Tooth cyst (radicular cyst) - symptoms and treatment

From this article you will learn:

• what is a dental cyst - symptoms, photos,
• why does it form?
• cyst on the root of a tooth - treatment.

The article was written by a dentist with more than 19 years of experience.

A dental cyst is a round-shaped inflammatory formation, which is a cavity in the bone tissue, which is lined from the inside with a fibrous capsule and filled with purulent contents (Fig. 1). In dentistry, the terms “root cyst of the tooth” or “radicular cyst” (from the word radix - root) are most often used to refer to this pathology. This is due to the fact that the most common place for its formation is the area of ​​the apex of the tooth root.

The formation of a cyst on the root of a tooth is associated with an infection in the root canals. Most often it appears - 1) either in the absence of timely treatment of pulpitis or periodontitis of the tooth, 2) or is a consequence of poor-quality root canal filling. The formation of a cyst occurs gradually and over a long period of time. First, at the apex of the root, under the influence of infection in the root canals, a small apical granuloma is formed, which subsequently increases in size and transforms into a cyst filled with pus.

What does a dental cyst look like: photo

Pay attention to how a cyst on the root of a tooth looks on an x-ray - it looks like intense darkening at the apex of the tooth (for your convenience, we have limited this area with arrows). Such intense darkening at the apex of the tooth root indicates the presence in the bone tissue of a site of bone destruction in the form of a cavity. In Fig. 3 you can see what a cyst looks like at the apex of the root of an extracted tooth (like a sac filled with pus).

This article is written for patients and therefore will contain unnecessary medical details. But to complete the picture, it is worth adding that a dental cyst can be localized not only at the apex of the tooth root, but also on the lateral surface of the root, as well as between the roots of multi-rooted teeth - in the root bifurcation zone. But such localizations of root cysts are quite rare, and therefore we will examine in more detail the symptoms and treatment of a dental cyst localized at the apex of the root.

Type of cyst on the root of an extracted tooth (video 1) –

What is a tooth root cyst?

A cyst is an advanced form of inflammation of the tooth ligament.
There are several types of jaw cysts, but the most common is odontogenic, i.e. tooth root cyst. We will talk about it in this article.

It is of an infectious-inflammatory nature, i.e. is a consequence of “no treatment” or poor treatment of the tooth.

Translated from Greek, “cyst” means “bubble”. Morphologically, it is a cavity with a fibrous wall and contents. Simply put, a sac under problem roots filled with inflammatory fluid (for example, pus). Its dimensions vary from a few millimeters to several centimeters. The cyst that appears is attached to the apex of the tooth root and is located in the periodontal space - between the root and the bone tissue.

The X-ray image shows an area of ​​bone tissue destruction (a large “dark cavity” adjacent to the root of the tooth). This is a cyst.

What is the difference between a cyst and a granuloma?

A dental cyst is often confused with a granuloma, another dangerous disease in which a round-shaped formation forms in the root area. It is important to distinguish between them, since the diagnosis directly affects the treatment plan and its prognosis. For granuloma, in most cases therapeutic treatment is sufficient. But a cyst requires more radical measures.

Here are the main parameters by which a dental cyst and a dental granuloma differ:

Why does a cyst occur?

Most often, a cyst is associated with an infection in the canals of the tooth. If caries and its complications (pulpitis, periodontitis) are not treated promptly, then microorganisms (bacteria, viruses, etc.) that live in the root canals of carious teeth sooner or later penetrate into the surrounding bone tissue. The body of a healthy person builds a barrier against microflora, which is the shell of the cyst. In this way, it tries to localize and isolate pathogenic microbes, preventing them from spreading further. The cyst zone is nothing more than the front line in which the body fights the infection, and military action is the infectious inflammatory process.

As long as the infection persists, that is, as long as the body has someone to fight with, the cyst will exist and grow.

Other causes of dental cysts may be:

• Tooth injury.
• Incompetent treatment of the root canals of the tooth, namely poor-quality mechanical and medicinal treatment of the canals or poor-quality filling of the canal (in particular, loose filling, with voids that are very quickly filled with bacteria, which can ultimately lead to a dental cyst.

Classification of dental cysts

There are not many types of cysts, so understanding them is not difficult. Four main types are distinguished by location:

- wisdom tooth cyst;

— a cyst due to an illiterate (unprofessional) installed dental crown;

- a cyst that arose as a result of the influence of a third-party infectious disease (sinusitis);

- a cyst localized in the area of ​​the front teeth.

At the same time, a classification is used based on previous circumstances preceding the occurrence of the cyst:

- a disease caused by poor-quality removal of one or more teeth;

— periodontal type cyst, provoked by an inflammatory process in the gums;

- a cyst caused by the growth of a wisdom tooth (retromolar or paradental);

- a cyst that occurs in children, first during the period of the appearance of milk (follicular) teeth, and then molars (eruption cyst);

— a cyst that arose as a complication of periodontitis (radicular);

— a situation is also possible in which the tissue forming the tooth degenerates (keratocyst).

How does a cyst manifest itself?

The insidiousness of a dental cyst lies in the fact that its appearance at first is almost asymptomatic. It makes itself felt when the purulent sac has already reached a fairly large size. Exacerbation of inflammation and the manifestation of cysts occurs when the immune system is weakened. It is often learned about during acute respiratory viral diseases, when the body weakens due to the fight against the disease. So, we list the possible symptoms of a dental cyst:

• acute toothache appears;
• swelling and swelling of the gums and cheeks;
• increased body temperature;
• weakness;
• general malaise;
• a fistulous tract may appear on the gum, through which pus from the cyst will enter the oral cavity;
• absence of visible symptoms (the cyst does not manifest itself in any way and is discovered by chance on x-rays).

If outwardly the tooth looks completely healthy and the patient does not experience any discomfort or pain, this does not indicate that the tooth is healthy. A cyst is one of the pathologies that does not always occur with any clinical manifestations. However, the consequences can be quite dire, both for the tooth itself and for the tissues surrounding it.

A dental cyst is diagnosed based on the results of radiography. On an x-ray, it looks like a dark spot at the apex of the root, in other words, like a black ball. Sometimes pathology is discovered completely by accident, when examining a neighboring tooth or during a routine preventive examination at an appointment with a dentist or ENT doctor during an examination of the maxillary sinuses.

An x-ray of all teeth (orthopantomogram) shows a zone of bone tissue destruction (“black ball” adjacent to the root of the tooth). This is a cyst.

Treatment

Treatment of dental cysts is carried out through surgery, laser treatment and conservative therapy. The latter has a positive effect only in the initial stages of the disease; overgrown cysts must be removed.

Surgery

To eliminate the pathology, it is not necessary to remove the entire tooth; only the tooth root on which the cyst is located is subject to resection. After removing the affected area, the dentist seals the remaining root, treats the surgical canal through which he removed the bladder with its contents, and stitches it up.

After a few days, the doctor removes the stitches and monitors the wound healing process. It is important to make sure that there are no cyst particles left in the dental canal; to achieve this goal, repeat radiography is performed.

Note! Sometimes it is impossible to remove the root along with the cyst; in these cases, the doctor completely removes the tooth. Indications for complete tooth resection are a difficult-to-reach location of the cyst and a severe course of the disease.

After surgical removal of a cyst, the patient must regularly visit the dentist and follow the recommendations prescribed by the doctor.

Conservative therapy

Tooth cyst - treatment of the disease with conservative methods is possible only in the early stages of its development. In order to eliminate the tumor, the patient is prescribed injections and rinses.

During therapeutic treatment, the dentist opens the dental canal, which leads to a cystic neoplasm, and pumps out exudate from it. The doctor does not fill the canal for ten days; during this period, the patient uses antiseptic solutions and tinctures to rinse the mouth.

Upon completion of the treatment course, the dentist treats the dental canal with medications and then fills the tooth.

Laser removal

Laser treatment is a modern method of treating dental cysts. When performing the method, the doctor opens the dental canal and uses laser irradiation to treat the area where the cystic tumor is located. The laser destroys not only the epithelium of the cyst, but also hundreds of thousands of bacteria that are inside the bladder.

The advantages of laser removal are rapid tissue healing and no risk of secondary infection in the oral cavity and dental canal.

Treatment with antibiotics

In some cases, dental cysts are treated with antibiotics. Taking antibacterial drugs is an auxiliary measure to destroy an expanded infection or the main method of treatment if a dental cyst develops against the background of a primary infectious disease.

Antibacterial drugs can only be prescribed by the attending physician; the following drugs are most often used:

• amoxicillin – has a high antibacterial effect, greatly facilitates the treatment of cysts with other methods;
• Cifroploxacin is a broad-spectrum antibiotic that actively destroys bacteria and relieves inflammation;
• tetracycline - this drug is prescribed more often than others, it actively relieves the inflammatory process, pain syndrome, and facilitates other methods of treating dental cysts.

Sometimes a doctor can prescribe topical antibacterial agents to a patient, but taking such medications is not always advisable - local drugs - antibiotics are quite difficult to distribute evenly over the diseased area.

Note! Antibacterial drugs are potent drugs that also affect beneficial bacteria in the body. You can take such medications only as prescribed by a doctor, without increasing the number of doses or dosage.

Treatment at home

Treatment of dental cysts at home is possible only as an auxiliary therapy. A cyst should not be confused with a granuloma; the latter can resolve on its own, but the cystic formation must be radically removed. Home treatment is not used to remove the cyst, but to eliminate the inflammatory process and destroy harmful bacteria.

The main goal of therapy at home is to provide an antiseptic effect. Propolis tincture, calendula tincture, eucalyptus tincture have an antiseptic effect. Tinctures are used as follows: a small amount of medicine is applied to a cotton swab and applied to the affected area, held for 5-10 minutes.

Medicines with an antiseptic effect can be used before surgery to remove a cyst and after tooth root removal. The antiseptic effect allows these medications to be used in the treatment of caries and other infectious diseases of the oral cavity.

Prevention

It is always easier and faster to prevent any disease than to cure it, so one should not forget about simple preventive rules that will help avoid the development of a dental cyst. The basic rules for preventing dental cysts are based on compliance with the rules of oral care.

How to prevent the formation of pathology:

• do not trigger the course of dental diseases such as caries, periodontitis, pulpitis; if infections occur, consult a doctor immediately;
• Brush your teeth daily and prevent the appearance of plaque, which can later transform into tartar;
• monitor the condition of the teeth and oral cavity after operations and mechanical injuries;
• visit your dentist regularly;
• monitor the condition of filled teeth and dental implants;

Patients who have had their teeth filled or have dental crowns or implants placed are advised to periodically have dental x-rays taken. This will allow timely detection of pathological changes and increase the chances of successful recovery without serious consequences.

Note! All diseases must be treated in a timely manner; inflammatory processes reduce immunity, as a result of which infections move freely from one organ to another; in addition, secondary infections can be added to already developed pathologies. It is important to monitor your health and strengthen local and general immunity.

To strengthen your immune system, strengthen your body, include fresh fruits and vegetables in your diet, play sports and walk outdoors more often. It is more difficult for any infection to get into a hardened body than into a weakened body.

How to treat a tooth with a cyst?

There are 2 fundamentally different ways to treat dental cysts:

Therapeutic and surgical.

• Therapeutic method : treatment of tooth canals, as a result of which the cyst disappears. As a rule, it takes several visits to the doctor, ranging from 2 weeks to six months.

It is carried out by a dentist-therapist, whose main task is to remove the infection from the root canals, that is, to eliminate the factor supporting the cyst. After root canal treatment, temporary medications are left in them, which act on the cyst and contribute to its regression and complete disappearance. At the end of treatment, the root canals are filled with permanent materials and the damaged tooth is restored. Subsequent dynamic monitoring of the tooth is also necessary, which consists of visiting the dentist every six months, and X-ray monitoring.

• The surgical method is to remove the tooth root cyst. It is used when the therapeutic technique is ineffective.

There are 2 types of surgical techniques:

• Removal of the cyst, preserving the causative tooth.
• Removal of the cyst along with the causative tooth.

Preserving a tooth is advisable only if the causative tooth is not severely damaged and does not cause inflammation in neighboring organs and spaces.

The cyst is removed by a dental surgeon under local anesthesia.

Causes

There are several reasons why a dental cyst develops. The main reason is the activity of pathogenic microorganisms in a closed dental space; the following risk factors contribute to this:

• severe pathology, lack of timely treatment and incorrect treatment of dental diseases - caries, periodontitis, pulpitis;
• infectious complications after tooth filling, implantation procedures - in such cases, the doctor removes not only the cyst, but also the crown or implant, this avoids relapse;
• complications during teething, especially when wisdom teeth erupt - dental tissues injure the gums, bacteria get into microcracks,
• microorganisms also enter wounds that form due to mechanical damage to teeth;
• Nasopharyngeal diseases – infections in the nose and throat can spread to the oral cavity.

To provide adequate treatment, it is necessary to accurately determine the cause of the development of a dental cyst; based on it, the dentist will prescribe suitable therapy. So, in cases of injury, treatment consists of removing the cyst and tissue regeneration, but if the cyst is a complication of another disease, then in addition to removing the vesicle, the patient will be prescribed treatment for the underlying disease.

How to choose a cyst treatment method? Who chooses it and what does it depend on?

The choice of treatment method for the cyst is made by the dentist, according to the specific clinical situation. The method depends on:

• preservation of tooth tissue (if the tooth cannot be restored after treatment of the cyst, choose a surgical method with removal of the cyst);
• on the anatomy of root canals and the ability to process them efficiently;
• from the availability of good equipment and equipment in the clinic (for example, a dental microscope, etc.), which allows you to go through root canals and process them efficiently;
• on the patient’s health and the presence of chronic diseases;
• on the duration of existence of the cyst;
• on the skills of a particular specialist.

What are dental cysts?

How successful is the prognosis for treatment of cysts and what does it depend on?

Surgical and therapeutic methods of treatment give excellent results, provided they are performed correctly and with high quality.

The success of treatment (and this is what we call the preservation of the causative tooth and the complete disappearance of the cyst) also depends on the following factors:

• on the anatomy of root canals and the ability to process them efficiently;
• from the availability of good equipment and equipment in the clinic (for example, a dental microscope, etc.), which allows you to go through root canals and process them efficiently;
• on the patient’s health and the presence of chronic diseases;
• duration of existence of the cyst;
• on the skills, abilities and experience of a particular specialist.

What happens if a tooth with a cyst is not treated? What's wrong with a cyst? Consequences of a tooth root cyst

• The cyst is prone to growth, and as it grows, it destroys the surrounding bone and disrupts anatomical formations (for example, the lower wall of the maxillary sinus, provoking the development of sinusitis, etc.).
• The cyst can fester, and the inflammatory process spreads into the surrounding spaces, causing serious complications that threaten the patient’s life (abscesses, phlegmon, etc.).
• As the cyst grows, it can push away neighboring teeth and significantly change their position.
• The cyst can lead to a pathological fracture of the jaw if it reaches a very large size.
• The cyst can eventually lead to tooth loss.

After treatment of a cyst, the tooth hurts, is this possible? And if so, what time is considered the norm?

Of course, immediately after treatment the tooth may bother the patient, this is natural. However, this does not always happen.

Normally, after treatment of a tooth with a cyst, the tooth either does not hurt at all or bothers you for 1-2 days.

If after dental treatment the pain persists and does not decrease for more than 2 days, we advise you to inform your doctor about this.

During treatment, an exacerbation of the inflammatory process may occur, which passes over time and this does not mean that the treatment is unsuccessful. The presence of an exacerbation depends on how aggressive the microbial flora lived in the root canal and on the patient’s immune strength.

Pain after treatment is stronger if the tooth began to be treated during an exacerbation of the inflammatory process. Therefore, our advice to you, dear patients, is not to let it get to the point where pain occurs (as most people mistakenly do). Start treatment while nothing hurts, during a calm period. It will be easier for you, and there may be no pain at all after the intervention.