst on the jaw dangerous? The danger of education lies in its hidden development and the presence of a large number of complications. At the initial stage of development, the neoplasm is asymptomatic. The cystic cavity may not appear for a long time (up to several years), while the destructive processes progress daily.

There may be a change in the color of the tooth or its displacement. The small formation increases and can grow up to 2-3 cm. At first, discomfort appears while eating, then the situation worsens, the following symptoms appear:

Pain syndrome occurs. The pain can be of different types - pressing, aching, throbbing;
Gum tissues, in the projection of the formation, swell, turn red, their sensitivity and pain increase;
The development of inflammation leads to the appearance of purulent flux;
Symptoms of intoxication occur: increased body temperature, headache, fatigue, general weakness, aches;
There is an increase in the lymph nodes and their pain on palpation;
The jaw bones become deformed and severe swelling appears. Swelling of the lower jaw can spread to the chin, causing facial asymmetry.

At the beginning of the development of the cystic system, it performs an important function - it protects the body from infection. As jaw disease progresses, it can lead to serious complications and the emergence of a number of pathologies.

Cyst in the jaw, consequences:

Development of purulent periodontal abscess;
Rapidly developing purulent inflammation of the root area;
Flux (periostitis) – inflammation of the periosteum;
Formation of phlegmon - foci of inflammation of the tissues of the face and neck;
Ostiomyelitis is an inflammatory lesion of the jaw tissue;
Loss of teeth that fall out of the cystic cavity;
Tumor formations in gingival tissues;
Blood poisoning.

In cases where the formation has grown into the maxillary cavity, a protrusion (Gerber's ridge) forms in the nasal passage, which is characterized by the following symptoms:

Impaired perception of smells;
Difficulty in nasal breathing;
Feelings of pressure, heaviness on the affected maxillary bone;
Constant nasal congestion.

An increase in size and inflammation of the cystic formation requires immediate medical intervention. In this case, severe complications and consequences can be avoided. An inflamed cyst cannot be treated on its own - this may worsen the situation.

Diagnostic examination

The leading method for identifying cystic systems is radiography. X-ray examination includes general images (frontal plane), local ones, focused on the affected tooth.

For small formations, an intraoral radiography of the jaws (orthopantomogram) is performed; large cystic systems are detected using an extraoral radiographic method.

The widespread use of orthopantomograms is due to the information content of panoramic images of the jaw rows. This method of examination allows you to accurately identify the location, the degree of growth of the formation, and the effect it has on neighboring healthy teeth. The negative characteristics of the procedure include a fairly high radiation dose, so an orthopantomogram is performed no more than once every 6 months.

Magnetic resonance imaging (MRI) is performed. During the procedure, the skull is scanned and a large number of pictures are taken with layer-by-layer images of tissues in different planes. The patient does not receive radiation; radiation exposure during this procedure is reduced to zero. There are a number of contraindications for MRI: it is not recommended during pregnancy, the procedure is contraindicated for patients with pacemakers or pumps.

Treatment of jaw cyst

What to do if there is a cyst in the jaw? The first thing you need to do is see a dentist. The doctor, after conducting the necessary examination, will decide on the treatment direction. The main methods of treatment are therapeutic and radical.

Therapeutic treatment is used in the presence of a formation not exceeding 1-5 mm. The direction allows you to do without surgical removal. This operation for a radicular cyst of the upper jaw or lower dentition combines:

Opening the dental cavity, washing and cleaning the canals from the contents;
Introduction of medications and disinfectants into the canals;
Cementing.

After the manipulations, drug treatment is prescribed. Drugs with pronounced anti-inflammatory and analgesic characteristics are used. Analgesics do not cause addiction and maintain clarity of consciousness. Anti-inflammatory drugs are aimed at inhibiting regulators of inflammatory processes, thereby relieving inflammation and pain. The main drugs used in therapeutic tactics include: Nurofen, Ibuprofen, Ketonal, Nimesil, Voltaren.

Radical treatment combines several surgical methods:

Partial excision of the cystic structure (cystotomy). This operation on a jaw cyst allows you to preserve a full-fledged dental unit. When performing this type of surgery, the anterior wall of the tumor is removed and the liquid contents are removed;
Cystectomy. The operation is characterized by complete excision of the cystic formation and the affected root area. After cleaning the cavity, the bed is filled with a restorative composition, the wound is sutured;
Plastic cystectomy, an operation similar to conventional surgery, differs in the final stage: the wound is not sutured. In most cases, this type of intervention is used to eliminate advanced conditions when complications occur;
Two-phase surgical treatment, which is prescribed in particularly complex, advanced cases. Surgical intervention combines cystectomy and cystotomy. The main task: to preserve healthy dental units as much as possible, minimally injuring the tissues, and completely eliminate the infectious focus;
Laser exposure. One of the most common methods for removing cysts of the upper jaw and mandibular dentition. Laser exposure has a number of advantages:

Does not require tooth extraction;
Does not injure nearby tissues;
There is no risk of infection;
Minimum recovery period;
The laser is a preventive measure against carious lesions.

Laser treatment is effective regardless of the location of the formation: a cyst under the jaw, a cavity in the maxillary row, under the upper lip. The laser is directed pointwise and affects the affected root canal and cystic formation. As a result of laser injection, the cyst is destroyed and the root is disinfected. The procedure is as effective as possible.

Hemisection. The operation is performed in situations where it is not possible to save the entire tooth. Hemisection involves the complete removal of the cyst of the lower jaw or maxillary row, along with the affected root and dental element. The resulting cavities are filled with osteoplastic material, and the wound is sutured.

In some cases, as an additional treatment, the dentist may recommend traditional medicine:

Herbal decoctions. 2 tablespoons of dry herbal mixture: sage, calendula, chamomile, yarrow, eucalyptus, pour a glass of boiling water. The broth is cooled and used as a mouth rinse;
Saline solution. 1 tablespoon of salt is dissolved in a glass of warm boiled water. The oral cavity is rinsed with the solution throughout the day.

A follicular dental cyst is a neoplasm of epithelial origin that develops in the jaw bone tissue. Despite the fact that the disease may not manifest itself in the form of certain symptoms for a very long time, this condition is dangerous and requires timely diagnosis and proper treatment.

What it is?

Let's look at this issue in more detail. A dental follicular cyst is a cavity developing from the enamel organ of a tooth that has not erupted. There is fluid inside that is sterile in the early stages of cyst formation, but can become infected later. An unerupted tooth can also be located in a cyst. At the same time, it is either completely immersed there, or only to the level of the neck. In the latter case, the tooth root is located in the bone tissue.

Most often, follicular dental cyst in children is diagnosed between the ages of twelve and fifteen years, mainly in boys. It is much less often detected in young people aged twenty to twenty-five years. The cyst is usually found in the area of the canine or mandible or third molar. The formation of the third molar of the upper jaw is much less commonly diagnosed.

Reasons for the formation of this pathology

There are different opinions regarding the reasons for the formation of a follicular dental cyst, which mainly boil down to trauma to the developing tooth, for example, pressure on the baby tooth germ or lack of space for an erupted wisdom tooth, or infection of the tooth germ.

Due to the correspondence of the period in which the normal development of the dental follicle is disrupted, the following may appear: a cyst that contains parts of the teeth; a cyst that contains already fully formed teeth; cysts without them.

Thus, this neoplasm is essentially a dental malformation.

A follicular dental cyst develops over a long period of time and slowly. Sometimes, when the epithelial lining is not completely removed after intervention, relapses occur.

If an inflammatory process exists in the periodontium or canal of a baby tooth for a long time, it can disrupt the developing molar tooth germ. One of the possible consequences is the formation of a follicular cyst.

Thus, the need for preventive regular visits to the dentist and treatment of baby teeth in a timely manner, and not in a neglected state, is once again confirmed.

Manifestations of a follicular cyst

What symptoms are observed with this pathology? A person may not feel the developing process of pathology at all. Attention is drawn to the absence of one or more teeth in the dentition.

As an exception, there are cases of development of a cyst in the jaw near a supernumerary (extra) tooth germ.

The tumor is most often diagnosed accidentally when the patient undergoes an X-ray examination due to another pathology. In advanced situations, the cyst may bulge into the oral cavity.

More rare symptoms with neoplasms of this type

In rare cases, the disease can manifest itself in the form of a number of symptoms:

headache;

painful sensations in the area of tooth eruption;

deterioration of health, increase in temperature;

growth of a follicular dental cyst into the oral cavity.

Such signs indicate the progression of the disease; you should not hesitate to visit the dentist. The inflammation process will not go away on its own, and lack of treatment can cause serious complications:

defects in the development of permanent tooth buds;

mixing of teething time;

negative impact on the location of permanent teeth in the arch;

damage to the jaw bone tissue.

The most serious complication of a dental follicular cyst is a purulent inflammatory process - acute phlegmon.

What is the main danger of this pathology?

When the jaw tissue is compressed by a growing cyst, the development of tooth germs, the timing of their eruption and their location in relation to the row of teeth are disrupted. The tooth germs may die.

In addition, there is a possibility of cyst suppuration. The accumulated pus tries to take up as much space as possible, causing the jaw tissue to melt.

As a result of the movement of pus, phlegmon of the neck and face can develop. When the vascular wall is perforated, sepsis occurs.

In addition, cases of transformation of a dental cyst into a tumor, mainly ameloblastoma, have been recorded.

When the cyst reaches a large size, the jaw bone tissue becomes thinner, and the jaw may break as a result.

How is a follicular dental cyst treated?

The treatment method is determined individually in each case based on the following factors:

location and size of the cyst;
absence or presence of suppuration;
level of damage to bone tissue;
prospects for further tooth eruption.

When a cyst forms in the wisdom tooth area, its contents are completely removed, as well as the unerupted tooth and membrane itself.

When treating a child's dental cyst in the canine area, the dentist will evaluate the possibility of saving the tooth. With the prospect of such an operation plan, the anterior cystic wall is removed. After this, a special “passage” is formed between the vestibule or oral cavity on one side and the cyst cavity on the other. The cystic cavity is filled with a piece of mucous membrane and then sutured. Taking into account the fact that the patients in most cases are children, an X-ray examination is carried out, preferably modern equipment. Thanks to this, the radiation dose is reduced. The operation plan helps to create the most accurate possible digital processing of finished radiographs, to avoid damage to the rudiments of the molar teeth and injury to the jaw vessels.

Removal of a follicular cyst of a tooth is carried out through cystectomy, that is, together with the tooth, or cystotomy, in which the doctor pumps out liquid from the capsule and then places a tampon with iodoform into the cavity.

Cyst at the root of the figure eight

A cyst is a cavity filled with pus or fluid that forms mainly at the root tip. It can hit any tooth.

There is also a follicular cyst of the wisdom tooth. Due to the specific nature of its growth and its location, it is susceptible to cystic pathology more often than others. In approximately 40% of situations, wisdom teeth remain partially or completely impacted and grow deep in the soft tissue, which is one of the main reasons for the appearance of tumors. Doctors distinguish a separate subtype of it, which occurs on the gum near an unerupted tooth and grows very quickly.

Interestingly, under the upper “eights” the cyst will progress at a higher rate than under the lower ones. This is due to the fact that the bone in the upper jaw is more porous, and because of this the infection spreads more easily.

Wisdom tooth cyst after removal

A cystic lesion can appear not only on the tooth root, but also in the gum when it has already been removed. This phenomenon, unfortunately, is not uncommon, as it is a reaction of the body’s defense to tissue damage. The reason may be:

lack of professionalism of the surgeon during extraction (for example, removal of a cotton swab at an untimely time);
"dry socket";
use of non-sterile instruments;
ignoring medical recommendations about behavior in the period after surgery, rinsing the wound with herbal decoctions, prematurely stopping the use of antibiotics, etc.

But even if all conditions are met, a cyst may still appear on the gum after removing the “eight”. To avoid the development of formation, the surgeon will prescribe antibiotics for treatment after extraction.

After the removal of a wisdom tooth, the cyst looks like a capsule, its diameter is from 0.5 to 0.8 mm. Doctors advise getting rid of it immediately after diagnosis, as it can quickly increase in size.

A sac with an accumulation of pus near the root of the tooth appears for various reasons. Some patients do not realize that they have a maxillofacial cyst for a long time and do not seek treatment. Sometimes, due to factors influencing the growth of a jaw cyst, characteristic symptoms appear. If you do not seek specialized help at this stage, treatment of the jaw cyst may take several years.

Why does a cyst form at the roots of a tooth?

A pathological formation at the apex of the tooth root is a jaw cyst (more details in the article: tooth root cyst - what is it?). It is covered with a dense layer of epithelium, its internal component is a kind of liquid, and in some cases, a porridge-like mass. Typically, the cavity of a dental follicular cyst is filled with pus (dead cells and microorganisms). The cyst of the upper jaw grows more actively, this is due to the slightly more porous structure of the tooth roots.

Jaw cysts can be small formations, just a few millimeters, but during the process of inflammation they increase and can reach enormous sizes. The body tries to protect healthy tissue from pathological areas, which is how jaw cysts arise.

Infection is the main source of radicular cysts of the upper jaw; it affects the internal tissue. Pathogenic microorganisms penetrate into the site of inflammation due to mechanical action or due to poor oral hygiene.

Most often, a jaw cyst is formed due to:

Types of odontogenic cysts

Jaw cysts vary in size, location and the reasons that provoke them. Cystic formation can occur near the tooth root, under a filling, and even between crowns. The cyst can be localized on the upper or lower jaw and in the maxillary sinuses.

The size of the purulent sac may not exceed a few millimeters, but residual cysts are clearly visible on x-rays. While the affected area is small, the patient does not experience any discomfort; as the cyst grows, convex, rounded formations may be noted, and the facial wall of the jaw becomes thinner.

In dentistry, odontogenic cysts of the jaw are divided into:

Kerokysts occur against the background of improper tooth formation. A follicular cyst most often appears during teething, while the residual type occurs after tooth extraction. If the process of eruption of “eights” is associated with inflammation, then we are talking about paradental cysts. The latter type is quite common; as a rule, it is formed from a granuloma.

Radicular cysts

Often the patient is not aware that he has a radicular cyst. During an examination, the dentist may see that the color of the tooth has changed. While probing the root canals, the doctor may notice the release of fluid with a yellowish tint. During the procedure, the patient experiences quite unpleasant painful sensations.

If the patient does not seek medical help for a long time, the radicular cyst, growing, displaces adjacent teeth, and deformation of the alveolar process occurs. Palpation reveals a characteristic crunch and pliability of the walls. In some cases, a radicular cyst leads to facial asymmetry. Cystic formation destroys bone tissue; if no measures are taken, a bone fracture is possible.

The symptoms of jaw cysts are much brighter in case of suppuration. With mechanical impact on the gum or tooth, as well as with sinusitis, the contents of the radicular cyst of the jaw turn into pus.

The patient begins to experience aching toothaches in the affected area, and symptoms of intoxication appear. Upon examination, the doctor reveals swelling and hyperemia of the tissues surrounding the radicular cyst. If treatment is not started during this period, a fistula may form, phlegmon or osteomyelitis may develop. The inflammatory process can spread to the maxillary sinuses and inner ear, leading to serious complications.

Follicular cysts

Follicular cysts of the lower jaw are formed from the enamel of an unerupted tooth; they can be localized in the area of the third and second premolar or canine. The cyst also affects the upper jaw. A pathogenic cavity can affect one immature tooth or several at once. Often, the cyst of the upper jaw contains already formed teeth.

Follicular cysts of the jaw consist of an outer and inner membrane. The first includes connective tissue covered with stratified epithelium. Inside the follicular cystic structure is fluid that contains cholesterol crystals.

Residual cysts

Often, after an incorrect tooth extraction, patients have to go to the dentist again, and they develop a residual cyst. An X-ray examination allows you to see a transparent cavity, which is located in the area where the tooth was previously removed. According to its clinical and histological characteristics, a residual cyst is similar to a radicular one.

Keratocysts

Keratocysts are localized in the lower jaw near the third molars. The formation occurs due to anomalies in the formation of the “eight”. This species stands out from the rest due to the keratinization of a thin layer of epithelium of the internal cavity of the mandibular cyst. In dental practice, there are both single-chamber and multi-chamber cystic formations, which in turn consist of one volumetric cavity and many small formations.

The symptoms of keratocysts are mild, usually detected on x-rays or with significant growth, when the area of the jaw next to the affected area begins to protrude. Often a cyst of the lower jaw degenerates into a cholestoma, less often a malignant tumor, which is extremely dangerous. If cystic structures are not surgically removed in time, serious consequences are possible.

The difference between a cyst and a flux

Periostitis is popularly called gumboil. This disease is caused by inflammation of the periosteum. Microorganisms, penetrating into the dental cavity or gum pocket, begin to actively multiply. The accumulated pus makes its way, stopping at the periosteum, and a flux appears in this place.

An inflammatory process begins in the soft tissues near the causative tooth. A patient with flux experiences throbbing pain (see also: how to rinse your mouth with flux to make the tumor burst?). If periostitis is not treated in time, the inflammation will affect the periosteum, the patient’s body temperature will rise, and the discomfort will intensify.

Many ordinary people may confuse the symptoms of gumboil and jaw cyst, but experienced doctors will always be able to find the differences. Cystic formations are usually the precursors of flux; they look like a sac with liquid contents, grow gradually, affecting healthy tissue and are almost always painless.

Treatment of cysts

If the affected tooth is removed, residual cysts will remain in place. They do not dissolve and should be promptly removed.

According to statistics, about 3% of patients encounter this problem, so before carrying out this or that procedure, the doctor needs to conduct a competent diagnosis. Often the existing follicular formation is a granuloma; at the initial stage, it is successfully treated with medication. To determine the presence of a follicular or any other dental cyst, the doctor sends the tissue for histology.

Therapeutic treatment

The altered tooth root must be treated with an antiseptic, the tooth thoroughly cleaned and sealed. Sometimes, as an alternative, electric shocks are applied to the affected tooth, after introducing a therapeutic suspension containing copper and calcium. Drug treatment is used in the following cases:

absence of fillings on root canals;
The root filling installed in the root filling is of poor quality and does not cover the entire length of the canal;
small radicular cysts up to 8 mm.

When treating small jaw cystic structures, special medications are used that have a negative effect on their shell and internal contents. Then the doctor removes the pus, filling the cavity of the cystic formation with a special paste that helps restore bone structures. Finally, a filling is placed on the tooth, but even the competent actions of the dentist do not provide a 100% guarantee that the cyst will not reappear.

Removal

In most cases, cystic formations of the maxillofacial area must be removed. These include:

large cyst sizes, more than 8 mm;
the appearance of swelling accompanied by pain;
there is a pin in the root canal;
A prosthesis is installed in place of the causative tooth.

Not so long ago, the cyst was removed along with the tooth, but today dentists using alternative treatment methods are able to save the tooth. If the roots are affected by cystic structures, only then surgery cannot be avoided.

There are three main methods of tooth extraction:

During cystotomy, large reticular cystic structures are removed. The surgeon creates an opening for fluid drainage. An obturator is installed to allow all fluid to leave the cavity. The doctor also removes necrotic tissue. This treatment method is quite complex, it requires constant monitoring by a dentist, and treatment can take several months.

Cystectomy is considered the most effective method for removing radicular cysts. Removal of cystic structures is carried out only if they are small in size and the process of their suppuration has begun. During the operation, according to indications, the surgeon may remove the top of the tooth. During hemisection, the entire tooth or part of it along with the follicular cyst must be removed.

Throughout the postoperative period, it is necessary to rinse your mouth with antiseptic agents; in some cases, the doctor may prescribe antibiotics. Pain and swelling after the intervention should go away over the next day; if the pain intensifies, then you need to visit the dentist as soon as possible.

Consequences

If you do not pay attention to the symptoms that appear for a long time, the proliferation of cystic structures can lead to:

suppuration of the cyst;
damage to bone structures, up to a jaw fracture;
inflammation of the maxillary sinuses, with maxillary localization;
hearing impairment;
osteomyelitis or periostitis;
abscess development;
sepsis.

If a cystic formation on the upper or lower jaw becomes large, as seen in the photo above, this leads to malocclusion, destruction of the dental pulp, and loosening of neighboring teeth. Prevention consists of regular visits to the dentist and compliance with personal hygiene rules.