Dental cyst: what it is, what it looks like and whether it should be treated

Many patients, especially those who have not been to the dentist for a long time and have decayed teeth, often hear the diagnosis «tooth cyst», or more precisely «cystic neoplasm», «periapical cyst». Should you be frightened by this diagnosis, can the cyst go away on its own, what consequences can you expect and what should you do if you are diagnosed with a cyst on your tooth?

What is a tooth cyst

A dental cyst is an abnormal mass at the top of the root in the bone, shaped more like a ball, but can be of other shapes. It is filled with fluid inside. A cyst occurs as a result of the body's response to infection or trauma. 

How it happens: the germs from the root of the tooth «break out» and penetrate the bone tissue, at which point the immune system tries to contain them and creates a tight shell around the abnormal cells to keep the inflammation from spreading to other healthy tissues. This is more like a sac or barrier that keeps the infection from penetrating further.

What does a tooth root cyst look like?

A cyst can be detected with an X-ray. The image will show a dark spot with clear boundaries at the root of the tooth. However, if the cyst is very large, it is better to carry out an additional histological examination in order to establish an accurate diagnosis and exclude the malignant origin of the cyst, as it may turn out that the cause is not due to germs at all.

Symptoms of a dental cyst

The presence of a cyst cannot be detected without X-rays, especially in the initial stages. One of the peculiarities of this pathology is that the symptoms of a tooth cyst may be absent and will appear only when the acute phase of the disease occurs, where it is necessary to urgently resort to surgical treatment. Among the most common symptoms it is worth highlighting the following:

• aching pain;
• swelling of the gum;
• fever;
• discomfort when eating;
• general weakness and malaise.

Unfortunately, a cyst cannot go away on its own. It will not go away, even if it does not hurt.

Phases of cyst development

As a rule, initially the process of cyst formation is quite slow, gradually the microbes multiply, and the body, in turn, tries to contain them. In doing so, the cyst grows larger over time and as the number of germs in the root of the tooth increases. When the cyst becomes large enough, it can lead to a decrease in bone tissue in the area of the tooth and neighbouring teeth. It is worth noting that this entire process can develop for quite a long period of time in a hidden chronic phase, that is, when the patient does not feel discomfort and does not suspect the process. The cyst grows, and there are no symptoms. In this phase, the cyst can only be detected by a dentist during an examination and in case such a tooth is x-rayed. Therefore, it is very important to go for regular check-ups and consultations with a dentist.

If a radicular (root) cyst is in the chronic phase, it is growing all the time. At the moment of lowering immunity, microbes begin to multiply much faster, and the cyst grows more actively. It is worth remembering that this weakening can be due to various factors, including viral infection, colds, being in the cold for a long time, alcohol intake and so on.

If there is a severe drop in immunity, the rate of cyst growth becomes faster than the rate of bone decay. At this point, the patient starts to feel pressure and pain. And in the case of a critical drop in immunity, everything can lead to a large swelling and flux. At this point, the cyst is easiest to detect, but it is already the moment of active «interaction» of microbes and bone and this will lead to the formation of pus - it is nothing but the remains of destroyed bone (a mixture of microbes and protein from the bone), which the body does not have time to process and therefore removes the simplest way — through the soft tissues, forming a fistula, or simply the output channel. And the patient sees a pimple on the gum or redness with discharge.

Causes of cyst formation

There can be several causes of cysts, we will look at two of the most popular ones.

Cavities

Neglected, and even more so under-treated, cavities can reach the tooth nerve, where many germs enter. The immune system tries to protect the bone from nerve decay products, germs and infections that enter through the damaged tooth. And since the source of this mixture is unlimited, the growth of the cyst is very active. However, such a tooth can still be saved. If there is a part of the tooth left above the gum, which can be restored, then in this case it is necessary to treat the roots, remove the inflammatory process through medication, fill the canals, install a post and then a crown.

Re-inflammation

In this case, a previously treated tooth (nerve) can become inflamed again, because after each (even the most thorough) treatment, a small percentage of germs remains at the root canal tip, which cannot be reached. And if the immune system is in good condition, it restrains the infection, but if not, then in 5-7-10 years a new inflammation will form, which will first go into a chronic phase, and then into an active phase, which will lead to repeated treatment of the canals.

That is, there may be several reasons for re-inflammation:

• Weak immunity;
• Poor quality treatment and canal filling;
• Outdated filling of the canals. For example, if the treatment was carried out 15-20 years ago, most likely there is no medicine left in the canals, which leads to uncontrolled multiplication of microbes.

In any of the options above, it is necessary to carry out a secondary treatment of the canals, which will cost more than the primary treatment, because this time the canals will initially need to be unsealed and cleaned of old materials.

A missed dental canal

A large tooth can have up to 6 root canals (although this is quite rare). As a standard, for example, there are usually 4 canals in the upper «six». However, the problem is that only 3 canals are easily and with 100% probability found in a root canal, but the detection of the others is possible only with a special microscope.

If the «extra» canals were not found and well filled, then later on an inflammatory process may begin, which will lead to the formation of radicular cysts. There is only one way out in this situation: find the missed canals and treat them.

Undiagnosed tooth root fracture

Another variant of cyst formation is an undiagnosed fracture of the tooth root. In this case, there is an inflammatory process due to the presence of a bone destruction zone and, as a consequence, a cyst occurs. But most often, if it is, for example, a transverse fracture, there is a destruction of bone even without the formation of a «cystic sac», as the gum begins to sprout inside the tooth as an attempt to replace the destroyed tissues.

Do dental cysts go away?

Many people quietly live with a tooth cyst for years without resorting to surgical treatment, however, as stated above, a tooth cyst does not go away on its own, and sooner or later it will need to be treated.

In any case, dental treatment needs to be viewed holistically, rather than aiming to simply cure the cyst.

Statistically, with primary treatment, the probability of long-term (5+ years) tooth survival is 95%. With secondary treatment this percentage drops to 50-60% and with each subsequent treatment this figure will rapidly decrease.

In case of recurrence of a cyst or when it is not possible to reach the root of the tooth using standard methods, the so-called «surgical treatment of the cyst» or resection of the root tip (apicotomy) can be applied. Such an operation is quite fast and takes no more than 20-30 minutes if modern methods of guided surgery are used. With a standard procedure, this manipulation takes about an hour, and the healing process lasts much longer because the incisions are deeper and larger.

What are the risks of untreated tooth canals and cyst formation?

1) Acute pain. When the decay reaches the nerve, the person feels intense pain that causes him or her to put aside other activities to seek emergency treatment.

2) Transition from the chronic phase to the acute phase. Sooner or later, the chronic phase of the cyst passes into the acute phase, which leads to pain and the formation of pus (flux). In this case, there is a need to urgently consult a doctor, but it is not always possible to get to a good specialist in a short time due to the busyness of his appointment, so you have to go to the one who is free. And here the risk is that instead of saving the tooth, they may suggest its extraction. This leads to additional costs in the future for a bridge or implantation.

3) Bone loss. Due to a large cyst, a one-stage implant protocol may not be available: where a tooth is removed and an implant is placed in its place. This is because the bone area is infected and must wait, which in turn will lead to the need for bone augmentation in the future (which is additional time, expense and trauma).

4)  If a tooth with a cyst has been extracted but an implant has not been placed, there is a risk that the teeth will simply move in together. In this case, in order to restore the tooth with an implant or bridge, you will first have to undergo orthodontic treatment to put the teeth back in place.