What are the methods of treating a dental cyst

Patients often come to us with indications for tooth extraction after prolonged and expensive treatment of dental cysts at other clinics. Sometimes such cases are so complicated by pain and purulent inflammation that treatment requires complex surgical intervention, and the recovery period can take up to a month.

However, not all dentists inform their patients that the diagnosis of “dental cyst” can only be made preliminarily, based on the size and appearance of the inflammation visible on an X-ray or CT scan. An accurate diagnosis can only be made after histological examination. Histology of a cyst is performed only after its removal, with or without the tooth — unfortunately, the nature of the cyst cannot be determined during the treatment process.

The modern WHO classification designates any neoplasm in the area of tooth roots as a dental abscess. However, we believe it is important to distinguish between cystogranulomas and cysts, and below we will describe each type of neoplasm.

Cystogranuloma is a neoplasm near the tooth roots that occurs as a result of chronic periodontitis. Without going deep into the morphology, it can be said that the cause of cystogranuloma is inflammation and its progression, which does not occur autonomously. This means that as long as the inflammation exists, the neoplasm exists too. By eliminating the inflammation, we can treat the growth process of the cystogranuloma.

Cyst is a tumor-like neoplasm that has its own membrane with blood supply, containing exudate — pus and/or cystic fluid. A cyst develops autonomously, regardless of the condition of the tooth itself. By destroying the bone around it, this cavity fills with epithelial tissue, has a round shape, and is a pathology.

The symptoms of a dental abscess include pain and/or swelling in the area of the affected tooth. When such symptoms are present, the treating doctor prescribes additional radiological examinations.

The doctor studies the X-ray and makes a preliminary diagnosis based on it. If the size of the neoplasm on the image is up to 5-7 mm with unclear borders, it is a cystogranuloma. Most often, a cyst has large dimensions with clear borders from 1 cm and larger.

Dentists have several opinions on this matter, and we cannot say that any single one is correct.

There is an opinion that by treating the tooth canals and introducing filling material into the cystogranuloma itself, it becomes mummified. This treatment method has the right to exist. However, no one can guarantee that the disease will not continue to progress.

As an alternative to treating the tooth, extraction of the affected tooth together with the cystogranuloma is proposed. Obviously, in this case, the guarantee of no recurrence is significantly higher.

When it comes to a dental cyst, the answer is unambiguous — a dental cyst must be removed surgically while preserving the tooth. Before performing a tooth-preserving operation (root resection or hemisection), the tooth is opened, the dental canals are treated, and only then the dental surgeon performs a cystectomy (removal of the dental cyst together with its membrane). In this case, part of the tooth root protruding into the cyst is necessarily removed.

Many doctors fill the cavity with bone-plastic material after cyst removal. We do not do this. The reason is that a cyst is a bone defect that should heal autonomously — the cavity formed after cyst removal fills with a blood clot and heals naturally.

If the jaw tissues around the tooth are so destroyed by the cyst that a tooth-preserving operation is impossible and not indicated, then the tooth and cyst are extracted. Subsequently, the area of the extracted tooth is restored with a dental implant or traditional prosthetics (dental bridges).

Cysts in the upper jaw develop much faster than cysts in the lower jaw. It is easier for them to destroy the soft spongy bone of the upper jaw and grow into the maxillary sinus cavity. This phenomenon is often the cause of odontogenic sinusitis. Subsequently, both the untreated tooth with the cyst that has grown into the maxillary sinus cavity must be extracted, and a sinusotomy must be performed.

The lower jaw has a completely different structure, but even chronic inflammation that causes pain and swelling is difficult to endure for long. Sometimes tooth-preserving operations on the lower jaw are so traumatic for the patient that it is safer and more effective to extract the tooth with the dental abscess.

The earlier a dental cyst is detected, the higher the chances of successful treatment. A cyst will first destroy the infected tooth and then may spread to adjacent ones. There is also a risk that the cyst may transform into a malignant tumor 15-20 years after its appearance.

Therefore, instead of dealing with the consequences of a cyst, visit your dentist regularly for preventive check-ups to maintain your oral health.